I hate that I like family med. It's full of owning your own business and time restraints (must see patients for no more than 30 minutes) and horrible pay. Despite all this, family med turns out to be what i think of when i think doctor. They do some procedures, some ob/gyn, some minor surgeries and get to follow up on their patients. They get to counsel the patients about their options and make diagnoses because despite the specialists the patients get referred to, most people pawn most of the patient care on the family doc. All specialists it seems state "follow up with your PCP in 2-3 weeks" after doing important tests and really leave it to the PCP(primary care physician) to discuss what the test results mean and how it changes the patient's life.
I hate to say that being a PCP would be frustrating and long hours and lots of paper work but it would be more fulfilling. You get to have a broader knowledge base and are expected to advise the patients about every step of their care. And there is a huge range of different types of things that a PCP can do to 'specialize' so you can own your own practice, you can do OB/GYN, you can work in the ER, you can work as a hospitalist for your patients, you can work in urgent cares, you can work in planned parenthood, you can do a fellowship in minor surgery, you can do geriatrics, sports med, international medicine, academic medicine, you can do sooo many different things and once you have a few years of experience under your belt you can change every couple of years. Which sounds INCREDIBLY attractive-- no burn out and amazing flexibility.
An interesting aspect of family med is that the residents are trained more about billing codes and what insurance companies cover and what they don't than any other residents i've seen. They seem to be more in tune with what meds cost what and what their patients are ready for and what they're not. PCP's are also very aware that they get paid based on how many patients you see that day. And are required to see a patient every 30 minutes. In 30 minutes, you can really only address at most 2-3 complaints per patient. That is the rule actually, any more than 3 complaints and the residents get yelled at. However, lots of patients don't show up, which means you get caught up on your paper work. But it drives me a little crazy.
Still this rotation I got hooked up with a resident this week that got so behind and didn't really want to be bothered teaching me, so he had me go see his patients first, and i hopped from patient to patient and then updated him and told him what i thought and what suggestions for patient we should do. I felt like a resident, which is sorta cool. There were several patients he didn't even go see because he was so behind and it was just a contraception consultation or just a med refill. He trusted me and even listened to my suggested plans. It was pretty freakin awesome!
I managed a diabetic patient on my own, which means I got to recommend types of insulins, give the flu and pneumonia vaccines, prescribe baby aspirin, explain why an annual eye and foot exam is necessary, counsel smoking cessation, order a fasting lipid panel, start an ACE inhibitor, and tell the patient exactly what having diabetes means. This is a standard new or uncontrolled diabetic appointment. I've probably seen it maybe 30 times. Thank goodness I remembered it all.
I also got people who come in with cough and I argued against the residents and attendings who wanted to give antibiotics for an obvious viral illness. We got well child visits (like 1 and 2 and 3 year olds who need their shots). I got a 19 year old girl who wanted to discuss types of contraception. I got a few other teens who were concerned about STDs. (funny its mostly girls). We also get tons of people who have chronic limb pain (shoulder, knee, back, hip, you name it i've seen it.). These patients are hard because you want to help them but you cannot prescribe narcotics too easily. The best we can do is give tramadol (ultram) and refer to a pain clinic. I got an older woman who had CHF and several people who wanted to follow up after their ER visits.
That said this rotation is what you make of it, several other students essentially just shadow the residents. Nobody really cares about students. If i said i wasn't supposed to be there except M,W,F they would say "okay" and even the residents don't take things all that seriously because they arrive 30 minutes late most of the time. And nobody pays attention in didactics. I had to force the residents to let me talk and present and stay late to help with paperwork etc. (cuz its not like i have anything else to do). But I think they know that I want to learn even if I may not be the smartest student they had.
And the truth is despite its reputation, i could be a PCP and be happy enough. I state this now, because I want to remember feeling competent at something. In Jan I start surgery and I know its gunna be a whole new ball game.
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