Rotation #1- Family Medicine

My third year has officially begun, and it's flying by already. My first two years were spent sitting on my toosh in school listening to lectures and studying the rest of the day and night until 10:30 pm or I couldn't handle it anymore. The third and fourth years are quite different. Here's how it works: I am assigned to a doctor(who is my "preceptor") for four weeks in a certain specialty and those four weeks are termed a rotation. The doctor is my teacher and also my evaluator. My responsibilites are different on each rotation depending on what the doctor feels comfortable letting me do, but in theory I'm supposed to go into the patients room after the nurse measures height, weight and vitals and get the history of the chief complaint and perform whatever physical exams I think are necessary. Then I let the patient know what I think needs to happen, go talk to the doctor to tell him about the case, and tell him my best educated guess of the diagnosis and proper treatment. He'll then see the patient and either agree with me, tell me i'm way off, or say i'm close but recommend a different course of treatment. That is what's supposed to happen but it doesn't always go that smoothly.

My first rotation was with Dr. Hoy in family medicine. He has his own private practice with a small staff of only one medical assistant, two receptionists and a billing specialist. It's rare to see a Dr. working for himself in todays world because of the fear of malpractice lawsuits and the insurance being so expensive. I'm glad I got to experience it first hand and see how an office is run. Dr. Hoy was a 60 year old vietnam vet with a slightly filthy mouth but was a great teacher who had great insights after 30+ years of practicing medicine. He had one problem though: he was addicted to smoking. Yeah I thought it was weird too to see a dr. who smoked. It was especially strange and disheartening when a patient responed after I inquired how managing her diabetes was going with "Dr. Hoy told me to start smoking again after I quit because I gained so much weight!" At first I couldn't believe Dr. Hoy would recommend such a thing, but then quickly concluded that she probably misunderstood him and was using that as an excuse to start smoking again. She was a typical patient at this practice. It was located about 15 min north of downtown Columbus in a fairly low income area. I was a little overwhelmed at first when it felt like every patient had 20 diseases and were taking hundreds of medications. That is an exagerration but certainly the majority of the patients were obese, had high blood pressure, diabetes, a heart problem, degenerative disk disease and some other crazy thing going on. Their was lots of diversity with an almost equal amount of african americans and caucasians. Sadly, not very many took care of themselves and it was a good thing I had the Vicks vaporub I could shove up my nostrils when the smell of a person who hadn't bathed in weeks became unbearable! I got to see a lot of patients and feel like I understand medicine much better than four weeks ago. I felt the most important thing I did on this rotation was seeing 100's of normal eardrums, eyes, mouths, noses, throats, hearing the normal heart and lungs and then comparing those with the abnormal eyes, ears, noses etc. I've got a long way to go but i'm amazed at how much easier it is for me to notice what is wrong after only one month of seeing patients. I think I'll feel pretty comfortable seeing patients after two more years of this and three more years of residency. Here are some of my conclusions of family medicine:

1. We need good docs in family medicine. They really are the quarterback of the healthcare team and the better the family doc, the better the overall care of the patient will be.

2. Family medicine can be a great lifestyle. My hours on this rotation were 9 am to 4:30 pm. and on fridays it was 9 am - 12 pm. Those are hours I can live with! The doctor's hours were more like 8 am to 5:30 or 6 pm and sometimes 7, but that really isn't too bad. Especially compared to the surgeons. He didn't take much call at home or on weekends either.

3. I don't like pap smears. I know ladies don't like them either, but I can assure you I hate performing them more than you hate getting them. I could elaborate...but this is a PG blog so enough said.

4. I really like suturing. I only got to put in two stitches the entire rotation, but I really enjoyed it. All the practice I did in surgical skills class definately paid off! :)

5. Vick's Vaporub is from heaven. I never knew there were so many foul smelling people in this world, and nasty smelling abscesses either. I don't think i would've kept my lunch on several occasions without it.

6. I enjoyed getting to know people, but still have a long way to go in learning the skill of asking the right question or phrasing a question the right way. I'll always remember the 40 year old lady who came in with a possible urinary tract infection, and I was trying to figure out what might be causing it. I asked her point blank if she were sexually active(I guess my blog is PG-13 now), and she gave me the most dangerous looking dagger eyes and said "Is that important!?" I said it was because "you may have an STD." Oops. Big mistake. She denied that it could ever happen and then went on a tirade of how she hated men. She told me she was "into women now" and all I could say to keep her from getting more upset was that it was ok. I don't think what I asked her was innapropriate because knowing her sexual history could've potentially affected how we treated her, but I think I can be more tactful in finding out that information and giving a better explanation to why I need the info rather than "you may have an STD". :) Live and learn, right?

7. There are some people who share with you wayyyyy more than you ever wanted to know about them. Enough said.

I really enjoyed working with Dr. Hoy and his staff and we sure enjoyed alot of fun times and tasty free meals together. I don't know if i'll end up as a family practicioner but I will definately consider it. I have another four weeks of family practice starting tomorrow with a different doc and we'll see how that goes.

I'm loving Columbus, and also visited Cincinnati and Cleveland the last few weekends. They are fun cities. I love how close I am to so many major cities and attractions. The next two years are going to be great!