Family practice ... ?

[Paws]

I am struggling through third year right now and I don't feel like I am doing very well with it. Mostly, it's the weirdness of constantly changing teams/people/rotations as well as being often chewed out or compltely ignored by residents and interns. The attendings are great, as are the staff, techs and nurses.

So, I guess I am really hating medicine in general right now. Or maybe just the constant criticism from PGY-1's.

Anyway, I sort of always thought I would like to do FP and maybe in a rural environment. But now I am not sure I can keep going like this for the next five years, which I assume will become worse than third year. Suddenly, I don't like any specialty and it all seems meaningless and horrible. Also, how do you squeeze a family into this situation? kids? I would sort of like to have a normal life and not make medicine the main focus.

I always had thought that an FR residency might be a good way to go, but I am sort of thinking if medicine is going to stink like this I might as well be really miserable and go into something way competitive like cardio or surgery. I am on internal medicine right now and it is the pitts. Some of my friends have hated it so much they swore they wouldn't do specialty training if it meant having to do an IM residency. So, no heme-onc or nephrology. I sort of agree with them on that. And yet, I also don't want to be the lowest paid in medicine and then also bear the brunt of eye rolling from the specialists. I feel so confused, any suggestions on trying to see if I really do like FP? Any feedback or experiences people might have had? I am hoping this all gets better.

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[jsaul]

go into patholgy

 

[erichaj]

Physical Medicine and Rehab. PM&R.

Check it out, you will like it.

 

[Faebinder]

Now that you experienced clinic and hospital rounds the question is....

Which kind of interactions do you prefer to do for the rest of your life?

1) Patients in clinic? (Then go FP)
2) Patients in the hospital? (Then go IM)
3) You hated both types (Then go Pathology)

Simple no?

 

[deleted87716]

Hmm...

It doesn't sound to me as if you're as much bothered by medicine as you are by medical school. Residency is a whole different ballgame (even the inpatient months), as is private practice. Both are infinitely preferable to being a third-year medical student.

Choose a residency that gives you the kind of training experience you're looking for, and take a job that will allow you to have a life outside of medicine. Totally do-able on both counts.

 

[Pureride]

"I am struggling through third year right now and I don't feel like I am doing very well with it. Mostly, it's the weirdness of constantly changing teams/people/rotations as well as being often chewed out or compltely ignored by residents and interns. The attendings are great, as are the staff, techs and nurses.

So, I guess I am really hating medicine in general right now. Or maybe just the constant criticism from PGY-1's.

Anyway, I sort of always thought I would like to do FP and maybe in a rural environment. But now I am not sure I can keep going like this for the next five years, which I assume will become worse than third year. Suddenly, I don't like any specialty and it all seems meaningless and horrible. Also, how do you squeeze a family into this situation? kids?"






Actually...the more I re-read your post it sounds like you may be depressed.

 

[skypilot]

Don't rule out Psychiatry as a specialty either. It can be great career and very refreshing for someone who isn't attracted to other specialties. I certainly wouldn't choose the most grueling specialties just for the money. That is a recipe for disaster!

 

[andwhat]

I am struggling through third year right now and I don't feel like I am doing very well with it. Mostly, it's the weirdness of constantly changing teams/people/rotations as well as being often chewed out or compltely ignored by residents and interns. The attendings are great, as are the staff, techs and nurses.

So, I guess I am really hating medicine in general right now. Or maybe just the constant criticism from PGY-1's.

Anyway, I sort of always thought I would like to do FP and maybe in a rural environment. But now I am not sure I can keep going like this for the next five years, which I assume will become worse than third year. Suddenly, I don't like any specialty and it all seems meaningless and horrible. Also, how do you squeeze a family into this situation? kids? I would sort of like to have a normal life and not make medicine the main focus.

I always had thought that an FR residency might be a good way to go, but I am sort of thinking if medicine is going to stink like this I might as well be really miserable and go into something way competitive like cardio or surgery. I am on internal medicine right now and it is the pitts. Some of my friends have hated it so much they swore they wouldn't do specialty training if it meant having to do an IM residency. So, no heme-onc or nephrology. I sort of agree with them on that. And yet, I also don't want to be the lowest paid in medicine and then also bear the brunt of eye rolling from the specialists. I feel so confused, any suggestions on trying to see if I really do like FP? Any feedback or experiences people might have had? I am hoping this all gets better.

