Surgery VS Family Medicine Part 2

It is better to travel than to arrive – Buddha

Hello everyone! It has been a hot minute since I’ve given you all an update on my internal battles. Life is just full of surprises. One moment you think you know yourself then the next moment life decides to happen and you stand there like “HAHA! Just kidding!!”

But I have learned a lot about myself from these experiences. I’ve learned that I tend to avoid confronting my battles aka I’ve become a PRO procrastinator. I like to fill my procrastination time with eating. I am a stress eater. I have learned that when eating tilapia with a sauce, the tilapia just becomes the sauce … so choose your sauce wisely. I learned that Hot Cheetos turn your BM neon red (if there is such a color). And that Nuun electrolyte tablets are the hangover cure. Just some of my thoughts over the past few weeks, so let just jump right into it. Enjoy!

Family Medicine Reflection

Laughters is the shortest distance between two people – unknown

Hello everyone! It has been 3 weeks since my family medicine rotation (I know, I’m really late. I’m sorry!). Reflecting on my experience, there were definitely things I loved like continuity of care and being a well rounded physician (literally I was pimped on everything). Some things that I did not realize until immersing myself in the field was how much mental health shows up at the office. I came to realize how prominent depression has become not only in my patient populations but amongst my peers and maybe even within myself.

I was assigned to read that I found very interesting:
– The Depression Cure The 6 Step Program to Beat Depression w/o Drugs by Stephen S. Ilardi, PhD.
– Feeling Good by David D. Burns, MD

 

Rotation #2: Family Med

Hi All!

Hope you’re doing well! I just finished my Family Medicine rotation and I’ve been with a great preceptor for these last 6 weeks!  I’ve learned a lot about life, medicine, and people. It’s been awesome! I don’t know about you guys, but I feel so much better about third year in general… no longer a deer in headlights!!

About the rotation:

Why it’s AWESOME: you get to do stuff! Lots of procedures (suturing, cutting, physicals). And you get to see everyone–male/female, geriatrics, peds–which is great! It’s also (for me, at least), been 8am-5pm, with weekends off and that’s been so nice!

Why it’s TOUGH: you have to know everything… seriously, everything. My preceptor knew the adverse effects of like every drug! Even the obscure effects!! And the COMAT is tough too–it’s like a mini step 1! It’s tough to figure out resources for the exam as well…

CAM00541
My awesome preceptor and me at her office!

I got a chance  to do so many cool procedures and spend time with patients. We had cases of Bell’s palsy, DISH syndrome, psoriasis, liver failure, anxiety, COPD, CHF, fibromyalgia, depression, skin excisions, and schizophrenia (or some kind of drug-induced hallucination issue). We also visited the ER to see patient. There was patient follow up, prevention, screenings, and I learned a lot about how to be both firm and compassionate.

All in all, family med was great! I hope everyone has an awesome next rotation! I’m in OB/GYN next (thanks for all the tips Jenny!) and am very excited about it (my FM preceptor has been referring patients over there all week!). 🙂

Family Med: Tips & Resources

Hi Everyone! I know I’ve been out of Family med for a while (> 1 week), but thought I’d put this post out there just in case any of you find this helpful.

As you can most likely ascertain from my previous posts, Family Med was a great rotation for me and this is likely because I worked in an Urgent Care Clinic. I will still need to do a proper Family med rotation as a PCE to see if this is a good fit for the future, but for what it’s worth, I’m pretty certain that if I get a chance to Moonlight during residency, I’ll do it in Urgent Care.

Outline of Urgent Care/Family Med rotation:

  • Hours: 9am-8pm three days per week (I personally love this type of
    schedule)
  • What to Wear: Business Casual. I wore my white coat if the doc I was with wore his, otherwise, I mostly tried to mimic their level of dressing.
    • Shoes: DANKSOS. I have pes planus and found these to be the most comfy, even if they are a little heavy to walk around in all day. I hear ya’ Priya.
  • Why I really liked this rotation:
    • Variety! Like our favorite IM doc from school, I loved that behind each door was an unexpected and different case. We had no scheduled appointments and as a result had either really busy days or slower summer-style days. Mondays were usually the busiest.
    • Low stress learning environment. My preceptor made sure that I knew this would be a safe learning zone. He encouraged me to take my time seeing patients, really practice taking a history and then present the case to him without feeling rushed. He also pushed me to formulate a diagnosis and treatment plan on as many patients as possible. I really appreciated this as it helped guide my thinking on how to diagnose and treat.
    • Seeing normal variance within patient presentations. Simple cases like UTIs, cough/colds, esophageal spasms, musculoskeletal injuries, etc. were great to see as each of them had slightly different presentation and treatment plans.
    • Getting plugged into the medical community. Working with this clinic I was able to meet other DO’s and learn about what specific medical needs were lacking or in surplus in their region. It’s nice to build alliances with doctors that are willing to take students from our school before other schools get a hold of them.
  • What I wish I had more of:
    • Patient follow up. After patients are seen in the urgent care they either disappear into the netherworld or follow up w/ their primary. But there were a few interesting cases I’d like to have seen a conclusion to.
    • Procedures. For whatever reason, we did not see nearly as many lacerations as I would have liked and I didn’t get to do any suturing. A small bummer.

