Wednesday, September 18, 2013

A day in the life of Family Medicine

Whew! Family Medicine is over and I am now 12 weeks into third year. I am so tired! This post is not unified or well written; it's a journal entry and nothing more. My advise: skim or skip.

Most of the mornings started at 8:00am in Family Med. I would go to 6:30 am Mass and then drive to a suburban hospital where there was a family practice group and a family practice residency program. I spent two weeks in the group and two weeks with the residents. A week of lectures and one week with the residents on their inpatient medicine service rounded out the clerkship.

I would eat breakfast in my car, parked in the church parking lot. Sometimes, I would see my mom as she arrived for work at 7:30 (she works at the primary school associated with our parish). I arrived at work at 7:45 and started clinic at 8:00.

I liked working in the residency clinic more than the group practice because it was more education-driven. I was also more like my preceptors: in the group, I worked with a doc who'd been practicing for ten years before I was born. He was so experienced (and maybe a little sloppy) that he hardly collected any history before announcing a diagnosis. He also typed with two fingers, and so was really slow with the EHR. I pitied him--even though I had about twenty minutes of training, I picked up at least as much as he had in the few weeks I was with him!

I was closer to the residents' age and experience level and, although I always treated them with the respect their degree and position commanded, I felt more comfortable imagining myself in their shoes. "Family medicine wouldn't be so bad," I thought, when I worked with them. (When I worked with the older doc, I thought, "this definitely isn't for me.... Advising all these old people to take mustard when they have a cramp even if they have stage III CKD and typing notes until thanks.")

Morning clinic would wrap up around 12:30 or 1:00, and clinic would resume at 1:30 or 2:00.

During the day I would see between five and ten patients: I would read their chart a little before tapping on the door and introducing myself. I'd ask them what they came in for and question them about their health or problems, and then I'd decide how to examine them and perform the exam. I documented my findings in the EHR and excused myself to "present" the person to my preceptor.

"Mr. So-and-so is a such-and-such-year-old white male with a history of hypertension and diabetes who comes in today complaining of a four-day history of tingling in his feet," I might say. I would describe the pain (or the cough, or the relevant details of his chronic disease) and then the pertinent positives and negatives, before describing my physical exam. "His heart has regular rate and rhythym without murmurs, gallops, or rubs, and his lungs are clear to auscultation bilaterally." Then I was supposed to say my assessment and plan, but frequently I didn't have to do this.

(Parenthetically, it's funny to write all that out, because all that text would become "Pt is a XXyo WM with 4d h/o tingling in bilateral feet....Heart: RRR s MGR, Lungs: CTAB" in the EHR)

The preceptor would ask me questions to which I usually didn't know the answers ("Does he have a family history of heart disease?" "What do you make of his elevated LFTs?"), and we would go see the patient again together. I liked seeing patients myself, making plans for them, and educating them. I really disliked presentations and not knowing enough.

I usually stayed past 5:00pm and got home tired and hungry. My family eats when my dad comes home, which is that caused some friction until mom told me I should just eat when I get home so that I can go and study. I would get to bed at 10:00 or shortly thereafter following night prayer. Usually, no recreation unless I stole some time to talk with my family, ride bikes, blog, or read.

I enjoyed working the inpatient week because I again got to see patients myself, examine them, and write notes in their charts with my own baby assessment and plan. However, this week I wasn't able to attend Mass, and so I asked our parish priest to give me the Blessed Sacrament before Mass began so that I could go to work early for shift change and rounding.

I was constantly readjusting and struggling to fit in all the things I thought I needed to do: morning and evening prayer, midday prayer, meditation, Mass, formation, work, and family took so much time that studying was almost eclipsed! I saw the result on my NBME, sadly. I would study on Saturdays and on occasionaly weeknights, but it never seemed to be enough. I always felt behind! Family Med contains so many subjects (acute and chronic diseases of every organ system in all ages and both genders! Mwaha!) that I was only confident in about a dozen by the end of the clerkship.

Where is God's will for this time in my life? I feel like I'm working two full-time lives: a medical student who needs to work and study, and a consecrated virgin in formation, who needs to study (different things!) and pray. And both are suffering because of the other! I work but I am tired because I don't get enough sleep and exercise; I study, but only a little bit, so that my work suffers; I study the Catechism (but am ten days behind) and listen to my Faith Foundations lectures (but they go in one ear and out the other b/c I listen to them in the car) and go to formation (where I am so tired they have been letting me go early); and I pray, but am so distracted and tired that I don't perceive God's presence. What needs to change???

My expectations, perhaps? Please pray for me, so that I can see God's will. I finally have a spiritual director here, and hopefully we will meet soon to talk about all this.

On to pediatrics!

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