I have experienced the same types of thoughts exactly initially during my clinical years in medical school, as in "why did I do this in the first place?" ignore the loser residents that treat you that way, they are very rare to begin with, they are just merely insecure in their own abilities. I had a couple of attendings that were just waaaaaaay out of line towards interns and medical students, surprised that he didnt get dealt with, during Surgery. In real life you will find out that some nurses that you thought that were nice are actually lazy as hell. Work hard and it will pay off. You shouldnt be criticized by PGY-1s that is horrible, but you know just suck it up, its a right of passage towards your future (with the notable exception of Internship year, in which you can disregard this whole message - because it is about five times as bad as what you are going through right now at this very moment but its just that, a year, a horrible one at that) - that is exactly what it is - they realize that you are transient, and will come and go, and your word versus their word means absolutely nothing, that is NOT the way that the real world works, our ex PD was like that and he was fired. Lifes good in general on the other side trust me, once you make it out of the third year that is. Doesnt get worse only better, has in my case. IM rotation was awful, running around and getting Xrays for the lazy intern or resident for presentations, alot of it was just pure and dirty scutwork. It will get much better believe me as time goes on after you finish this horrible year. Eye rolling from specialists? generally doesnt happen. On rare occasion yes it happens to interns. Generally not though. I most certainly dont think that you are depressed lol. Third year of medical school, kissing everyone's as+ and still people are unhappy, it can be miserable. Just suck it up and imagine that it will get over, or work out each and every single day after your long and grueling day, helped to keep me sane. I used to run 3 to 5 miles every day after work - did I say work? Isnt medical school supposed to be educational as well? Yes I said work. Along with educational, that you received maybe at grand rounds, when the loser intern wasnt bugging you to answer his pages lazy as+. Along with hanging out with the super hot nurses in NYC that was amazing lol. That definitely kept me calm.
Hang in there.

 

[Paws]

Thanks guys, I appreciate the feedback. I don't really feel depressed, just sort of bummed about being hassled by a lazy resident. I guess he really is lazy because he does no teaching and makes no effort to work with or help students. His focus seems to be completely on "impressing" the attending. That seems sort of sad to me, and they also don't seem to be too impressed. The whole system seems messed up.

Anyway, I love our path department, those guys are awesome!! But I dunno if I could never see any patients. IM I am begining to think, no no no! mostly because the hospital stuff might make me insane. Rehabilitative medicine might make me feel sad, I wonder if I would feel frustrated that people's conditions are limiting their lives. One thing I have always liked about family med is that you can have newborns, elderly, teenagers, mothers, menopause, infertility, impotence, cancer, depression, trauma, some surgical procedures - and the list goes on and on. Plus, I think you can really structure your life and job in ways that work for you and your family life.

That is what I like about FP. When I hear our hospital patients complain about the "incompetent" rural docs, or the outlying hospitalists and surgeons, I always say: I don't want to be that doctor, I want to be the competent and sharp doc who can take good care of her patients. Of course, I don't know, they might go back to their small town and complain about us in the big city teaching hospital!

Thanks guys, I feel more encouraged. I am going to keep reading in this forum to learn more.

 

[Faebinder]

Thanks guys, I appreciate the feedback. I don't really feel depressed, just sort of bummed about being hassled by a lazy resident. I guess he really is lazy because he does no teaching and makes no effort to work with or help students. His focus seems to be completely on "impressing" the attending. That seems sort of sad to me, and they also don't seem to be too impressed. The whole system seems messed up.

Anyway, I love our path department, those guys are awesome!! But I dunno if I could never see any patients. IM I am begining to think, no no no! mostly because the hospital stuff might make me insane. Rehabilitative medicine might make me feel sad, I wonder if I would feel frustrated that people's conditions are limiting their lives. One thing I have always liked about family med is that you can have newborns, elderly, teenagers, mothers, menopause, infertility, impotence, cancer, depression, trauma, some surgical procedures - and the list goes on and on. Plus, I think you can really structure your life and job in ways that work for you and your family life.

