SLUser11

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Hi,
First of all, if I'm asking in the wrong forum, I'm sorry in advance.

I have a family friend who is retiring from OB/GYN due to stress, etc, and has gotten a new job as more of a general practitioner . He will be overseeing the medical care of mentally handicapped people in a mixed independent living/group home/nursing home type of environment. He'll be doing annual physicals, medications, etc. The well-woman things will obviously come easy to him, but I think he'll need help with the maintenance of general medical problems.


Do you guys have any suggestions for a relatively quick and easy reference book? Something that a poor resident like myself could afford to give him as a Christmas present?

The first one that I looked at was "5 Minute Clinical Consult." Do you guys have any feedback on that book?


Thanks a lot for your help.

SLUser
 

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I have a family friend who is retiring from OB/GYN due to stress, etc, and has gotten a new job as more of a general practitioner ....I think he'll need help with the maintenance of general medical problems.
Um...yeeeeeah.

Do you guys have any suggestions for a relatively quick and easy reference book?
He should start with this one: http://www.amazon.com/Physician-Pro...=sr_1_3?ie=UTF8&s=books&qid=1228445445&sr=1-3

He might also want to look up the definition of "retirement."

Edit: Sorry to be so blunt, but I have incredibly low regard for retired specialists who think they can dabble in primary care. It's every bit as insane as me thinking I could "retire" from family medicine and "just" practice OB-Gyn. If he had half a brain, he'd buy a set of golf clubs and be done with it.
 
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sophiejane

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"more of a general practitioner".....?

would it be okay for me to just remake myself as "more of a general surgeon" in retirement after doing toenails, mole removals, and the occasional c-section for X number of years.

Does that mean he's "more or less" doing primary care? I'm sure all those old and disabled people aren't going to have ANY complicated medical problems. And the ones they do, well, golly, he'll have a quick and easy reference book--what more does he need?!

And really, how many "well woman" exams is he going to be doing at the group home? Really? That will help him there about as much as his OB experience.

Merely handling "medications"...oh, that ought to be a breeze. A pharmacopoeia ought to be sufficient. How hard can it be to do refills for "general medical problems" ?

No offense, but I give him about 2 months at the new gig .

It's not okay to use old and disabled people as guinea pigs for a burned out OBGyn to dabble in primary care. How is that even legal???

To answer your question, 5 Minute Clinical Consult is designed for FPs and internists who have completed residency training or are in residency and need a REMINDER or an UPDATE, not a primer on how to "do" primary care.

The best gift you could give him if he's serious about this is an ERAS application and instructions on how to scramble for a FM or IM spot in the spring, so he can complete the appropriate training, get board certified, and then go knock himself out at the old folks home.
 
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SLUser11

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Um...yeeeeeah.



He should start with this one: http://www.amazon.com/Physician-Pro...=sr_1_3?ie=UTF8&s=books&qid=1228445445&sr=1-3

He might also want to look up the definition of "retirement."

Edit: Sorry to be so blunt, but I have incredibly low regard for retired specialists who think they can dabble in primary care. It's every bit as insane as me thinking I could "retire" from family medicine and "just" practice OB-Gyn. If he had half a brain, he'd buy a set of golf clubs and be done with it.
"more of a general practitioner".....?

would it be okay for me to just remake myself as "more of a general surgeon" in retirement after doing toenails, mole removals, and the occasional c-section for X number of years.

Does that mean he's "more or less" doing primary care? I'm sure all those old and disabled people aren't going to have ANY complicated medical problems. And the ones they do, well, golly, he'll have a quick and easy reference book--what more does he need?!

And really, how many "well woman" exams is he going to be doing at the group home? Really? That will help him there about as much as his OB experience.

Merely handling "medications"...oh, that ought to be a breeze. A pharmacopoeia ought to be sufficient. How hard can it be to do refills for "general medical problems" ?

No offense, but I give him about 2 months at the new gig .

It's not okay to use old and disabled people as guinea pigs for a burned out OBGyn to dabble in primary care. How is that even legal???

To answer your question, 5 Minute Clinical Consult is designed for FPs and internists who have completed residency training or are in residency and need a REMINDER or an UPDATE, not a primer on how to "do" primary care.

The best gift you could give him if he's serious about this is an ERAS application and instructions on how to scramble for a FM or IM spot in the spring, so he can complete the appropriate training, get board certified, and then go knock himself out at the old folks home.
I guess it was the wrong forum. I'm sorry you guys are so pissed about the way some specialists view your profession (not me or my friend, btw), but it doesn't change the fact that you don't have to be board certified in Family Medicine, etc. to do this specific job. If that was the case, you could all get your panties in a bunch regarding locum tenens or moonlighting work that many of us residents do.

