Medical consults at church

It seems now at church every week I get asked to see someone for the medical problems. I do not mind it usually but I think that some of the members are a little thrown off when I switch into doctor mode. A few weeks ago I had a 55 year old woman at church ask me about some intermittent pain in her legs. So we went into an empty room and I began my exam which include palpations and several uncomfortable questions about her menopause and and other unmentionables. She answered the questions but I think she was a little surprised. If I am going to be asked to see someone I certainly do not want to miss something so I am going to do a thorough exam. Hopefully no one asks me about a lump in their breast. 

Today at church we had a 3 year old boy who was pulled by his older sister at church and they thought t hat he may have dislocated his shoulder. I was asked to go to the nursery and see what was going on. I explained to the parents that shoulder dislocation in children is rare and a humorous fracture is more common. The boy was guarding his right arm and obviously did not want it touched. So I began to examine him and did the proper maneuvers to determine if it was dislocated and reduce the shoulder if needed. It did not appear to be dislocated so I examined it for other injuries. I explained the finding to the parents and told them it was either a separated shoulder or possible fracture or a strain / sprain. The only way to make a complete diagnosis would be an xray. I at least save the the headache of going to the ER. I told them how to care for it and what to watch for and that if by tuesday / wednesday  the did not see some improvement to take him to a doctor, not the ER. My opinion is that the child most likely has a sprain. He did not have the level of pain associated with a dislocation and  when I tested range of motion his shoulder it was clear that his shoulder was not dislocated. 

It was cool to be able to help. When I was working in the ER I had the opportunity to examine several kids with the exact same symptoms and I used an xray to confirm my diagnosis. I also was able to reduce a handful of shoulder dislocations so I at least knew what I was looking for and how to fix it if it was in fact a shoulder dislocation. It is interesting as I continue my training I am realizing that each patient is an added level of training. There is no easy way to learn this stuff, it just comes over time with lots and lots of exposure to patients with particular illnesses. There are no short cuts just tons of hours seeing patients and studying.