That is what I like about FP. When I hear our hospital patients complain about the "incompetent" rural docs, or the outlying hospitalists and surgeons, I always say: I don't want to be that doctor, I want to be the competent and sharp doc who can take good care of her patients. Of course, I don't know, they might go back to their small town and complain about us in the big city teaching hospital!

Thanks guys, I feel more encouraged. I am going to keep reading in this forum to learn more.

Welcome to medicine... everyone hates everyone. Radiologists think ER docs and surgeons are idiots.... Surgeons think radiologists and IM are idiots.. IM think ER and FP are idiots... FP thinks Surgeons and ER are idiots.... Pathologists think Surgeons are crazy.... etc etc etc etc... Inside the hospitals, there are many prestige battles to be fought.

 

[lowbudget]

Hang in there, kid. Like these guys said, hospital life is truly dysfunctional. Why do you think there're all these books about medical training?

To survive 3rd year:
Take care of yourself. Work "should be" educational, but often times, we're so stressed out over patients that we, unfortunately, forget our students. So make the best of your time by focusing on 1) medicine like how patients present, how the team diagnoses and manages the patient, and 2) how to be an intern. If you learn how interns get stuff done and are one step ahead of them with the scut (discharge summaries, prescriptions, xeroxing, lab follow ups) and help them go home earlier, great! It'll help you on your subsequent rotations, all of your 4th year, and your intern year... They *should* pay you back by teaching or letting you go home early. If you gain nothing from any of that, then redirect your energy towards your shelf exam. Don't worry about interns/residents ignoring you, usually it's not personal. Don't worry about being perceived as incompetent. Let actions and the quality of your work speak louder than the words.

If all else fails, take a break, get some sleep, get some exercise... and visit the newborn nursery.

 

[andwhat]

Hang in there, kid. Like these guys said, hospital life is truly dysfunctional. Why do you think there're all these books about medical training?

To survive 3rd year:
Take care of yourself. Work "should be" educational, but often times, we're so stressed out over patients that we, unfortunately, forget our students. So make the best of your time by focusing on 1) medicine like how patients present, how the team diagnoses and manages the patient, and 2) how to be an intern. If you learn how interns get stuff done and are one step ahead of them with the scut (discharge summaries, prescriptions, xeroxing, lab follow ups) and help them go home earlier, great! It'll help you on your subsequent rotations, all of your 4th year, and your intern year... They *should* pay you back by teaching or letting you go home early. If you gain nothing from any of that, then redirect your energy towards your shelf exam. Don't worry about interns/residents ignoring you, usually it's not personal. Don't worry about being perceived as incompetent. Let actions and the quality of your work speak louder than the words.

If all else fails, take a break, get some sleep, get some exercise... and visit the newborn nursery.

do NOT I repeat do not act or show even 1% that you are unhappy, your life can and will only get ten times worse. Keep a cool and positive perspective, strike up a conversation even if you are pretty sure that you will be ignored, smile at the nurses, remember when you get out in the real world then they will work for you. Never ever show that you hate a rotation, always show your appreciation, even if you get treated like garbage. That was the hardest and most difficult thing for me to do, if all else doesnt work, just find the residents or attendings that suit your personality best, but do not ever complain, or show that you are upset. You can do plenty of that once you are a resident, when at this point people might actually listen. FP is really nice, in the sense that you get to deal with a little of everything, you are not unidimensional, and what you do not feel comfortable with you just refer, and followup on the recommendation of the specialist. You can consider doing that recommendation on the next patient with similar problems. Pretty much you treat, diagnose and manage alot its very nice. Only some of the rotations in residency are kind of worthless, like Urology ENT and Opthalmology. Not that they are not great specialities, which very much indeed they are, just that they are boring for FP.
FP is good overall. Downside, Ob, but just dont do it if it doesnt suit you.
Also endless Nursing home work and assignments, a decent amount of paperwork, difficult families and patients at times, lazy as hell nurses that do not want to do anything. Outpatient medicine is fun. Procedures are a plus too. EMR will change everything though, I have heard nothing but bad about this thus far.

