Rotation roundup: urban family medicine

And there it goes.  The very first rotation of clerkship, gone in a flash.  I’m excited to be moving on and trying something different… but at the same time, I’m rather bummed.  I mean, I just recently became accustomed to the odd schedule (2:30pm to 10:00pm followed by 7:00am to 2:30pm?  Ouch.),  never mind getting used to the clinic routine, the computer system, the GP’s approach to medicine, my preceptor… it’s all ending so quickly.  There’s just such a huge variety of stuff to see in family med, you can’t possibly cover it all, never mind become proficient at any one thing.  Well, except maybe upper respiratory tract infections.  And cough.  I am the cough queen.  Post-nasaldripAsthmaGERDDrugs.  It’s all one to me, like TBSyphilisSarcoid.

So.  Time to dish.

The where: Edmonton (south side)

The good:  I won’t gush long about this since I can’t really mention her by name, but my preceptor has been pretty fabulous.  I don’t know if it’s this way with everyone, but I feel that I can be honest and put ideas out without being shot down or patronized.  Occasionally I’m even right.  Plus I discovered she also likes The Avengers.  And Jeremy Renner.  A lot.  It’s great.

Again, it’s all about the follow-up.  My preceptor is actually going to text me on my anesthesia elective with the results of my one patient’s specialist consult after I made a pretty cool, superstar diagnosis.  And it’s lovely to see people again that you enjoy speaking with.  As my preceptor rightly pointed out, the fun part about this job is getting to chat with people you like hanging out with, even if it’s only for 15 minutes or so.

I saw an even greater amount of variety in this clinic in terms of disease presentation and complexity of patient’s histories.  Which was often tricky, but always cool.  Again, I’ve got to credit my preceptor with letting me see the patients complicated enough to be interesting without being so complicated that I can’t actually remember all their diagnoses.

The biggest difference between this month and my summer elective was my skill base.  I’ve done a whole lotta Pap tests, throat swabs, liquid nitrogen treatments… and I’ve probably done over 500 blood pressures.  Never mind about 50 full physicals.  And full physicals where I actually FOUND stuff.  (I’d like to renounce my title as cough queen so I may be newly dubbed the murmur queen.)  The idea that some GPs don’t do physicals just blows my mind – how else are you going to pick up that asymptomatic murmur?  Or that abdominal mass?  You can’t just check all the boxes and expect to find it on routine bloodwork.  Craziness.

The not-so-good:  I’ve had a couple of rough patient encounters, but not as many as I’d thought.  Some of them were tough just because they were dealing with difficult situations or instability at home.  Some of them were tough because the patients wanted me to give something that I just couldn’t, whether it be extra time off work or triplicate prescriptions or reassurance that everything was going to be okay.  But the toughest one so far stems simply from the fact that I absolutely believe the best in people.  I’m fully aware of that and fully aware that people will probably (at least try to) take advantage of that.  But to have someone maliciously try to deceive me… it hurt more than I thought it would.  Especially since it wasn’t me that the anger was directed at.  You still feel a little crushed though, when you’re as naive as I am, when people don’t turn out to be as well-meaning and forthcoming as you’d hoped they were.

The better you know your patients, the more it hurts to hurt them.  Physically or emotionally.  Full stop.  You can explain that one away and say that you need to maintain your professionalism, etc., etc., but there’s just no getting around the fact that you will hurt people you’ve grown to like a lot.

Time.  I feel a bit like Gandalf; “Three hundred lives I’ve walked this earth and now I have no time.”  I love taking time with patients to really hear them out and sort out what’s most important to them.  So you can imagine that 15 minutes doesn’t really seem like enough.  It’s something I know I need to work on, but it’s hard when I believe I’m called to be a servant to others.  In that exam room, I’m not there as a powerful figure of knowledge and judgement, I’m there as an aid to help them along a path to health.  So who am I to cut them short when they feel like they have something important to say?  Anyway.  That’s basically a flowery way of saying I’m behind all the time.

The verdict: More please!  Family med rotations are heavily preceptor-dependent, so be prepared to cross all available fingers for a great one.  That being said, I enjoyed this rotation quite a lot and I can’t wait for another whole month of rural family!

And that’s that.  Stay tuned for Rotation Roundup coming from anesthesia and radiology!

 – Atalanta

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2 Comments

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2 responses to “Rotation roundup: urban family medicine

  1. I can so relate! I suspect the reason that some GPs aren’t doing as many physicals could be that they work with NPs who do the physicals for them. (This is actually a great use of NPs due to their focus on preventative medicine, and the fact that they can spend more time with patients due to the way they’re paid.) Sadly, in my career I have come across some of the negative situations you describe – people admitted to hospital for social reasons rather than medical, people who have the “magic wand philosophy” (i.e. “I come in,, you tap me on the head with your magic wand and I get better right away). I remember well one case I had in my primary care preceptorship. We had a patient come in with complaints of low back /hip pain. In the course of the assessment, we learned that she’d had a cough for 3 months. My preceptor decided to do some X-rays to see what was going on (all coughs lasting >6 weeks should be checked out, and she thought an X-ray might help determine the cause of the back pain). Well, we sure found something – sadly, it turned out that she had lung cancer and the lumbar X-rays showed possible spinal mets. She wasn’t even that old – middle-aged, I think. I really enjoy family medicine; had I carried on as an NP instead of becoming a nurse educator that’s definitely what I wanted to specialize in.

  2. Christina

    “That’s basically a flowery way of saying I’m behind all the time.”

    Ahahaha, fabulous. My excuses for being slow in morning assessments are kinda similar to what you gave 😛

    I have noticed the NP-does-physicals thing around the city. Different from the small town, but I think it’s a good use of resources. Better than the one I shadowed who basically was stuck doing phone calls all day!

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