Reflections on Family Medicine I

I posted my tentative schedule for the year a couple months ago (it feels like a billion years ago), and I figured I’d do a recap/reflection on each of my rotations! This one’s obviously super late because I finished the rotation back in September, but disappeared on a family vacation shortly thereafter and subsequently got my life swallowed by Emergency Medicine. As such, it’s not as detailed as I would’ve liked (particularly with the “Memorable Cases” and “Notable Quotes/Conversations” parts, which I decided to add in later. Unfortunately, there’s really only so much that my brain can remember. :[

Reflections on Family Medicine I

1. It’s still what I think I want to do most.
   I always add the “I think” part because I’m still trying to keep an open mind, but I really do love Family Medicine (specifically, outpatient FM). Things change all the time and I’m well aware of that, but…it’s been about 6.5 years since I first set foot into Paul Hom Asian Clinic as an interpreter and patient advocate, and I still want to be able to go back there someday (when I’ve graduated and finished my residency) as a volunteer physician. PHAC is what piqued my interest for FM, and I honestly can’t say that it’s ever left. I love the idea of being able to get to know my patients and to be able to follow up on them so I can better take care of them; that was my favorite part of the entire rotation.
2. It’s an awesome first rotation to have.
   Osteopathic medical schools tend to push for primary care, so my school makes a definite effort to start us all off in Family Medicine (if at all possible). I appreciate this a lot, because FM covers a very wide spectrum of pretty much everything that you could see, but in an environment that isn’t frighteningly high-stress or hectic, which tends to be a much friendlier learning environment (at least to me). I work better in an environment where I’m not constantly being pimped, so that was also a plus. (I can only speak for the rotation that I had though; I’m sure there are FM rotations that will pimp you like there’s no tomorrow. Not gonna lie, I’m somewhat dreading coming across one of those.) That being said, since this was my very first rotation, I felt like I knew nothing and didn’t ask for a letter of recommendation because of this, which kinda sucks because…uh, refer to #1.
3. Know what you’re expected to learn before you start.
   This technically applies to any rotation and probably would’ve fit in well here, but it’s something I definitely should have looked into more before starting. I went with the “I need to know absolutely everything” mentality and just ended up feeling really overwhelmed. Look through your syllabus or through your required reading for a list of topics covered and take notes on them! Try to go through a couple topics each night, at least on the cases you saw that day, if nothing else.
4. Approach each patient as though you’re their actual physician.
   Practice thinking! For the first two years, you’re constantly drilled on the nitty-gritty details, taking the history, and perhaps even doing the physical exam (if you’re lucky). Here, you want to improve on coming up with a differential diagnosis based on said history and exam. You want to figure out what labs/imaging to order, and how you would treat your patient. Slight emphasis there on the “approach” part because you really do not want to be doing any kind of treatment/procedure that you haven’t cleared with your preceptor yet. >_> I found The 5-Minute Clinical Consult (affiliate link) to be really useful for that, because I felt like I was pretty terrible about coming up with differentials and treatments/plans.
5. Common things are common.
   But don’t let that cloud your judgment. I would frequently overthink cases because we spent so much time going over “zebras” (the rare diseases/pathologies) in my first two years of medical school, I was also constantly worried about overlooking something and would try (operative word here is try) to be as thorough as possible, which also made me worry about slowing my preceptor down. Try to worry less about that. If your preceptor’s had students before, s/he’s probably gotten used to this and will be able to work around you. Focus on continual improvement! Upward trends are awesome.

Memorable Cases

• A patient recently diagnosed with ALS :[
• A super sweet old lady who used to make Disney princess dresses for kids and the best-tasting peanut butter candies in the world (I bet her grandchildren absolutely adored her) – see below (first quote) for what she told me! <3
• Several ladies who were trying to lose weight that I counseled on diet and exercise
• A super nice man who had Parkinson’s and is a part-time clown for birthday parties and events (he used a string of beads to make a mini puppy for me :)!
• The patients who sacrificed themselves as my first IM injection patients (they’re fine, I promise)

Notable Quotes/Conversations

• “I wish for you everything that is good in this world. You’re going to be great at what you do!”
• “Thank you! It was nice meeting you! You’re going to be a great doctor! I can tell.”
• “This one’s a real solemn one. She never smiles or anything.” (hah! possibly hard to tell on here, but he was totally kidding)

Resources (affiliate links!)

• UpToDate
• Boards & Wards (Carlos Ayala, Brad Spellberg)
• The 5-Minute Clinical Consult
• The Sanford Guide to Antimicrobial Therapy

Read about my other rotations here!