 

[sophiejane]

Welcome to medicine... everyone hates everyone. Radiologists think ER docs and surgeons are idiots.... Surgeons think radiologists and IM are idiots.. IM think ER and FP are idiots... FP thinks Surgeons and ER are idiots.... Pathologists think Surgeons are crazy.... etc etc etc etc... Inside the hospitals, there are many prestige battles to be fought.

I have to disagree here--this really has not been my experience at all. But I've also done all of my rotations at county and community hospitals, not university ones. A familiar refrain around here is that academics is not real life, and I have to believe that's true, especially if community and county hospitals are any example.

I have found physicians to have a generally very collegial attitude toward one another. Everyone has their thing they do, and we all rely on each other to do it well.

Now, talk to medical students and residents and you will see what Faebinder is talking about. But I have trouble believing this the way the entire medical field operates. If it was, we'd never get anything done.

 

[nerfherder]

Dear Paws,
I'm an FP intern and your post sounds so much like me 2 years ago. I started off 3rd year thinking I would do FP and by the end of the year I was seriously considering rads, path or PMR. Third year really sucks, it sucks to be a med student and have scut work dumped on you while you have shelf exams to study for, all the while trying to decide what the hell you're going to with the rest of your life. And most of the time you feel lower on the totem pole than even the janitors (no offense to janitors) Just hang in there, it's only one year and 4th year is the best year. So far, I still think 3rd year is worse than intern year. There is much more work intern year, but it's less degrading and stressful (in some ways).
Hang in there

 

[sophiejane]

I am hoping this all gets better.

It can't get any worse, can it?

3rd year is just hard. Not so much for the work, but for the constantly changing situations you find yourself in, the interpersonal landmines everywhere, the dueling egos, the power struggles. And you, my dear, are a pawn in that game right now, unfortuately.

But we do survive, and 4th year is a dream, I promise you.

The other hard thing about 3rd year is deciding what you want to do. It is very early yet. My advice would be to try to keep an open mind as much as possible, and give yourself time to experience everything before feeling like you have to make a decision.

The other thing is to remember your job is to LEARN. Not to feed egos or suck up, but to learn. Let everything you do be working toward that learning, make your patients your first priority, and you will be fine.

I'm sorry you have some ugly interns to work with. They are out there. But the vast majority are good folks--tired, overworked, maybe a bit snippy sometimes--but generally good people.

Best of luck. Deep breath. It gets better.

 

[iatrosB]

EMR will change everything though, I have heard nothing but bad about this thus far.

I am understanding that you think EMR will make thing WORSE? Please explain, as I think it is a godsend.

 

[Paws]

Thanks for more feedback! I am thinking too, that it must be 1) academic centers are harder for interns/students and 2) that students/interns/residents have a way different experience than regular working attendings.

I think overall most people have been really super to work with. I really have liked the teamwork of nurses, pharmD's and other hospital teams. So far that has been pretty cool. When I have been able to negotiate something for a patient by having to coordinate several outside services and it has been successful, then I feel great!

I try not to take it personally when the interns/residents are sort tempered or ignore me. I can see it is a hard process for everyone. I also try my best to be professional no matter what is going on around me, but sometimes the best I can do is just keep a blank face. As I watch my other classmates, I can see that they are doing the same thing. In fact, most of the students seem to have that same blank face! It's the 'don't speak unless spoken to' face.

Oh well, I will just keep going and do my best. I am glad to hear that other people struggled with this too.

What is EMR? I wasn't sure what you guys were talking about.

 

[Mangrad]

Would agree with Faebinder and others.
I am almost done with my FP residency. Let me tell you my honest opinion - what Faebinder is said true. Even before I got into FP, I was in a similar dilemma but finally decided "what is important to me and what would I enjoy doing" ..... Pick up what you enjoy doing but remember every speciality has pros and cons.

Welcome to medicine... everyone hates everyone. Radiologists think ER docs and surgeons are idiots.... Surgeons think radiologists and IM are idiots.. IM think ER and FP are idiots... FP thinks Surgeons and ER are idiots.... Pathologists think Surgeons are crazy.... etc etc etc etc... Inside the hospitals, there are many prestige battles to be fought.

