Challenges of working with underserved/rural populations

[casexyouxloose]

hi guys,
I recently got accepted to a school in a rural area with huge emphasis on serving underserved populations. I have few experiences working with underserved- tutoring underprivileged high school kids and working with health department to address nutrition needs of low income populations. However, I do not have any clinical experience that revolves around helping underserved. I loved the school but before I commit myself to anything I would like to know what challenges should I expect to face as a physician if I decide to work in a rural/underserved area.

does anyone have clinical experience working with underserved populations? if anyone does, can you please comment on if you liked/disliked it and how was it overall?

thanks =)

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[iWillOneDay]

hi guys,
I recently got accepted to a school in a rural area with huge emphasis on serving underserved populations. I have few experiences working with underserved- tutoring underprivileged high school kids and working with health department to address nutrition needs of low income populations. However, I do not have any clinical experience that revolves around helping underserved. I loved the school but before I commit myself to anything I would like to know what challenges should I expect to face as a physician if I decide to work in a rural/underserved area.

does anyone have clinical experience working with underserved populations? if anyone does, can you please comment on if you liked/disliked it and how was it overall?

thanks =)

This should be more appropriate on the Medical forum, just because there are more people there with experiences.

 

[Mad Jack]

The hardest things are:

They're poor. They often lack insurance. This means that they often cannot afford the care you would like to prescribe.

They're usually far from specialist care, so everything falls on you.

Poverty and lack of education tend to go hand in hand, so they often have difficulty understanding their disease process and treatment instructions.

 

[Bea5T]

I'll put it this way: Some people won't listen no matter how hard you try to educate them


Hard to save someone from themselves

 

[cabinbuilder]

I work exclusively with rural populations. Many times I am the ONLY PROVIDER they have ever seen or will ever see.
Some of my personal rules:
1. Expect that they cannot afford the medication your prescribe. I always give an antibiotic shot in the office so I know they got something until payday.
2. Even in urgent care I don't use the "only one complaint rule". I have found lots of bad things by listening to that elderly person with their "list". You would be surprised how many times item 5 or 6 has been a major issue. Had a lady one time list "purple feet" at item 5, she had gangrene and went to surgery that day. Be mindful of that.
3. Many people don't have running water or just the basics. Many times I have given showers in the clinic. Got food from the cafeteria. Ride vouchers or rides from local police, etc. due to cold, rain, or snow conditions.
4. Expect at least 5-10 dental/tooth pain/dental caries a week. If you can learn a dental nerve block you will be the hero - you tube will show you. Treat with clindamycin at any sign of facial swelling. Don't be stingy with pain medication for dental folks. These patients can get septic quickly. I filed down a broken tooth once with a diamond ronjour. I got a bunch of strange looks from staff but the patient left happy.

DO yourself a favor and LEARN all procedures you can and expect that folks will not or cannot get to a specialist unless they are going to die - and sometimes that doesn't even work. Learn to reduce fractures without conscious sedation or just with a pain shot/pill. Be able to cut out lesions, even on the face if you have to. Be able to splint and cast - you may be the only "ortho" around. Be able to read your own xrays and CT scans to at least know if you need to ship or hold for now. Be able to inject/drain any joint/bursa. Be able to do a good belly exam without a CT scan as you may not have one and know who is urgent and who can wait. Abdomen xray is great for determining constipation. Many times people say they are and the film is normal.

In the end, most rural folks live out in the sticks because they want to. Don't take it personally if they refuse treatment at a larger facility. Do what you can and be content with what you can offer. They appreciate you being there. It's ok for someone to tell you that they want to die at home. It is not a failure to let them. Hope that helps. I love what I do every single day.

