Ophthalmoscope

A couple of months ago, I went in for a review session on how to use an ophthalmoscope. I think this was the first clinical thing I've done in three years besides take my kids' temperature. And clip their fingernails - that's just like a medical procedure.

I was pretty terrible at it. This isn't a surprise since it is one of those things that takes practice. Which I haven't done. It involves rotating your head and arm at the same time around a very tiny hole (the pupil). I should stop being lazy and start practicing on Trouble.

I had forgotten things about medicine, though. I had forgotten about cramming the night before in case the very nice retired doc who was running the sessions decided to pimp us on other aspects of the eye exam besides the scope (cranial nerves!).

I had forgotten that there is no chit-chat in medicine. There can be chit-chat, but only once things are rolling along. In academia, the chit-chat comes first and then the business.

I had forgotten how it feels to walk into an exam room as a provider instead of a patient. At the moment, it feels terrifying; there is all this stuff in there and I'm not really sure how to use it. I've mostly ignored that fact for the last few years. I know I'll learn, but I'm very aware of my ignorance at the moment.

I had forgotten how many layers there are to any physical exam maneuver. For the opthalmoscope/non-dilated eye exam, the levels may go something like this:
1. Get the retina in focus - see a blood vessel. This, I can do.
2. Follow the blood vessel to the optic nerve. This, I can do about half the time.
2b. Notice some stuff that might be related to disease. Not so much right now, but I'm sure I'll get down before I need to.
3. Follow some blood vessels out away from the optic nerve. This, not so much.
3b. Same as 3a. Eventually.

Levels 1-3 can all be done from the same position. Apparently, there is also
4. While approaching the patient, change the focus on the scope and visualize different areas in the eye (besides the retina). Right. Like, maybe in 5 years.

I had also forgotten how intimate medicine is. There is touching. And breathing the same air. It certainly isn't sitting in a coffee shop with a computer.