 

[deleted87716]

I am understanding that you think EMR will make thing WORSE? Please explain, as I think it is a godsend.

Yeah, I've gotta disagree with that one, too. I've used an EMR (in residency) and paper charts (in practice), and believe me...EMR wins, hands down. We're working towards EMR in my group right now, but it's not something to jump into lightly when you have 50+ docs.

 

[andwhat]

Yeah, I've gotta disagree with that one, too. I've used an EMR (in residency) and paper charts (in practice), and believe me...EMR wins, hands down. We're working towards EMR in my group right now, but it's not something to jump into lightly when you have 50+ docs.

I dont know its weird, I would agree too that EMR would be a good thing, but then again have heard that it will change everything for the dark side... I wonder how, I am not sure, but I would welcome EMR, it doesnt sound too bad, and hopefully it isnt. Maybe its the hesitation of trying a new thing? I have no clue...

 

[lowbudget]

In fact, most of the students seem to have that same blank face! It's the 'don't speak unless spoken to' face.

Oh, you mean the "show up, shut up, and put up" face? What about the "I have conference" face?

Yea, and then during intern year you learn the "Are you f*ckin' finished? I'm post-call" face.

There are days... and then, there are DAYS...! Do you ever have days when you look around and just want to say, "Are you serious?"...

Or, "Hello? Can we... be normal?"

Yea, I think you're in good company here.

 

[Faebinder]

EMR = Electronic Medical Records.

I think it's about time we moved from the stone/paper age.

 

[andwhat]

EMR = Electronic Medical Records.

I think it's about time we moved from the stone/paper age.

'

man even if you exhibit freakin perfectly appropriate behavior, you STILL get complained about. Today in a.m. clinic, I gave strict instructions to CT/Radiology to contact my nursing staff with whom to initiate contact with, and share the results of a CT - which was my nursing staff, unless it was something serious. Wouldnt you know it? interrupted my afternoon preceptorship rotation, during a Pap smear, women's annual. So after waiting ten freakin minutes on hold, I finally get into contact with someone, in other words somebody bothers to respond to a page that they sent out. "Hello this is Dr. +++++ did someone page me?" of course as I was expecting the usual
"duuuuuuuuuuuuuuuuhhhhhh um let me ask around"
so then wait another five or so minutes, finally somebody else picks up the line, "hello, this is Dr. ++++++ did you page me, or can you please direct me in the proper direction as to who could have paged me please?!"
"duuuuuuuuuuuuuuuuuh um ok...... wasnt me"
so finally I am so fed up at this point that I just hung up and called back, and spoke directly to the supervisor, just to find out that nobody has a clue as to who paged me or for what particular reason. So my nurses in my clinic call me back like ten minutes later, and it turns out that I supposedly reamed someone out at CT Radiology?! WTF???? asking who paged me and for what??
Medicine man it is a lose lose situation at times like this..... just shake your head and say screw it some days. Unfortunately you are in the spotlight, meaning that even something that you didnt say or do will be said against you in the court of Medicine some days.

 

[iatrosB]

'

man even if you exhibit freakin perfectly appropriate behavior, you STILL get complained about. Today in a.m. clinic, I gave strict instructions to CT/Radiology to contact my nursing staff with whom to initiate contact with, and share the results of a CT - which was my nursing staff, unless it was something serious. Wouldnt you know it? interrupted my afternoon preceptorship rotation, during a Pap smear, women's annual. So after waiting ten freakin minutes on hold, I finally get into contact with someone, in other words somebody bothers to respond to a page that they sent out. "Hello this is Dr. +++++ did someone page me?" of course as I was expecting the usual
"duuuuuuuuuuuuuuuuhhhhhh um let me ask around"
so then wait another five or so minutes, finally somebody else picks up the line, "hello, this is Dr. ++++++ did you page me, or can you please direct me in the proper direction as to who could have paged me please?!"
"duuuuuuuuuuuuuuuuuh um ok...... wasnt me"
so finally I am so fed up at this point that I just hung up and called back, and spoke directly to the supervisor, just to find out that nobody has a clue as to who paged me or for what particular reason. So my nurses in my clinic call me back like ten minutes later, and it turns out that I supposedly reamed someone out at CT Radiology?! WTF???? asking who paged me and for what??
Medicine man it is a lose lose situation at times like this..... just shake your head and say screw it some days. Unfortunately you are in the spotlight, meaning that even something that you didnt say or do will be said against you in the court of Medicine some days.