Here is a picture of me presenting a case to my preceptor, he is trying to stay awake and I am speaking quickly. 🙂 
preceptor TDC
Now begins the onslaught of resources. You can skip this part as needed.

Online Resources: 

Book Resources: 

  • Family Medicine Case Files
  • Blueprints Family Medicine
  • Step-Up to Medicine: Ch. 12 Ambulatory Medicine

QBanks: 

  • COMBANK COMAT Family Medicine
  • COMBANK Step 2-CE – Family Medicine
  • UWorld
  • AAFP (create a free account)

General Advice:

  • Stay engaged. Only yawn if you’re tired and even then, hide it.
  • Read daily – try to pick one case each day to read about patient presentation, findings on physical exam, labs, indicated diagnostic testing, differential diagnoses, and treatment plans.
  • Make friends with everyone (not best friends, like EDC-status, but Be Friendly)
  • Be professional: dress the part, act appropriately (try not to laugh at weird things patients say), and don’t suck up (gross!)!
  • Consistency is key. Don’t be a different person each day.
  • Ask questions – engage your preceptor! Make it apparent that you have a clear thought process and you know where your knowledge gaps are!
  • Understand that patient’s don’t know how to tell you their history and it’s up to you to convert what they’re telling you to a communicable format for other medical professionals – don’t be frustrated by this!
  • Be Assertive, not confrontational – a fine line, but when used appropriately can help break down barriers and build relationships.
  • And finally, most importantly, Be Confident.

Last thing: remember, if you’re in Seattle, tell me so we can go Paddle-boarding together. Unless you’re a stranger and we’ve never met.

SUP

The Urgent Care Clinic

I am mid-way through my Family Medicine rotation, sadly only 3 weeks left. For my 6-week long Family Medicine rotation I’ve been working in the Urgent Care Clinic in Silverdale, WA. Urgent care is essentially the bridge between the Emergency Department setting and your standard outpatient family medicine clinic. Cases that are not quite as acute as a Heart Attack, but problematic enough that you don’t have time to see your family med doc, are seen at the Urgent Care clinic, or Prompt Care clinic for those of you born in the 60’s.

We’ve encountered some really exciting cases: Pneumothorax, new-onset atrial fibrillation, Dens Fracture, Umbilical hernias, and some solid box-cutting knife-inflicted wounds. Some of these cases will get sent over to the Emergency department and others will simply be sent home with the expectation that they will follow up with their primary care doc. We also see a lot of regular complaints, like bug bites that get infected causing cellulitis, upper respiratory infections, sinusitis, otitis media and externa, urinary tract infections, MIGRAINES and BACK PAIN. Complaints of Migraines and Back Pain are interesting because physicians really have to be wary of prescribing narcotics for pain management, a hairy subject for any doctor that has worked in the ER or urgent care. Luckily the doctors I work with have shutdown the majority of local drug seekers and are very strict about when they dispense narcotics.

I didn’t expect to enjoy Urgent Care nearly as much as I have been, I like a quiet life. The two doctors I’ve been working with practice medicine differently and it’s great to see variation in styles. Though it’s funny to think that there is a “finesse” to practicing medicine, I’ve discovered that there really is and like many challenging professions, it takes a lot of practice to get to that point of having any semblance of command over this form of art.

Another unexpected finding is that now I have two GREAT mentors that I can ask the pertinent life questions of when is it a good time for me to get a puppy? (wait until after residency) How do you get along with others on 2 hours of sleep? (you don’t) Which nurses will distrust me the most? (OB/GYN and Inpatient peds nurses). And of course the less interesting, am I meeting the appropriate benchmarks as a 3rd year student? (tbd) How can I impress preceptors on rotations? (Be eager, work for knowledge, have enthusiasm for any task, research your cases, be reliable, be presentable, be inquisitive). I’m feeling quite indebted to these doctors for being willing to humor my idiotic responses and bizarre, out of left-field (or right-field?) questions. But doctors that really care about medicine want to see it fall into the right hands and will contribute to molding students into the types of physicians that patients will be able to trust.

In other events, I’ve discovered Paddle Boarding and I love it. If you are in Seattle and it’s more than 70 deg F outside, lets go. Seriously. I’m slow, but I keep going, and I enjoy the ride.

from vashon ferryView from Vashon Island Ferry terminal last night.