family med- week 1 continued

My doctor has every wednesday off so consequently, i dont have to work on wednesdays. bummer. i spent the day a lil sick but still tried to see a little bit of portland. from what i have seen so far, i can definitely see myself living here in the future.

yesterday, day 2 of family practice, was a good day. We didnt see a ton of patients so again we had some down time [i had a 2 hour lunch] but i still enjoyed it. We started out the morning with another pap smear and spent a good amount of time talking with a very pleasant lady.

my doctor spends upwards of 40 minutes with some patients. She sits and talks with them for a long time and really gets to know them. Some people just need someone to talk to and she is there to listen. i really like this aspect of family medicine. i am curious if all practices are like this or if she is taking a hit on her paycheck by spending so much time with each patient? maybe its just because she doesnt have that many patients anyways so she can spend so much time with each one? i am still trying to decide this.... either way, i am finding a lot of patients are on anti-depressants or have anxiety and really just need someone to talk to and vent for a bit.

The next patient we saw was a patient i had just met the previous day. she had come in monday because of neuropathy in her legs. she is the sweetest lady and is an ovarian cancer survivor. she was just diagnosed and had chemotherapy last year and is in remission now. unfortunately, the chemo drugs are still creating side effects. she is mildly overweight and has apparently been pre-diabetic for a long time and when her blood results came back we had to call her to come back in on tuesday. her blood tests showed she was not pre-diabetic anymore, she now had diabetes. it was pretty rough having to tell her this and explain what this meant and how her lifestyle needs to drastically changed. she was very surprised and cried. i felt pretty bad for her. she kept repeating "i just feel like a failure" and im glad Dr. X was in the room because i really didnt know how to respond to this. i didnt want to give her false assurance [because she really did need to change her diet] but i also didnt want her to continue thinking she is a failure. we had to increase her medication and will continue to monitor her blood sugars and HbA1C.

the next patient was a 37yo women who had fallen on her elbow and wanted it looked at. dr X thought this would be a good patient for me to start off solo with so i went in first and did a history and physical and then went back, presented to dr x, and we then went in together. we did some OMM on the patient and also talked about medications because she wanted to go back on her anti-depressants. i wonder if she used her elbow as an excuse to come in as i think her depression was her primary concern.

after a couple other patients we had a 2 hour lunch and i did some reading. when i walked over to the area where the computers and nurses are i saw them just hanging out reading so i jokingly said, "oh do you guys have some down time? which one of you can i practice blood draws on?" and to my complete surprise, one of them got up and said oh i will, lets get in room 5. i was shocked and nervously laughed and said i was joking but Molly [the nurse] said nope, you got yourself into this lets do it. she apparently lets students practice on her all the time. so, we went into a patient room and she showed me how to use their needles and she was a pretty easy stick. got blood on the first try. their needles are called 'butterflies' and once you put it in the vein you can let it go [which is very different from what i learned on at school] so it really was a lot easier than i expected. hopefully i can do some more during my rotation there. i asked her how i did and she said, great. i told her she was probably lying and that she had a good poker face. either way, she completely increased my confidence on drawing blood so im very appreciative.

in the afternoon i started charting my elbow pain patient and dr. x helped give me some corrections/advice. we then saw some more patients, one of them was a couple and the husband reeked of cigarettes. it was awful. i was doing OMM on him and had to breathe out of my mouth a couple times to keep from gagging. not cool.

after a good day, i chatted a bit with dr.x and the nurses and the topic of having children came up. i laughed and said i didnt want any and she kinda smiled telling me she used to feel the same way and that once i am done with school and married, things will most likely change. i reluctantly agreed. I told her it was nice to see a female doctor working for herself but still being able to enjoy her family and home life. dr. x really does had a good balance. she does not do any charting at home and from what she told me, she basically leaves her 'doctor self' at the door and when she gets home all she is is 'mom.' again, it is very nice to see that this is possible. she gets most of her charting and paperwork done at lunch and before she goes home so that no work is brought back with her.

i asked her when she thought the best time to have children was and she told me after residency. she followed this with, "but make sure you work somewhere with benefits and save money, be a saver. dont be one of those doctors who graduates with a sense of self entitlement and buys a BMW" i laughed hysterically to myself trying to not crack a smile and just nodded. OOPS.....