He's filling a gap, in an undesirable role and location, treating an underserved population, where all of the other doctors are IMGs with strong language barriers, some of which haven't passed the boards yet. All you need to legally do this is a medical license, which he has. Keep turning your nose up, but I personally don't have a moral problem with what he's doing.


As for comparing it to general surgery, I don't think you could do my job, but I also don't think I could do your job. I respect the FP's contribution to medicine, which is why I thought some of you might have some useful suggestions. I guess I was wrong.
 

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OK, then...to more directly answer your question, I can't think of any reference book that will turn a retired OB-gyn into a competent primary care physician.

Maybe try asking in the OB-gyn forum?
 
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sophiejane

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All you need to legally do this is a medical license, which he has. Keep turning your nose up, but I personally don't have a moral problem with what he's doing.


As for comparing it to general surgery, I don't think you could do my job, but I also don't think I could do your job. I respect the FP's contribution to medicine, which is why I thought some of you might have some useful suggestions. I guess I was wrong.

So, you are saying at the same time, that all you need to do our job is a medical license and you don't see anything morally wrong with what your friend is doing, but that you couldn't do our job? Is this not a contradiction, or am I misunderstanding what you are saying?

It's okay for a retired ObGyn with a medical license to fill in for FPs, but you wouldn't be able to do it? What makes him more qualified than you?

I can also moonlight in EDs with my license. That doesn't mean I'd take a position doing it full time without having done an EM residency.
 

SLUser11

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OK, then...to more directly answer your question, I can't think of any reference book that will turn a retired OB-gyn into a competent primary care physician.

Maybe try asking in the OB-gyn forum?

I can't think of a reference that will replace 3 years of training, and yet I do locum tenens work to help fill a physician gap here in Kansas in my own time. Am I being a bad doctor because I provide primary care to our small-town-underserved-population? Do you think our real-time family physicians share your absolute disregard for other doctor's help? Or do you think that they want one to two days off in fourteen?


So, you are saying at the same time, that all you need to do our job is a medical license and you don't see anything morally wrong with what your friend is doing, but that you couldn't do our job? Is this not a contradiction, or am I misunderstanding what you are saying?

It's okay for a retired ObGyn with a medical license to fill in for FPs, but you wouldn't be able to do it? What makes him more qualified than you?

I can also moonlight in EDs with my license. That doesn't mean I'd take a position doing it full time without having done an EM residency.

First of all, your comment about FP physicians doing ER is a slippery slope. You're okay with doing some ER work, but not full-time ER work, without board certification. Whatever. Let's assume ER docs think you suck at their job as much as you think we suck at yours.

Secondly, it's not like my friend is stealing bread off your table. This job has been open for a long time, and plenty of worthy FPs have seen it and snubbed their nose. Now what? Should the patients continue without doctors? Do you have a better solution? I would like to hear it.......



This is not Family Practice. My friend is not laying out the doormat and drawing in random people to his new "hobby." He's a board-certified physician helping an underserved population, and I thought, with your enlightened view on world-medicine, that you'd appreciate his contribution.


We can argue about this all day. I've thought about it and have an informed opinion. Still, all I really want is a suggestion for a Christmas present. If you guys could get off your high horse and give a legitimate recommendation, I'd appreciate it......
 

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I think you understand, at least from what you've said, it seems you do...that what is disturbing is the notion that, as you presented it, a retired specialist from another field could just walk into a job--albeit, apparently one nobody else wants--and start doing what we trained 3 years to do, which is basically learn to manage 80-90% of medical problems involving ALL body systems--with a handy pocket reference and a license.

I guess he'd feel the same way about me delivering babies and doing sections, except that I am getting trained to do that in residency, and his residency training in medicine was umpteen years ago and probably consisted of a month or two on the wards.

Anyway, since we are in the holiday season and you asked for a gift.... here are my suggestions:

1. The Washington Manual for quick medical reference

2. Joining AAFP and getting online and print access to American Family Physician would yield a huge amount of helpful information, articles, etc.

3. Fitzpatrick's Clinical Dermatology--lots of rashes in primary care

4. As many CME conferences and lectures he can get in geriatrics and long-term care.

5. A friend/mentor in the field, either an internist, FP, or geriatrician who does regular nursing home work.
 

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Am I being a bad doctor because I provide primary care to our small-town-underserved-population?
Depends...are you practicing outside your scope of training and expertise? If you are, the chances of you winding up being a "bad doctor" at some point increase substantially.

