Objective: Demonstrate a broad working knowledge of the fundamental science, principles, and processes basic to the practice of medicine and apply this knowledge in a judicious and consistent manner to prevent common health problems and achieve effective and safe patient care.
Surgery was my first rotation during my third year and was filled with many first introductions to the practice of clinical medicine. I chose to spend my time at Mt. Carmel for OB/GYN portion. Of these many introductions, the nuance of women’s health was impressed on me. One case, of particular interest to me, began when a woman came with complaints of irregular menstrual periods. She primarily was anxious about her and her husband’s desire to have a child which was being complicated by the newfound issues with menstruation. I considered the possibilities, ranging from recent steroid use to thyroid or growth hormone deficiencies. Nothing clearly fit the picture. The only pertinent history I was able to gather was a mild increase in facial hair, new acne, and a history of diabetes. However, new to the game and hoping to impress my resident, I confidently reported back to the resident and suggested Cushing’s syndrome. “Did you ask if her menstrual cycle has ever been normal?” I stared blankly into space now realizing what I mistook for a secondary amenorrhea is actually metrorrhagia—this woman, on further investigation, had polycystic ovarian syndrome.
Having missed this diagnosis, it stuck with me. So, I decided to use this experience to further supplement my understanding of menstrual disorders by presenting it during our weekly small group meeting. This case and the presentation not only helped me to learn about a common disorder in women but also highlighted how nuanced management and clinical decisions can become for even the most common conditions. One of the primary treatments for PCOS is oral contraceptives pills, indefinitely. However, as previously stated, this patient was hoping to bear children in the near future. With that in mind I learned about the use of clomiphene and was able to educate my small group on the keeping the pregnancy concerns of patients in mind in when making clinical decisions for patients of child-bearing age.
Interestingly, I also learned about the increased incidence of mental health concerns in patients with PCOS, due to the increase of circulating steroids and other unknown factors. Since my desired specialty is psychiatry, this understanding drove my interest in expanding the scope of my medical knowledge so I can be cognizant of easily ignored psychiatric symptoms of physical ailments. The intersection of different specialties within certain disease processes can sometimes be very subtle. The patient I presented on had described a great deal of anxiety related to her menstrual issues and her desire to become pregnant. While our clinical team, rightly, addressed her most immediate and apparent concerns, upon further investigation we may have discovered that she was also suffering from a mental health issue. Such a thorough investigation, in theory may have allowed us to refer address these concerns during the visit or have her referred for the appropriate psychiatric care, therefore saving her the cost of future appointments and the interim continued suffering.
Future endeavors would see me continuing to expand the scope of my knowledge to capture this nuance and being more prudent with patients with conditions associated with common psychiatric conditions. One example of this would be my choice to do a rotation in developmental behavioral pediatrics. As an aspiring child and adolescent psychiatrist, I may need to understand the nuances of early childhood development and the management of developmental disorders to better serve my future patients.