Glorious Ambulatory Block

Day 35 of residency, and day 4 of my glorious ambulatory block. So far this week I've enjoyed half days in a variety of clinics (and more to come). It's interesting spending time in the different clinics, but it's not enough time to get "good" at any given one since we switch clinics every half-day. So I'm basically bumbling through a series of clinics, wide-eyed and bemused, carrying a vitals sheet a nurse handed off to me and trying to find the correct patient rooms. So far:

GI Clinic: you've been an intern for 4 weeks and you still don't know how to manage Crohn's disease like a GI specialist?!? Well then, you're in the right clinic. Because the GI docs don't care. For all intents and purposes it appears this clinic exists to entertain the GI attendings, and save them the trouble of writing follow-up notes. After I saw the patients and presented them, before I even shared my treatment plan, the attending is already dictating to me the plan he's had since he saw the patient's name on the schedule. Aaaaawesome. Why am I here again? Do you have carpal tunnel syndrome, Dr. Attending?

Asthma Clinic: outstanding. Overall a very pleasant experience. You get to listen to the musical stylings of the pulmonary tree while reminding asthmatics to avoid their chronic asthma triggers.
Patient: "My asthma flares up when I roll around on the grass or rub my cat on my face. I was allergic to trees, pollen, and cat dander on my allergy test 3 years ago. Do you think I still am?"
Me: "I would say so."

Endocrine Clinic: I went on a Diabetes Clinic day.
300 pound woman: "I don't know why my sugars run so high. I just have coffee and a small breakfast, salad for lunch, and boiled chicken for dinner!"
Me: "SHENANIGANS!!! So it's between meals that you're fitting in all those donuts??"
You need to be inputting a certain number of calories daily just to maintain your body weight. So if you weigh over 300 pounds, YOU AREN'T FOOLING ANYBODY with the salad routine. Unless you're slathering those salads in mayo and eating them with forks made of bacon. How about instead of injecting you with more insulin we agree that you could just stop eating so many deep fried cheese sticks and call it a day?

County Chest Clinic: surprise, this is the county Tuberculosis clinic! We can't afford N95 masks- come on, this is COUNTY! We just clearly mark the "sputum collection" room as "do not enter," and the door is closed most of the time, which is just as good as a negative pressure room. You were always wondering when you'd seroconvert on your annual TB skin test; now you know!

And lastly, my own Continuity Clinic: every other patient has fibromyalgia. Every other patient is on controlled substances. My goal is to slowly wean all the FMS patients off their narcotics and start them on yoga. The prayers for DNKAs start now.