Friday, July 12, 2013

How to make your OPD Triage post worthwhile

MANNING the Out-Patient Department Triage is the most coveted post during one's Internal Medicine ER rotation. Sure, you have to be there at 6:30 am, but the Triage ends at 11 pm, and, if you're fortunate enough, you'll have the entire afternoon off.

How to make the most out of this post is the subject of today's blog entry. Here are some tips. 

1. Exercise the clinical eye. 

Predict what general condition each patient has even before he/she tells you his/her chief complaint. Patients with splints are a bonus—they immediately get thrown to Ortho. Elderly patients with whitish eye opacities are referred to Ophtha. Patients with neck masses, some of them the size of a baby's head, are immediately sent to ORL (Otorhinolaryngology). Crying, hysterical children are turfed to Pedia.

The more challenging group to predict are females in childbearing age. Especially if they have soft, flabby abdomens easily mistaken for a five-month pregnancy. Consider an actual conversation I had with a voluptuous woman holding hands with a healthy-looking teenager.

Mommy: Dok, kukuha po ako ng blue card [PGH's patient ID].
Me: Ay, ang mga buntis po doon sa OB nagpapatingin.
Mommy: Hindi po ako ang pasyente. Siya po [pointing to her child].
I hope she finds it in her heart to forgive me someday. She really did look pregnant.

2. Teach your patients proper spelling.

A grandmother brought her child for clinical evaluation of what I interpreted as cognitive developmental delay. She wanted to enroll her grandchild to a SPED facility, which required proof that the pupil has an autistic disorder. 

As she explained her situation to me, she took out a crumpled sheet of paper that bore her own handwriting. The actual letter read: "Magpapa-assest po ang apo ko kung siya ay may othism." Disturbed by the spelling, I graciously crossed out the misspelled words and wrote the correct ones above. She brightened up at the new stuff she learned and went away, profusely thanking me for the free editing of her manuscript..

4. Make your patients do gymnastics. A lady in tight-fitting leggings came in for bilateral foot swelling. 

"Masakit ba?," I asked. 

"Minsan," she said. 

"Pwede ko pong makita?," I asked.

Without warning me she put her foot on the table, like cheerleaders do when they suddenly raise their legs and shout, "Oh, yeah!" 

To her credit her foot looked clean. 

3. Ask the Family Medicine resident his/her memorable experience at the Triage. I was with Dr. Masalunga, who told me a story. One day a woman, bulging at the equator, asked her a question she would never forget until the day she dies: "Magkano po magpa-lipo dito?"

4. Reunite with very distant relations. A patient I had not seen before excitedly came up to me and told me, "Catedral ang family name niyo, Dok?" He had a sonorous Ilonggo accent that reminded me of home. "Oo, Catedral guid eh. Ngaa haw?" I asked in the vernacular. 

He told me he came from Iloilo, which I had already predicted. 

"That's where most of my relatives come from, but I haven't connected with them," I said. "My grandparents migrated to Mindanao a long time ago, but some of my father's relatives still live there, I suppose."

He told me about the famous radiologist in Iloilo who carried the same family name and about the so-called bigwigs of Central Philippine University who were also named Catedral, to which I replied, "I'm afraid I don't know them personally, but I'm sure we're blood-related. There aren't a lot of us in the world." 

I was genuinely glad to meet him, and I hope I bump into him in the not-so-distant future.

Once the clock hit 11 am I packed my bags and headed to the Dermatology Clinic. There weren't any new patients to chart, but boy I was glad to see the beautiful dermatology residents, all of them gifted with the cleanest pores on earth.

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Blogger Unknown said...

... yey for derma. Haha.

Fri Jul 12, 04:16:00 PM GMT+8  
Anonymous Anonymous said...

I didn't know that IM had an OPD triage post. Based from your stories, it looks like something I should look forward to. :) -aa

Wed Jul 17, 08:00:00 PM GMT+8  

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