Should the patients continue without doctors? Do you have a better solution? I would like to hear it.......
So would I. I do not believe that the best solution for the primary care crisis is to encourage unqualified or semi-qualified people to perform jobs that require broad-based knowledge and training that they simply don't possess, whether they're retired specialists, mid-levels, or naturopaths. The road to hell is paved with good intentions. I applaud your friend for wanting to help the underserved, but unless he's doing it in a free clinic, his motives aren't as saintly as you're trying to paint them, and neither are yours when you moonlight.

The best solution to the primary care crisis will likely necessitate that the government to take steps to ensure that those of us on the front lines of medicine are paid appropriately for the work that we do, and to provide incentives for more people to want to choose careers in primary care instead of so-called "lifestyle" specialties where doctors function more like technicians. That way, patients won't be forced to settle for poorly trained doctors or doctor substitutes.

I've thought about it and have an informed opinion.
So do I. The fact that our opinions are different does not automatically make mine wrong.

Still, all I really want is a suggestion for a Christmas present. If you guys could get off your high horse and give a legitimate recommendation, I'd appreciate it......
I'd go for one of these:

Current Diagnosis And Treatment in Family Medicine

Outpatient and Primary Care Medicine

Principles of Ambulatory Medicine

Better yet, access to the Internet, and a fat Rolodex of people to call when he needs help.

I'd still be curious how your question would play on the OB-gyn forum...
 
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Whew... yea, I agree with BlueDog & SophieJane on this one. It has nothing to do with being an FM Nazi, although that's the easiest argument to argue.

This population of patients is one of the hardest populations to manage, even for the residency-trained, board-certified PCP. If your friends' patients are anything like mine was during residency, it's like "adult pediatrics" or "human veterinarian" medicine with serious behavioral issues and occult medical ones. And the people who work in these situations whom your friend will be relying on aren't always the best, sharpest, or dedicated caretakers.

SLUser11, I think what you've run into here in this forum are people who, through training & experience, know what your friend is up against. We feel like we'd be in better position because we, through our broad training, have a foundation on how to take care of these people. Getting up-to-speed is easier with us.

With your friend... it's like literally starting over. Like from maybe 2nd year of FM residency... or even intern year.

It'd be, at best, *tolerable* if you provided episodic care (e.g. locum) to this population. But to be the medical director? And the ultimate person responsible? The person who comes up with protocols & policies? And the person that the newspaper & state government will nail and drag in public if there's an *appearance* of neglect or abuse?

I'd find books in the field of Geriatrics, Hospice, Psych, & PMR in addition to some of the Internal Medicine stuff that everyone has recommended. It's hard to say because of all the people who don't follow the textbook pathology?... yea, it's this patient population. A lot of the stuff your friend will see will fall under the "art" of medicine, which you get either from experience or mentorship. I'd also recommend that he go back and get his ACLS. He has a lot of literature to catch up on.

Like they say, malpractice is life's tuition.

I'd start with reading up the latest literature on the use of atypical antipsychotics in the elderly for aggression. I'd then read about wound care & nutrition.

Start here: http://www.aafp.org/afp/20060615/2175.html

Then figure out what the deficiencies are and cross-check here:
http://www.aafp.org/online/en/home/aboutus/specialty/rpsolutions/eduguide.html

The secret that all of us FM's know (and one that you'll soon find out) is that THERE IS NO ONE BOOK you can read that will prepare your friend for what lies ahead.
 

SLUser11

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Anyway, since we are in the holiday season and you asked for a gift.... here are my suggestions:

1. The Washington Manual for quick medical reference

2. Joining AAFP and getting online and print access to American Family Physician would yield a huge amount of helpful information, articles, etc.

3. Fitzpatrick's Clinical Dermatology--lots of rashes in primary care

4. As many CME conferences and lectures he can get in geriatrics and long-term care.

5. A friend/mentor in the field, either an internist, FP, or geriatrician who does regular nursing home work.
Thank you.


The best solution to the primary care crisis will likely necessitate that the government to take steps to ensure that those of us on the front lines of medicine are paid appropriately for the work that we do, and to provide incentives for more people to want to choose careers in primary care instead of so-called "lifestyle" specialties where doctors function more like technicians. That way, patients won't be forced to settle for poorly trained doctors or doctor substitutes.