Sorry for your bad day bro, crap happens...just some days seem to be full of crap. Hang in there

 

[andwhat]

Sorry for your bad day bro, crap happens...just some days seem to be full of crap. Hang in there

thank man... yeah that sucks sometimes... when I used to bag groceries, I used to get yelled at sometimes... and now I get accused falsely of yelling at people lol... you just gotta say "whatever man" sometimes.... then again its part of the game... doesnt help that our superstar preceptor was gone these past few days, and we were seeing his patients, thank goodness that he is back tomorrrrrow!!!!

 

[erichaj]

do NOT I repeat do not act or show even 1% that you are unhappy, your life can and will only get ten times worse. Keep a cool and positive perspective, strike up a conversation even if you are pretty sure that you will be ignored, smile at the nurses, remember when you get out in the real world then they will work for you. Never ever show that you hate a rotation, always show your appreciation, even if you get treated like garbage. That was the hardest and most difficult thing for me to do, if all else doesnt work, just find the residents or attendings that suit your personality best, but do not ever complain, or show that you are upset. You can do plenty of that once you are a resident, when at this point people might actually listen. FP is really nice, in the sense that you get to deal with a little of everything, you are not unidimensional, and what you do not feel comfortable with you just refer, and followup on the recommendation of the specialist. You can consider doing that recommendation on the next patient with similar problems. Pretty much you treat, diagnose and manage alot its very nice. Only some of the rotations in residency are kind of worthless, like Urology ENT and Opthalmology. Not that they are not great specialities, which very much indeed they are, just that they are boring for FP.
FP is good overall. Downside, Ob, but just dont do it if it doesnt suit you.
Also endless Nursing home work and assignments, a decent amount of paperwork, difficult families and patients at times, lazy as hell nurses that do not want to do anything. Outpatient medicine is fun. Procedures are a plus too. EMR will change everything though, I have heard nothing but bad about this thus far.

Isn't it sad that someone has to suck up soooo much just to finish what is suppose to be an educational rotation?

How pathetic are we as doctor to allow this to continue?

This is a direct reflection of the kind of doctors those people are going to be.

I understand that no all doctors like to teach, but if they don't they should let the education director know this and not be forced to do it. That way you work with the doctors who like to teach.

There is no room for arrogance in medicine.

To the third year that is going through the difficult times, I have but one thing to say:

Do not be like them when it's your turn.

 

[sophiejane]

Isn't it sad that someone has to suck up soooo much just to finish what is suppose to be an educational rotation?

How pathetic are we as doctor to allow this to continue?

This is a direct reflection of the kind of doctors those people are going to be.

I understand that no all doctors like to teach, but if they don't they should let the education director know this and not be forced to do it. That way you work with the doctors who like to teach.

There is no room for arrogance in medicine.

To the third year that is going through the difficult times, I have but one thing to say:

Do not be like them when it's your turn.

Amen, Amen, Amen, Amen.

I couldn't have said it better. The future is ours to change.

 

[andwhat]

Isn't it sad that someone has to suck up soooo much just to finish what is suppose to be an educational rotation?

How pathetic are we as doctor to allow this to continue?

This is a direct reflection of the kind of doctors those people are going to be.

I understand that no all doctors like to teach, but if they don't they should let the education director know this and not be forced to do it. That way you work with the doctors who like to teach.

There is no room for arrogance in medicine.

To the third year that is going through the difficult times, I have but one thing to say:

Do not be like them when it's your turn.

agree 100%, and remember, it is their inadequacies and insecurity that is trickling down to you. That is what it is majority of the time. They have these monstrous egos and are treated like children at times by attendings and upper levels, and are passing that on down to you. Hang in there man...
and remember, either run every day, or hang out with hot chicas, or in my case.... both.... lol j/k... well not really actually...

