Clinical rotation: Medicine

My first rotation after my holiday break was Medicine.  Medicine was an interesting rotation, full of interesting people.  Again, like the two other clinical rotations I’ve done, I saw a variety of medical issues.  While it felt like there was more variety of nutrition diagnoses in the Medicine rotation compared to the Psychiatry and SCI rotations, there were still trends.  I conducted many diabetes educations and spoke with many patients about reducing salt intake. Courtesy of the GI team, I observed a colonoscopy which was kind of neat.

As I continue through my clinical rotations, my patients are becoming increasingly more complex.  In Psychiatry and SCI, I would end up with 1-2 nutrition diagnoses per patient.  In Medicine, it was more along the lines of 1-3.  Sometimes we (my preceptor and I) had nutrition consults placed, in addition to the normal assessments and follow-ups we had.

Medicine is much more acute care than the Psychiatry and SCI rotations.  In Psychiatry and SCI, the patients were in the hospital for anywhere from 7-90 days.  Sometimes patients in those wards had even longer stays.  In Medicine, the patients were not typically in the hospital for very long.  Most were there for a procedure and would only be in the ward 2-3 days.  Some transferred from the ICU to the ward once they were stable.  Some of the patients ended up in ICU.  Since Medicine is an acute care rotation, I didn’t follow the patients long term.  Some of the patients needed long-term follow-up with a dietitian so I ended up handing out a lot of referrals and phone numbers and encouraging patients to call once they were home.

During this rotation, I really had to learn how to decide when nutrition education is appropriate.  As an RD-to-be, whenever I walk into a room to see a patient, I want to help them learn something to keep them from having to come back to the hospital for the same reason.  However, sometimes the patients just don’t want the education.  Sometimes, you just have to try to plant a little “seed” in the patient’s head and hope that they become interested later on.  Sometimes, you have to try to approach the situation from a different way and change your topic entirely.  Learning how to best provide nutrition education is probably going to be a lifelong challenge.

One of the most important things I learned during this rotation is how to introduce myself to other healthcare staff.  When you start asking questions about a patient and a nurse or doctor responds “Who are you?” your answer should be “I’m with Dietetics” or “I’m from Nutrition” not a cheerfully delivered “I’m Christine!”  (Yes, I did that, and yes, it was very airheaded and bubbly.  It was actually a little funny, now that it’s in the past.)  Best way to stave off any awkwardness is to introduce yourself as “Hi, I’m with Dietetics and I’ve got a few questions about [Patient’s name.]”  You can give your name later, if necessary.

My Medicine rotation happened to coincide with that horrible Polar Vortex that made for (what everyone tells me was) an unusually cold St. Louis and a whole bunch of snow. Some of the RDs couldn’t make it in because their streets were too dangerous to drive.  Others were late.  Some, like me, ended up with car troubles because of the weather. It was amazing, though, to see everyone get together and figure out coverage.

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