I'd go for one of these:

Current Diagnosis And Treatment in Family Medicine

Outpatient and Primary Care Medicine

Principles of Ambulatory Medicine

Better yet, access to the Internet, and a fat Rolodex of people to call when he needs help.

I'd still be curious how your question would play on the OB-gyn forum...
I agree that the FPs are very much over-worked and underpaid. I don't think putting retired specialists in these positions is the best solution, but until your suggestions become a reality, there is still a huge gap. Specifically listening to him describe the facility's current doctors, he seems to be immediately one of the most-qualified guys, as bad as that sounds. While I'm aware of the tough road in front of him, I just don't have as big of a problem with it as you do.

I guess what he should do is learn as much as he can, and be very quick to defer problems to another facility when he's over his head. His facility does not have any IVs, so any acute problems that go beyond the basic lands the residents in a regular hospital.

As for the OB forum, I'm sure they believe FPs shouldn't be delivering babies, or at least they believe that FPs don't do it as well. We all have strong and biased opinions. That's why SDN is such a fun place to argue......


The secret that all of us FM's know (and one that you'll soon find out) is that THERE IS NO ONE BOOK you can read that will prepare your friend for what lies ahead.
I completely understand.
 

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To answer your question about 5 Minute Clinical Consult, I think it's an excellent resource. Superficial, obviously, but a good book to have handy to, like SophieJane said, remind you of things.

Find out if your friend already has an iPhone or Palm-phone or some other PDA. A good Christmas gift would be the electronic version of 5MCC. I have one (old, but good).

Another option is to purchase a subscription (1 year or whatever) of the Premium ePocrates Essentials for him. The premium comes with 5MCC but has more stuff too (like antibiotic guidelines, Symptom oriented). Check it out on epocrates.com.
 

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Better an ob/gyn than a NP, if you ask me. Just keep the practice of Medicine (as opposed to the practice of Nursing) to PHYSICIANS. ANY physician...Hell I would take a Pathologist or a Radiologist over a NP.
 

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Better an ob/gyn than a NP, if you ask me. Just keep the practice of Medicine (as opposed to the practice of Nursing) to PHYSICIANS. ANY physician...Hell I would take a Pathologist or a Radiologist over a NP.
Not I. I bet a group of practicing pathologists and radiologists would rather see a NP with primary care training than one of their colleagues. Not that I think either of them should be the mainstay of our healthcare system's primary care, but I think many of the posts in this forum are over reacting to the specific situation. As someone who helps out at an indigent clinic, we are happy for any volunteer help regardless of specialty. The key is making sure your pathologist, or OBGYN or NP or board certified FP knows when they are in over their head and they need help.
 

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I wish physicians in all specialties "man-up", get rid of their "com-ba-ya" mentality (or greed for some), and organize to protect their bread and butter from "outsiders", who are slowly but surly gaining more and more of what we do.

Lets face it, medicine and surgery are NOT "rocket science", and yes, ANYBODY can do it if he/she studied the protocols, and had hands-on experience. Technically you do not have to be a MD or DO to "practice medicine", and having a MD does not neccessarily make you a better practitioner/surgeon.....It is about THE M-O-N-E-Y, people. It is about protecting our bread and butter from OTHER professions (who already have their own bread/butter, and protecting it fiercly). It is about protecting our own business, and there is no shame in that. Their turf is getting bigger and bigger, and our turf (penis/titts) are getting smaller and smaller. Think of the furure generations who have to deal with this crap!

If I am patient, and had the choice between paying $500 for an Anesthesiologist vs. $200 for a CRNA with 20 years experience under her belt....I will go for the CRNA. Simple economics.

Screw "cum-ba-ya", and lets act like Wall-Street bulls (like THEY ARE DOING), and kick them TFO back to THEIR profession (which is a very noble proffession by it self).
 
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I think you guys are wrong. If you had said it was a Pathologist or Radiologist I would have agreed, but OB GYNs are already on the front lines and with a residency and years of experience I bet they could do a fair job managing most primary care probs. Many of the problems present in female and pregnant patients as well and have to be managed by the ObGyn.
 

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OB GYNs are already on the front lines and with a residency and years of experience I bet they could do a fair job managing most primary care probs.
Two things come to mind:

1. Do you really want someone doing a "fair" job of treating your health?

a. bad b. fair c. good d. excellent.

2. Which front lines are you referring to.

a. The part where they have to manage an MI
b. The part where they have to manage CHF
c. Wait they don't go to that front
or d. The only front I'm use to looking at is not the front you're use to looking at.

Sorry this is a trick question. The answer is c and d.
 
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