Been a while

It was a busy week with travel to the usual areas and teaching in clinics and hospitals. The topic of the week was outpatient workup of breast masses. Here there is a tendency to simply hear the complaint and refer for surgical excision, something that can be rather non-cosmetic. I brought the idea of a comprehensive history, appropriate physical and fine needle aspiration/biopsy to the table as a means of more immediate diagnosis. It was well  received as the docs are generally unsatisfied with the lack of imaging and other alternatives available pre surgical intervention. The FNAB idea should help allot. 

On Friday I went to Kanye with an actual Penn med student who matched in Family Medicine, at the Ventura program no less. We were assigned a clinic at the outskirts of Kanye only to find that there wasn't an MO there so we saw about 35 pts in a three hour period, most were kids with "fever at night". It was illustrative for the student in that we prescribed only one antibiotic; for an adult with abscesses. A significant paradigm shift to be sure, and one not lost on the nurses and staff.

Yesterday I met with some FM residents through the Stellenbosch University (in SA) distance learning program. We did a unit on "how we learn" and then exchanged ideas on what it is that attracts us to FM. Interesting spectrum of reasons from "I will make more money" to "I enjoy the patient population"

Today I took a drive out to an area about 45min from Gabs on a spur away from the road to Kanye. It was an area I pass on the way out and back to Kanye and wanted to see but never had the time. It follows a valley back to the Gabs area. Glory be it was beautiful. Along the way there was a grove of what reminded me of Aspens or Tulip Poplars that were just beginning to change color (it's early Fall  here with crisp mornings bright sun that is lower lying on the horizon and warm afternoons). The grove of trees had a stream running through it not unlike Oregon, a real refreshing, quiet, reflective time.