Outpatient Clinic

So this past week was my turn to work in the outpatient clinic (OPD). Like Justin, I was given my own room and free rein to see and treat patients as I thought appropriate. Occasionally, I would present the patient to the staff physician working in the clinic that day (usually Dr. Malsol), but I quickly realized that wasn't necessary. After that, I usually just gave her a quick rundown of the patients I saw before I left for the day.

Generally, I saw the usual mix of people that I would have expected in any urgent care type setting - a few diabetics, asthmatics, hypertensives, and your ever present chronic pain patients. But what interested me is the absolute separation of the OPD from OB/GYN. The main reason why this strikes me as odd is because the OB/GYN team works primarily on a schedule full of appointments; they don't squeeze patients in. So what happens if a female patient comes in to the OPD with female related problems? Apparently, not much unless I'm there.

In the first day I saw two patients with OB/GYN related issues - a first pregnancy at 18 (she didn't know, I diagnosed it) and an abnormal vaginal bleeding case. After asking around for the things/tests I needed for the exam and work-up, I realized that my exam room wasn't stocked with those things because they don't normally deal with them in the OPD. The first patient came in with a complaint of vomiting that morning. The nurse brought me the chart and plopped it on my desk verbally assuming I was going to diagnose gastritis and send her on her way with instructions to drink plenty of fluids. As I delved more into her history, I found out that she had just started to be sexually active and hadn't had her period in 2 months. She tried to convince me that her periods were always irregular and there was no way she could be pregnant. I told her I wanted the test anyway to at least rule it out and went in search of a urine pregnancy test. This proved harder to get than I would have thought. I had to ask several nurses and they then had to pull one out of their supplies for outreach clinics on other islands. It was the quickest positive result I think I've ever seen. At this point, I talked to the patient about what that meant and got her in the system for prenatal appointments with the OB.

The abnormal bleeding case was worse in my mind. You can always get a pregnancy test from a pharmacy or grocery store, but there's not much you can do about bleeding except see a doctor. Granted, it wasn't an emergency and she probably could have waited for an appointment, but something like abnormal vaginal bleeding is disturbing enough that I would want it checked out quickly and at least be reassured that I can wait for a more thorough exam by a gynecologist. They even registered her complaint as abnormal vaginal bleeding at the OPD triage center, knowing that vaginal exams are not done in the OPD. Well, they are when I'm there. I noted the patient's history, ordered an ultrasound of her reproductive system to look for overt causes like fibroids or polyps, and went and talked to Dr. Olmo (the doctor I worked with last week) about my patient. I was gathering all the supplies I would need for the exam, but we decided that I would just bring her back to Dr. Olmo once the ultrasound results were back. My patient got her initial exam to reassure her that there was nothing obviously wrong on her ultrasound or on her cervix and was given some medication that will hopefully stop the bleeding and an appointment for a more thorough follow-up in a couple of weeks. I'm not sure what would have happened if I wasn't given her chart. I assume that the OPD physician would have just told her that she needed to make an appointment with the OB/GYN and that's it. She might have given her the prescription for the medicine, but I'm not sure. To me, that would not have been enough....