Week Six:
Children’s Hospital Colorado Center for Gait Movement and Analysis

July 27, 2015

Remember last week, when I said I was almost 100% done with data entry? Remember the enthusiasm in that paragraph? Forget about that. Turns out you can be done with data entry, but data entry is never really done with you. After a few yoga classes with Wallace here on campus, I have come to terms with this.

This Wednesday I thought I had tied up all loose ends on my data. The final 6 patients were in, an issue with recording the sensory portion of the exam, which I won’t go into, were all taken care of! Woo! I excitedly emailed my boss, I had done everything but put a bow on the data.  Sadly, I spoke too soon.  As I’ve mentioned before, our study is based on a template used  (or not used) by providers. I entered all instances where this template was used (over 700 patients with anywhere from 4-10 instances of this template, so at least 2800 individual entries, but in reality closer to 6000.) What I did not realize is that we would have to also enter all instances in which the template was not used. This was originally going to be done entirely by a resident who has taken the lead on this project. But, once everything was said and done there were about 750 individual entries that had to be examined. In an effort to expedite the process, and hopefully see some results before I leave, I jumped in to help. So I suppose, in a way, my data entry is done, but looking at the new spreadsheet doesn’t make it feel that way! Hopefully I can report back to you next week that I am truly done with data entry.

Now for this week’s shadowing story! This week I shadowed a Physician’s Assistant (PA) at a remote Children’s Hospital campus. I have been debating between being a PA or a Nurse Practitioner (NP), so I was excited to watch the PA and compare my experience a few weeks ago with a NP, although in the Orthopedics department here they do have similar roles.

At the clinic we saw lots of follow-ups. Some general check ins, cast removals, pin removal (literally pulling out the pin that has been holding the fractured bones together while they heal.) There was one case in particular that stuck out to me, I will discuss it very generally here, to comply with patient privacy laws. A patient came to the clinic with joint pain. The pain went away with Tylenol, but without pain medicine the joint pain would wake the patient up. Waking up in the middle of the night with pain is a huge red flag, especially for pediatrics. This patient was very active and participated in athletic activities very frequently. While I listened to the case I thought ‘Of course you have joint pain! With all that working out, kicking, running, punching, it’s going to happen! Ice it, stretch, and you’ll be fine’, which is exactly why I’m not the one in charge. The PA student I was with had similar feelings, probably just a pain from overuse, but decided to take an x-ray to be sure.

The x-ray came back: Lesion. Or, as it’s more commonly called, a tumor. Could be cancerous, could be completely innocent. We had to send the family to a specialist immediately. I thought this was terrifying. Come in with joint pain, leave with a possible cancer diagnosis?  I saw the same thing in the ER a few weeks ago when a patient came in with headaches and left with a possible brain cancer diagnosis. It’s scary stuff!

Both of these cases show why it is so important for all providers, and especially in family medicine to be careful and prudent, to not allow themselves to fall into routine.  From shadowing the PA I learned that being thorough and conscientious is vital to medicine, at all levels. It’s not that I didn’t think that before but I now I have seen it in action. This patient was not on the schedule, the family came in because they were concerned. It would have been easier on the providers to have turned them away. Or, if they did see the patient, to recommended a heating pad, pain pills and no sports for the week. They could have rushed back to their scheduled patients to get back on track so they could go home on time. But they didn’t, they were patient and thoughtful and may have saved a life because of it.

So, here’s to a week of feeling extra thoughtful! Whether it be shadowing, or my beloved data entry. Maybe this project will change some aspect of treatment here, even just a tiny detail, and makes one child’s life a little better.