 

[iWillOneDay]

I work exclusively with rural populations. Many times I am the ONLY PROVIDER they have ever seen or will ever see.
Some of my personal rules:
1. Expect that they cannot afford the medication your prescribe. I always give an antibiotic shot in the office so I know they got something until payday.
2. Even in urgent care I don't use the "only one complaint rule". I have found lots of bad things by listening to that elderly person with their "list". You would be surprised how many times item 5 or 6 has been a major issue. Had a lady one time list "purple feet" at item 5, she had gangrene and went to surgery that day. Be mindful of that.
3. Many people don't have running water or just the basics. Many times I have given showers in the clinic. Got food from the cafeteria. Ride vouchers or rides from local police, etc. due to cold, rain, or snow conditions.
4. Expect at least 5-10 dental/tooth pain/dental caries a week. If you can learn a dental nerve block you will be the hero - you tube will show you. Treat with clindamycin at any sign of facial swelling. Don't be stingy with pain medication for dental folks. These patients can get septic quickly. I filed down a broken tooth once with a diamond ronjour. I got a bunch of strange looks from staff but the patient left happy.

DO yourself a favor and LEARN all procedures you can and expect that folks will not or cannot get to a specialist unless they are going to die - an sometimes that doesn't even work. Learn to reduce fractures without conscious sedation or just with a pain shot/pill. be able to cut out lesions, even on the face if you have to. Be able to splint and cast - you may be the only "ortho" around. Be able to read your own xrays and CT scans to at least know if you need to ship or hold for now. Be able to inject/drain any joint/bursa. Be able to do a good belly exam without a CT scan as you may not have one and know who is urgent and who can wait. Abdomen xray is great for determining constipation. Many times people say they are and the film is normal.

In the end, most rural folks live out in the sticks because they want to. Don't take it personally if they refuse treatment at a larger facility. Do what you can and be content with what you can offer. They appreciate you being there. It's ok for someone to tell you that they want to die at home. It is not a failure to let them. Hope that helps. I love what I do every single day.

No offense to your expertise but should you be saying things like "Treat with clindamycin at any sign of facial swelling." on SDN?
Not only should you not tell people how to practice outside of clinical settings (or even in it) but you are generalizing every patient. Some people are allergic to Clinda...
Also, giving out pain medication, especially narcotic medications, like candy isn't a good practicing method either. Of course, dental pains are terrible and many require pain medications but that depends on individual's hx and etc.

 

[Doctor Bob]

No offense to your expertise

It reads in a very offensive and pejorative way...

but should you be saying things like "Treat with clindamycin at any sign of facial swelling." on SDN?

Sure. Why not? This isn't a medical reference website.

Not only should you not tell people how to practice outside of clinical settings (or even in it) but you are generalizing every patient.

When discussing treatment strategies, you have to generalize. And then through the ongoing practice of medicine, as well as the schooling process, we all learn to nuance the approach.

Some people are allergic to Clinda...

Woah.. wait.. what? That's a practice changer for me.

Also, giving out pain medication, especially narcotic medications, like candy isn't a good practicing method either.

Going from "don't be stingy with pain medication" to "giving out pain medication ... like candy" is reading too much into what was said.

Of course, dental pains are terrible and many require pain medications but that depends on individual's hx and etc.

Oh goodness... don't lecture an attending physician on how to treat patients.

 

[iWillOneDay]

It reads in a very offensive and pejorative way...



Sure. Why not? This isn't a medical reference website.



When discussing treatment strategies, you have to generalize. And then through the ongoing practice of medicine, as well as the schooling process, we all learn to nuance the approach.



Woah.. wait.. what? That's a practice changer for me.



Going from "don't be stingy with pain medication" to "giving out pain medication ... like candy" is reading too much into what was said.



Oh goodness... don't lecture an attending physician on how to treat patients.

[/QUOTE]

Sometimes, I questions the authenticity of those on here.
I mean, can't anyone technically choose the status to be anything?

If responding the way you did makes you happy, good for you.
And no, you should not generalize. Didn't you learn that every patient is different when you attended medical school? If you didn't, maybe you should go back???
And yes, I have no medical degree to tell someone anything about medicine.
But I know enough to know what is wrong and right.
Just because you may be a physician doesn't mean you can't do something wrong. There is no authority in medicine (well, there shouldn't be).