 

[Faebinder]

Again welcome to medicine.... and life even. There will always be ranks and always be people trying to go up the ranks.

Inflating your CV and how high your position is matters... it's true for everything in life and true for medicine...

I daresay that many family practioners are none confrontationalists about this.... they are laid back nice people.... joining AAFP is a step in the right direction.

But don't forget what's important in the end... being a good person.. not an A$$ as you climb up the ranks.

 

[lowbudget]

I read an editorial about FM and teaching in one of the STFM journals. There was a group who tried to research the reasons why private practicing docs did *not* want to precept. They weren't able to finish the study because no one wanted to go on record. Anecdotally discussed over happy hour, the group found out that many family doctors did not want to teach med students because typically they were too busy with their own practices to be able to spend quality time teaching OR community family doctors had such high expectations for professors that they did not feel like they can meet those expectations.

I never really thought about it, because as a student I too resented attendings who couldn't teach. Maybe I just felt entitled. I think it's hard teaching students personally, because it truly is a huge undertaking. I'm willing to bet that there're more attendings out there who don't want to teach compared to those who do want to teach... so mucho props to those who do.

http://www.stfm.org/fmhub/fm2006/July/Anne464.pdf

 

[8744]

I read an editorial about FM and teaching in one of the STFM journals. There was a group who tried to research the reasons why private practicing docs did *not* want to precept. They weren't able to finish the study because no one wanted to go on record. Anecdotally discussed over happy hour, the group found out that many family doctors did not want to teach med students because typically they were too busy with their own practices to be able to spend quality time teaching OR community family doctors had such high expectations for professors that they did not feel like they can meet those expectations.

I never really thought about it, because as a student I too resented attendings who couldn't teach. Maybe I just felt entitled. I think it's hard teaching students personally, because it truly is a huge undertaking. I'm willing to bet that there're more attendings out there who don't want to teach compared to those who do want to teach... so mucho props to those who do.

http://www.stfm.org/fmhub/fm2006/July/Anne464.pdf

That's one of the problems with family medicine, too much research into fuzzy things which are intuitively obvious to anybody but the researchers, the results of which are always found to confirm that everything is swell and that family medicine physicians are superior to all other physicians.

 

[sophiejane]

That's one of the problems with family medicine, too much research into fuzzy things which are intuitively obvious to anybody but the researchers, the results of which are always found to confirm that everything is swell and that family medicine physicians are superior to all other physicians.

Ah,careful. If you are so into hard research and the scientific method, perhaps you should steer clear of such sweeping generalizations and hyperbole when declaring the "problems" of an entire specialty.

One man's experience does not describe the whole of Family Medicine.

 

[Paws]

I have been thinking about these comments through the week as I finished another rotation. I was also talking to some of my friends and they also feel similarly to me in terms of what I have described with the stresses and subjectivity of third year. Some have had the same experiences on different roations so that is always affirming to know I am not the only one!

But! some of my high powered hard working honors friends who I had always sort of thought would want to do cardiology at Stanford or wherever, now are saying they want to do family and just have a nice life. I mean, these are the smartest people in the class some of them. So, I was really pleased to feel that people I consider the most talented, and strongest students in the class want to be FP physicians. Cool!

I just had a brief evaluation where the attending described someone I didn't even recognize. "Who are you talking about?" I wanted to say. But then, he didn't even know me and hadn't bothered to even talk to me so really, who was he talking about? He was belittling and didn't even seem to care what I had to say. That seems like a poor way to educate people. He didn't even seem to "see" me. I think his evaluation was really the residents' in disguise. Very hard on your moral. I don't want to be a doctor like that.

 

[andwhat]

I have been thinking about these comments through the week as I finished another rotation. I was also talking to some of my friends and they also feel similarly to me in terms of what I have described with the stresses and subjectivity of third year. Some have had the same experiences on different roations so that is always affirming to know I am not the only one!

