Well I’m long overdue for a post, but now that I’ve finally decided to write something, I don’t have internet access. Bummer! I kept thinking I should write about my Family medicine experience, but I never quite found a good time to do it. It’s ironic, though, since I found time to write when I was on OBGyn and working 14-hour days but when I was working 8-6 in the clinic I couldn’t quite find the time. I was too busy having fun, I guess.
Family medicine wasn’t what I expected it to be. I really had no expectations for it, except that I was pretty sure I didn’t want to be a family doc. I have met quite a few during my time here in med school and I didn’t think that I had their personality.
I was so wrong!
I really, really enjoyed FM. I liked the variety of patients – I saw everyone from pregnant women (and their soon-to-be babies) to 97 year old women in the nursing home! I saw just about every complaint imaginable – cardiac, psychiatric, musculoskeletal, etc – and the amazing thing was: we could do something for almost all of them! I had imagined that we would do tons of referrals to other doctors since FM docs don’t have a specific specialty. Instead, we handled a majority of complaints, and when we did refer out, patients would come back to us looking for answers and explanations that their specialty doc didn’t give to them.
I loved spending time with the patients, discussing things that were going on in their lives and what was worrying them. I felt like this is what a “doctor” should be - you should be able to treat just about everybody (and know when you’re out of your league) and be able to really know your patients one-on-one.
People throw around the term “continuity-of-care” but I never really paid much attention to it – but I found myself wondering about my patients when I went home at the end of the day. I wonder about the 21 year old guy who lost 35 pounds in the past few months without trying, I wonder what happened to the poor old lady with the bowel problems that we sent her to the hospital for, I wonder what happened with the little boy who was taking seizure meds that had delayed his speech development…If they were my patients, I wouldn’t have to wonder!
I felt like I had a purpose being there as well. I was there to listen. The doctors had only 20 minutes to see each patient, but my time was unlimited. Some patients just need to be listened to, especially those with chronic pain, depression, and stressful living situations.
Chronic pain is another issue I learned a lot about. Not necessarily medical knowledge, but I got to spend time talking with multiple patients about their daily struggles with pain. It’s a sticky subject in the medical profession because doctors are afraid to walk the fine line between creating drug dependence and really helping those in need. Some of the residents I worked with refused to give out narcotic pain medication altogether. I think that it should be what it is - a controlled substance – but I think that it has a purpose and it works for some people. Going to pain clinics can work for some, physical therapy for others, but some people just need a pain pill and I think they deserve that. I read that one of the most undertreated diseases in the US is chronic pain because doctors are scared of prescribing someone too much medicine and creating addicts. But if I were in chronic pain, I’d rather be an addict than live my life hurting all the time. I think doctors need to step out of their own shoes once in a while, take off that white coat, and imagine what it would be like to have crippling pain all the time. Waking you up in the middle of the night. Preventing you from being able to do things you love. Making you cranky and irritable and no one wants to be around you. You would want to take some Vicodin too.
Whew…Back off the soapbox. Thanks.
The only thing that I didn’t like about the specialty itself is something that others may say is silly – but I feel like FM docs are sort of looked down upon. “FM is the specialty you go into if you can’t get into anything else.” “Smart people don’t go into family medicine.” While I know these things aren’t really true, I dislike the fact that the sayings exist. I also don’t like that my FM doc could spend 45 minutes with a patient discussing different issues, and get paid pennies compared to what some specialists get paid in a few minutes of seeing a patient. We took some skin tags off a patient and billed about $150, a dermatologist would bill over $300 for the exact same procedure! Hopefully with the shortage of PCPs (due in part to the striking difference in reimbursement) things will change. I know things aren’t all about money, but when I graduate I’m looking at a debt of over 100K – that’s a lot of money. I want to pay it off so I can get a house, a family, a car with air conditioning, and someday afford to send my kids to college. Will I really be able to do that with a FM salary? Yes, but I could do it much quicker and easier if I spent an extra few years specializing.
Okay, off the other soapbox.
Anyway, in summary, I really, really, liked family medicine. I surprised myself I liked it so much. I was happy to go to work every day and help the young and old, the sick and healthy, the rich and poor. I enjoyed the continuity of patient care, and the variety of issues that are brought up. No two days were the same. I had a great time, and even though it’s still early in the year, I think that this was a rotation that is hard to beat.
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