 

[AlteredScale]

No offense to your expertise but should you be saying things like "Treat with clindamycin at any sign of facial swelling." on SDN?
Not only should you not tell people how to practice outside of clinical settings (or even in it) but you are generalizing every patient. Some people are allergic to Clinda...
Also, giving out pain medication, especially narcotic medications, like candy isn't a good practicing method either. Of course, dental pains are terrible and many require pain medications but that depends on individual's hx and etc.

I really wish this was one of your joking posts. This is a physician with years of rural experience who is providing general tips to those who will be working with rural populations.

And you have the audacity to try one-up her clinical knowledge and question her authenticity because she gave "poor clinical" tips according to your vast and wide mastery of medicine?


You haven't even started med school and you're correcting physicians...

 

[iWillOneDay]

I really wish this was one of your joking posts. This is a physician with years of rural experience who is providing general tips to those who will be working with rural populations.

And you have the audacity to try one-up his clinical knowledge and question his authenticity because he gave "poor clinical" tips according to your vast and wide mastery of medicine?


You haven't even started med school and you're correcting physicians...

Are people who protested for the Ferguson shooting incident cops?
Were they cops and had all the knowledge before going out and trying to fix what is wrong?

Do you need at math degree to correct a math teacher who says 1+1 is 3?

Are judges so perfect that they never send an innocent person on a death row.
Doctors are so perfect to never misdiagnose?

This is the problem in current society. People are so afraid to speak up just because someone "higher" says something to you.
I'll stick to my way and you keep sucking up to people.

 

[Goro]

They'll smoke more, be fatter and sicker, and are less likely to have health insurance.

hi guys,
I recently got accepted to a school in a rural area with huge emphasis on serving underserved populations. I have few experiences working with underserved- tutoring underprivileged high school kids and working with health department to address nutrition needs of low income populations. However, I do not have any clinical experience that revolves around helping underserved. I loved the school but before I commit myself to anything I would like to know what challenges should I expect to face as a physician if I decide to work in a rural/underserved area.

does anyone have clinical experience working with underserved populations? if anyone does, can you please comment on if you liked/disliked it and how was it overall?

Not healthy to have such a condescending attitude towards people who might be your future patients, either.

This happens in extremely wealthy communities as well. Witness the strength of the anti-vax crowd...highest in blue states, and lowest in red states.

I'll put it this way: Some people won't listen no matter how hard you try to educate them
Hard to save someone from themselves

I just love it when pre-meds give clinicians advice of how to practice Medicine!

No offense to your expertise but should you be saying things like "Treat with clindamycin at any sign of facial swelling." on SDN?
Not only should you not tell people how to practice outside of clinical settings (or even in it) but you are generalizing every patient. Some people are allergic to Clinda...
Also, giving out pain medication, especially narcotic medications, like candy isn't a good practicing method either. Of course, dental pains are terrible and many require pain medications but that depends on individual's hx and etc.

And people who actually know something will have to keep slapping down the ignorant who feel they have open their mouths to correct perceived injustices.

This is the problem in current society. People are so afraid to speak up just because someone "higher" says something to you.
I'll stick to my way and you keep sucking up to people.

 

[Mad Jack]

Sometimes, I questions the authenticity of those on here.
I mean, can't anyone technically choose the status to be anything?

If responding the way you did makes you happy, good for you.
And no, you should not generalize. Didn't you learn that every patient is different when you attended medical school? If you didn't, maybe you should go back???
And yes, I have no medical degree to tell someone anything about medicine.
But I know enough to know what is wrong and right.
Just because you may be a physician doesn't mean you can't do something wrong. There is no authority in medicine (well, there shouldn't be).

I really love when premeds tell physicians, attendings, and faculty members how they should or shouldn't be practicing medicine. It is a failure on so many levels as to be sublime.

