Victoria Yeh: Many Lessons Learned BACK

Published by AFAR

This is Victoria Yeh's second entry. Read her first MSTAR Diary to learn how she began her MSTAR experience.

During the past few weeks, I’ve been looking through many patient exercise diary entries to record the illnesses and injuries they experienced during the time that they were monitored. Throughout this process, I’ve learned a lot about the challenges of data collection in clinical research. One of the most important lessons I’ve learned is that the wording of survey questions is very important – for example, if you ask patients whether an injury interfered with their exercise this week, they might say that their broken foot prevented them from running. However, they might have actually broken their foot a few weeks ago, and meant that the pain from the foot was still bothering them. In addition to this, sometimes patients reported the same injury or hospital visit multiple times, but described the event in two different ways so that it was difficult to tell if they were talking about the same incident. I’ve also discovered that there’s a lot of variability in the patients’ journaling styles – some of them left most of the pages blank unless something very serious happened, while others seemed to feel obligated to record a sentence or two in the journal every day. I think this leads to some bias in our reporting of illness/injury incidents, but it’s a problem that’s hard to avoid.

Sorting out the data has been difficult at times, but I’m almost finished with this step and I’m eager to start the statistical analysis to look for interesting patterns. So far, I’ve been very surprised by the data I’ve seen, though I knew that these were patients with a history of cardiovascular problems, they had far more hospitalizations and emergency room visits than I would have expected, and a lot of minor illnesses (cold, flu, allergies, stomach problems, etc.) as well. I think that as a future physician, this is something I should definitely keep in mind, since these problems could definitely interfere with the patients’ treatment plans and their overall health.

By shadowing my faculty sponsor, I’ve learned that observational skills are absolutely necessary when caring for elderly patients, as some patients are very weak and even basic physical exam procedures can be difficult to perform on them. For example, a few of the patients wouldn’t open their eyes for a long period of time because of the light, or had difficulty opening their mouths. Observational skills were also very important when patients couldn’t response verbally to questions. Last week I saw a patient who only spoke a few words the whole time we were there, and when I saw the patient’s charts I noticed that it said he’d been depressed. I was very puzzled because I wondered how you would know someone was depressed if they never said anything – don’t people usually ask the patients screening questions? My faculty sponsor explained that they figured it out from changes in his behavior and eating habits. I started thinking about how the physical diagnosis skills that I’d been taught were so heavily dependent on asking our patients questions, and realized that although I’d had a lot of practice asking past medical history and review of systems questions, I’d be totally lost if the patient couldn’t talk to me! Hopefully I’ll be more observant as I gain more experience, and become less reliant on asking questions.

I’ve also been seeing a bit more of the retirement community’s facilities in the past couple of weeks – for example, I stopped by the physical therapy center and watched some of the therapists working with the residents on different exercises that were tailored to their needs. I also met an occupational therapist who explained how she helped patients with activities of daily living, such as going to the restroom and moving about their apartments on their own, and a speech therapist who worked with patients on both their verbal and cognitive abilities. It has been great to see how the whole team of doctors, nurses, and therapists work together to improve the patients’ health.

Victoria Yeh
Case Western Reserve University School of Medicine

 

"Diary of an MSTAR Student" follows scholars in the 2011 Medical Student Training in Aging Research (MSTAR) Program, highlighting their summer experiences. As they continue their path of research, training and clinical practice, read their daily thoughts at www.afar.org/mstarblog. New diary entries are posted every day, so check back soon.