But! some of my high powered hard working honors friends who I had always sort of thought would want to do cardiology at Stanford or wherever, now are saying they want to do family and just have a nice life. I mean, these are the smartest people in the class some of them. So, I was really pleased to feel that people I consider the most talented, and strongest students in the class want to be FP physicians. Cool!

I just had a brief evaluation where the attending described someone I didn't even recognize. "Who are you talking about?" I wanted to say. But then, he didn't even know me and hadn't bothered to even talk to me so really, who was he talking about? He was belittling and didn't even seem to care what I had to say. That seems like a poor way to educate people. He didn't even seem to "see" me. I think his evaluation was really the residents' in disguise. Very hard on your moral. I don't want to be a doctor like that.

yes, regarding your last paragraph, welcome to the brutality world of IM. Certainly not all programs. Where attendings regularly belittle even the hardest working residents. At morning rounds, they got criticized. The great thing was though, that the medical students on our IM rotation were used as scapegoats, or it felt as such sometimes. It was great though, watching those egotistical jerk at times IM R2s getting blasted in front of like fifteen or so people, sweating it out, went like this -- R2 would present the morning admission, although the R1 was supposed to, but rudely got cutoff by the arrogant R2. Attending steps in halfway through the presentation by the R2 wannabe gunner --
"Gosh that medical student's presentation last week was about ten times better than yours, what do you think that you are doing wasting our time? I really wish that medical student +++++ did the presentation today instead of you. Your presentation was awful I am so confused about what happened with the patient that you admitted last evening".
Anybody that has done IM for even 4 weeks time should know what I am talking about, its nuts at times, and malignant. Not to say that this sort of behavior cannot happen in any profession or specialty, just that I saw it moreso in IM. Surgery man that was another one where Interns got blasted at times. Seemed as if everyone in Anesthesia was cool as hell too, except there was this Surgeon vs Anethesia thing that you read about. In NY, you get to see it live in action. Man its hilarious.
"You worry about your side and we will worry about ours". Cannot help but laugh at the end of the day though. Anesthesiologists are for the better part very cool, laid back people. Except sometimes for the rare old school ones sometimes.
FP and IM attendings for the most part are so willing to teach and are extremely nice. Goes for the good Surgery attendings as well. Some are malignant, and you dont even want to say a word to them, and others go out of their way literally to help. Almost always extreme opposites seems like in Surgery.

 

[lowbudget]

That's one of the problems with family medicine, too much research into fuzzy things which are intuitively obvious to anybody but the researchers, the results of which are always found to confirm that everything is swell and that family medicine physicians are superior to all other physicians.

Yea well, at my med school, it was IM, Pedi, and FM who were most interested and most inviting when it came to teaching students, particularly the 1st and 2nd years the fundamentals in clinical medicine. I mean, they were everywhere, volunteering as preceptor after hours at our student-run clinic, helping us set up health fairs, sponsoring interest groups. These guys made their career out of teaching, so it's no surprise that they would base their scholarly activity on medical education and teaching.

The problems with research in family medicine isn't so much the "fuzziness", it's the availability of research dollars. You research things that are/can be funded, or at least you twist your research so that it can qualify for some grant. It's still a young specialty trying to find a niche in the research community. Presumably community medicine is that niche (which you loathe, I know) because it bridges tertiary academic research to the grassroots. But we'll see. Not too many young physicians are interested in research in ALL specialties, much less family medicine. But hopefully some day there will be a breakthrough that comes out of these primary care research network that would justify more money to be put into it and the research can be more meaningful. We saw that in the Neuro and Psych, so hopefully we'll see it some day in primary care.

By the way, family medicine isn't the only field that publishes materials to justify its own existence. All specialties do. Emergency medicine is one I can think of. OB/Gyn when it comes to primary care is the other.

 

[chocomorsel]

Oh, you mean the "show up, shut up, and put up" face? What about the "I have conference" face?

Yea, and then during intern year you learn the "Are you f*ckin' finished? I'm post-call" face.

There are days... and then, there are DAYS...! Do you ever have days when you look around and just want to say, "Are you serious?"...

Or, "Hello? Can we... be normal?"

Yea, I think you're in good company here.

I love, loove, this reply. Very funny, but accurately true.