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Being Well and Staying Well: A Dictation by Tehmina Ahmad, Medicine Class of 2017

Congratulations to Tehmina Ahmad, Medicine Class of 2017, on her winning submission for the Nishant Fodzar Scholarship for Clerkship Students.

Dictation Date: October 22/2015
Dictated By: Tehmina Ahmad, Meds3
Send Copies To: Physicians Everywhere

MOST RESPONSIBLE DX: Staffarehelpinus buildresilience

ID: Patient is a 27yo previously healthy female, arriving to the hospital by car. She appears rather well, but is also anxious, eager, and slightly diaphoretic.

CC: She has been suffering from post-call pager syndrome, where she immediately alerts to any beeping or buzzing noise.

HPI: Since beginning clerkship in September 2015, our patient noted that she grew a pager overnight from the lateral side of her R. hip. She was told it was completely benign. At most, the pager may buzz, ring or vibrate at any given moment.

The constant daily and nightly interruptions have left the patient anxious and worried about answering the next call. Though she is nervous, she finds she is so eager to help that some nights she does not sleep, in anticipation of the next pager sound. She attributes her diaphoresis to the uneasiness felt before a potential page.
There are no relieving factors, except to answer the page. She does not have any constitutional symptoms or other health concerns.

PMHX: From September of 2013 until June of 2015 (Meds Years 1& 2), our patient noticed her mood would decrease seasonally. She attributed this to “Viral Exam-thumb”, occurring on a monthly basis. She describes Viral Exam-thumb as short-lived and with self-resolving episodes of sleeplessness and low mood, often occurring in didactic learning environments. Otherwise, healthy.

MEDS: Self-medicating with 3-4 coffees/day to help her stay awake.

ALL: NKDA

O/E: Looks well and remarks that she is coping uneasily with a pager.
Normal Vitals, unremarkable physical exam.

AX/PLAN: 27yo previously healthy female arrives well, but anxious, eager, and slightly diaphoretic. She has been nervously coping with her pager during clerkship.

1. Anxiety revolving around your ability to perform a task can be reduced with vigilant self-reflection. The practice of self-analysis is paramount for resolving inner conflict, whether it is about performance in clerkship or life outside of medicine. Introspection allows an individual to gain clarity regarding healthy and adaptive mechanisms to respond to stress. Self-reflection is highly individualized, but seeks to further achieve personal goals.

2. Without an eager teacher, it can be difficult to continue being an eager student.
Yet, by empowering and crediting our staff members for demonstrating thoughtful reflection on patient cases, we can create functionally balanced workplace environments that equip students with self-management tools that aid in reinvigorating students towards the shear spirit of medicine.

3. Many clerks feel uncomfortable seeing patients on their own for the first time ever. However, without physician mentors modeling how to turn stress into a positive motivator, clerks can easily forget their raison d’etre. Implementing a physician mentorship program with constructive role models would generate the capacity for clerks to earnestly learn, critically think, and genuinely care for the health and well-being of others.

Thank you for involving our team in this care plan.

Tehmina Ahmad, Meds3, on behalf of Drs. Beingwell & Stayingwell