 

[iWillOneDay]

Uh huh... you keep saying that.

and I know for a fact that when you guys go to interviews and get asked ethical questions that involves a provider doing something unethical or wrong, you guys say "of course, I would report it."

 

[VanEman]

I'm sure every rural area is a little different, but I can tell you what I've seen as a clinical volunteer in a hospital that serves both rural and city underserved populations. More often than you'd like, the emergency room serves as "primary care." It's hard for people to come long distances and wait for a long time, so they won't unless it's an emergency. Before Obamacare, there was a long, long wait to get a doctor's appointment because there just aren't enough doctors, now that everyone has insurance it's an even longer wait. If you're treating someone from the city at your hospital, dollars to donuts you'll get to meet some family members and know what kind of care the patient will get when they're home. Rural patients may not get visitors or family visits---it's hard for people who care to come. On the plus side, I've seen that successful care providers to rural areas rarely subscribe to the typical medical "hierarchy." They promote, partner with, coach and learn from RN's, PA's, social workers, community health clinics and from what I've seen are amazingly resourceful. They also keep their sense of humor, and are able to laugh out loud when some physician from the "big city" says they're coming to our rural area for a "rest in the country." I'd say rural medicine would be a great match for someone who needs to be needed, is particularly flexible and creative, willing to be more of a generalist than an urban doctor might, and is excellent at partnering.

 

[Mad Jack]

Uh huh... you keep saying that.

and I know for a fact that when you guys go to interviews and get asked ethical questions that involves a provider doing something unethical or wrong, you guys say "of course, I would report it."

I find your lack of experience... Disturbing.

 

[iWillOneDay]

I find your lack of experience... Disturbing.

I find your God complex disturbing.

 

[deleted480308]

Uh huh... you keep saying that.

and I know for a fact that when you guys go to interviews and get asked ethical questions that involves a provider doing something unethical or wrong, you guys say "of course, I would report it."

cabin is one of the senior forum members, particularly in rural fm...just trust her

 

[yankees527]

@iWillOneDay From your posts ive noticed youve been kind of condescending and rude to others. Its just someone giving their advice from experience, so please dont be "that pre med" that trys to be a doctor before they are one

 

[Mad Jack]

I find your God complex disturbing.

I know enough to know that I know damn-near nothing, and I'm a freakin' medical student that was working in healthcare while you were likely getting drunk at your junior prom. I'm not the one running around telling experienced attending physicians how to practice medicine when I don't even have a bachelor's degree.

This is all irrelevant to the thread. The point is, cabinbuilder's post was a solid look into rural practice and you shouldn't be discrediting it when you've got zero hours in the trenches that are the backwoods of America.

 

[cabinbuilder]

cabin is one of the senior forum members, particularly in rural fm...just trust her

Thanks. Only on SDN can an innocent, trying to be helpful generalized reply be turned into something sick and twisted. I know that I give good care in some of the most challenging locations. Medicine is an art and I agree that generalizing may be too simple a concept for some pre-meds out there. There is no absolute and no case fits every textbook.

 

[Yoda DO]

@cabinbuilder
I will be starting at KCOM next Fall and I am really interested in rural medicine. How effective are the rural track residencies at training rural physicians versus a regular FM track? Do you think a rural practice residency will provide the unique training you are talking about?

For the record, I am totally OK with generalizations and medical advice.

 

[cabinbuilder]

@cabinbuilder
I will be starting at KCOM next Fall and I am really interested in rural medicine. How effective are the rural track residencies at training rural physicians versus a regular FM track? Do you think a rural practice residency will provide the unique training you are talking about?

For the record, I am totally OK with generalizations and medical advice.

Honestly, residency is what you make of it and how aggressive you are about learning things. No one is going to bend over backwards to teach someone who doesn't want to be taught. I did a regular FM residency but I knew that I was going to work rural so I sought out rotations with attendings who I knew would let me be hands on and teach me what I needed. A lot of the "rural track" deal with c-Sections, scopes, etc. Honestly in a lot of places you may or may not get privileges. You may not have staff to even have an running OR there. I looked at the practical and learned what I could do by myself in the woods. I learned scopes in residency and never did them again - didn't have time. I don't do OB or prenatal and that has not been an issue for me. I learned central lines but haven't done one in 8 years. You will have to look at what their rural track emphasizes and how practical in real life it will help you.

