Latent TB clinic

Today was TB day in Preventive Medicine. After arriving at 7:30 and finding the office I share with the interns still locked (the lieutenant colonel who has the key forgot his Army ID at home, so when he got to the gate he had to turn around and get it and was a bit late), I sat in the conference room for awhile reading from the epidemiology textbook I have to get through this month. After my room was unlocked, I logged onto the computer and spent the next three or so hours reading the TB materials in the Preventive Medicine database. It would have gone faster, but I spent a lot of the time laughing with one of the interns, which somewhat impeded both our abilities to get work done.

Once I got those out of the way, I spent some time flipping through the various public health and preventive medicine journals we have in the office, trying to find an article for journal club on Friday. Journal club isn't nearly as much fun as it sounds--pretty much, the lowest people on the totem poles (so in this case, me and the residents) pick articles, describe the research methods and the results, discuss whether or not it's applicable to our current situation (so in this case, for preventive medicine in the Army), and point out the flaws in the research and reasoning. Then after we present that, the higher people on said totem poles (the attendings, and in my case, the residents) ask all sorts of questions and pretty much make me feel like an idiot. I couldn't find anything all that exciting in the journals, so I finally settled on an article on visibility of calorie content on menus and purchasing decisions in fast food restaurants in New York City. The conclusion: when people can easily see the calorie contents of the food, they're more likely to buy things with fewer calories. Subway was the winning restaurant on making those visible to the customers.

Anyway, back to TB... the afternoon was latent TB clinic, which is people who had a positive TB skin test, but don't have symptoms and don't have any findings on chest x-ray. They come to us, and we decide 1) if we believe the positive TB test, 2) if we want to treat them, and 3) what to treat them with. There's no requirement to be treated for latent TB (unlike active TB, which you not only have to be treated, but they have to see you take your medicine), so part of #2 is the patient's preference. If they decide to be treated, and we decide that's a good idea, they get isoniazid (also called INH) for nine months. They can't do this if they have abnormal liver function tests, are pregnant, take other medications metabolized by the liver, or can't go nine months without drinking. I didn't do much in clinic today; I pretty much shadowed one of the residents and watched closely to learn how to document things in AHLTA, the DoD's electronic medical record system.

I have no idea what I'm doing tomorrow, but I'm guessing it will involve reading from my textbook, preparing my journal club presentation, and researching my scoliosis project.