Clinic

Often while in training, surgical clinic could be routine (hernias, small lipomas, colon cancer, breast lumps, gallstones etc.). It could even be a little boring. Most of the patients were referred by other doctors and came with stacks of laboratory tests, imaging, pathology and notes that would often tell me everything I needed to know. I would confirm it all with the patient, but there wasn't always much new information to get. And, of course, I would look at the CT scan before reading the radiologist's report...but I always had to report to read and radiologists to call to discuss my interpretation.

Clinic here is a whole new ball game. Half of the patients have orthopedic (bone) or urology (mostly prostrate) problems.  Even if I recognize the problem, I still have to figure out how to treat it in this setting. My old algorithms don't work anymore. Take, for example, the breast mass: mammogram (not available), ultrasound (if I do it myself), biopsy (in OR, takes weeks to months to get back), MRI (nope), CXR (got it...just no radiologsit).  Physical exam: I can do that!  In some ways, things are much simpler...but right now it just seems harder to know what to do next.