Well into PGY-1 year, I feel as if I excel more in inpatient than outpatient, worried

[ibarne242]

I'm a tiny bit worried because I just feel like on the outpatient side I am not progressing that well in my ability to manage patients. I'm in FM.
In the hospital, where I've spent the vast majority of my time, I feel pretty OK about how well I can handle patients...even though of course I still don't manage them on my own
I mean, my program is literally 1/2 day/week outpatient during intern year, with the vast majority of other rotations being inpatient.
I feel like on the inpatient side I'm insightful and more able to adequately grasp my patients' issues
I don't feel that way at all on the outpatient side. People are more "mysterious"...their lab work isn't back...their imaging isn't back...their specialist notes aren't scanned in...it's like outpatient issues I don't even know how to approach them a lot of the time. Someone came in with some cyst today. No clue in hell what to do about it until my preceptor guided me.
This is gonna get better I imagine...I've always wanted to be an outpatient doc but now I wanna do both to some extent. But is it worth thinking about...maybe just being a nocturnist/hospitalist?

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[GoSpursGo]

It's natural to feel most comfortable doing what you do most often. I felt the same way in my peds residency where we did 1/2 day outpatient per week and had an inpatient-heavy intern year.

Think of it this way--your first day on service you probably struggle to get a handle on your new patients. By the end of 3-4 days, you probably feel much more comfortable after seeing those patients for a few days, right? Well, when you're in your outpatient clinic, EVERY patient you see is probably someone you're meeting for the first time. Assuming you get any sort of continuity in your patient panel, you should see that you get much more comfortable in 2nd year, where hopefully you will start seeing several of your patients for follow up visits rather than having a full slate of brand new patients every time you walk into clinic.

 

[Elixir6]

This is completely normal and when I was in medical school and PGY-1 I didn't like outpatient because of all the uncertainty and unfamiliarity. Most of my co residents also didn't like clinic. But by PGY-2 onwards I got comfortable and really liked it (though many of my co residents still never did).

You'll get the hang of it.

No one uses it, but Pocket Outpatient Medicine is decent, and ACP "In the Clinic" series is good too. Also remember that you don't need to accomplish everything in one visit. Totally fine to make some changes and address some problems and ask the patient to come back to continue to work on things or refer to specialists.