■ 12:00 PM
I check in on one research subject who was admitted to our center for a 2-week stay. This is a normal, healthy graduate student who is taking part in a study of the relationship between growth hormone and weight regulation. Participants in this study are required to consume a high-calorie diet with limited activity for 2 weeks. This particular participant is feeling well physically but does appear quite bored after 5 days of this regimen. At the end of the study she will undergo a muscle biopsy. Because I am learning how to perform this procedure, I will perform it with the study physician.
■ 12:15 PM
I take a break to eat lunch, catch up on writing notes, and prepare for my afternoon appointments. My husband calls me to say hello and to ask if I petted the cat goodbye before leaving the house this morning.
■ 1:15 PM
I perform a follow-up exam on a participant in a study that will determine the effectiveness of a low-salt diet on chronic kidney disease. With the guidance of the research dieticians, this 66-year-old gentleman has been following a low-salt diet for the past month. During my exam, I focus on volume status markers, including lower extremity edema, lung crackles, and jugular venous distention. Since I last saw him, his leg swelling has markedly improved, his blood pressure has improved, and he is feeling better. Bioelectrical impedance testing (done by the study team) confirms the improvements.
■ 1:45 PM
My next participant has type 2 diabetes and is presenting for a screening visit for a study on peripheral neuropathy. I am careful to ask about the signs and symptoms of neuropathy and to assess neurologic functioning, including a monofilament foot exam. These study participants will also undergo further neuropathic testing in the hospital neurology lab.
■ 2:30 PM
My last H&P of the day is for an alternative medicine study involving the use of chamomile extract for chronic insomnia. I evaluate these study participants for secondary causes of insomnia, such as chronic pain and depression. Unfortunately, this study participant was a no-show. I joke with the staff that perhaps he was too tired to come today. In reality, however, there are many cancellations in the world of research. Our study participants are volunteers; many of them are generally healthy and often simply do not show up. Other participants present for their appointments but do not meet the inclusion criteria for the study. Some have decided not to participate after talking to the study team and reading the consent form. I take advantage of the extra time to do some medical reading.
■ 3:30 PM
I communicate via e-mail to study teams to clarify their needs for upcoming studies. I assist the nursing staff with blood draws, as a number of participants need labs at this particular time. I sign orders for a study participant arriving later this evening for an overnight admission. I also briefly review the next day's schedule. My first case for tomorrow is a fistula exam in a participant receiving an experimental treatment for Crohn's disease. In the afternoon, I will be traveling to an offsite clinic to examine subjects with fibromyalgia.
■ 4:30 PM
On the way home, I reflect on how different my current position is from my frenetic years in inpatient internal medicine. I saw much suffering inside the hospital walls during that time. It is intriguing to think that I am now involved in studies that aim to develop new understandings and treatments for various medical conditions. Although it may take many more study subjects before results are known and several years before others can benefit, anticipation of what the outcomes might promise is exciting. I feel privileged to play a small role in these endeavors. JAAPA
Alexandra Scott works in the Michigan Clinical Research Unit, University of Michigan Hospital, Ann Arbor. The author has indicated no relationships to disclose relating to the content of this article.