 

[AlteredScale]

Do you need at math degree to correct a math teacher who says 1+1 is 3?

In the sense of medicine: you're not even in school and you don't even know what the numbers mean.

Its arrogant and disrespectful.

 

[Doctor Bob]

Sometimes, I questions the authenticity of those on here.
I mean, can't anyone technically choose the status to be anything?

That's true. It's just a faceless internet website.

If responding the way you did makes you happy, good for you.

It did actually.

And no, you should not generalize. Didn't you learn that every patient is different when you attended medical school? If you didn't, maybe you should go back???

You're right. I should go back to school to learn that every patient is a unique and beautiful snowflake with their own hopes and dreams. Thanks for the career advice.

And yes, I have no medical degree to tell someone anything about medicine.

Clearly

But I know enough to know what is wrong and right.

There is no evidence to support this claim as of yet.

 

[midweststudent1]

Thanks. Only on SDN can an innocent, trying to be helpful generalized reply be turned into something sick and twisted. I know that I give good care in some of the most challenging locations. Medicine is an art and I agree that generalizing may be too simple a concept for some pre-meds out there. There is no absolute and no case fits every textbook.

I've read probably hundreds of your posts and have learned a lot from you over the past year. Thanks for all your contributions to SDN, it really does teach some people like me, who are early enough in medical school, a lot of valuable things to think about as we approach picking a residency/specialty

 

[GUH]

Where I am, "underserved" is often synonymous with "Hispanic uninsured" or "drug abuser". This is not a rural area.

The main challenges I've seen in my limited clinical experiences here are language barriers, poor follow-up, and very little will/ability to change behaviors.

 

[premed2113]

This should be more appropriate on the Medical forum, just because there are more people there with experiences.

You should have taken the advice you gave at the beginning of this thread. You have no experience with this, therefore you cannot refute any of the advice that has been given in this thread.

 

[docmartin99]

Honestly, I just want to say thank you to physicians that will come on a board such as this and give advice. Learn all the procedures you can, for example, great advice - thanks.

 

[cliquesh]

From my experience, rural patients are typically polite and thankful. They are, in general, a pleasure to work with. Inner city underserved populations are the exact opposite.

 

[hallowmann]

Is it weird that this thread is making me seriously consider rural medicine again?

I know enough to know that I know damn-near nothing, and I'm a freakin' medical student that was working in healthcare while you were likely getting drunk at your junior prom. I'm not the one running around telling experienced attending physicians how to practice medicine when I don't even have a bachelor's degree.

This is all irrelevant to the thread. The point is, cabinbuilder's post was a solid look into rural practice and you shouldn't be discrediting it when you've got zero hours in the trenches that are the backwoods of America.

This. If you think you know enough to "know what's right and wrong" in medicine and tell a physician when they're giving bad medical advice, something is wrong. I'm practically halfway through med school and not only did I see nothing wrong with cabinbuilder's advice, even if I did, I'd chalk it up to the fact that I know next to nothing compared to a resident let alone an attending when it comes to real medical care.

Also, medical care is built on generalizations. As much as we like to think its completely patient centered/catered, all that means is that we are slightly modifying our generalizations (i.e. slight changes to A, B, and C treatments for the patients that present with X, Y, and Z).

 

[Yoda DO]

@hallowmann
Do it! I'm just a premed, but I have worked in a rural medical environment for >3 years. I think it is awesome, you might have a farmer bring in a couple of his fingers in a plastic bag. The best part is he waits patiently to see the triage nurse, while the drug seeker won't stop complaining. While doing the history you find out the farmer has no primary and has had some problems with frequent urination. This eventually results in the discovery of an A1C of 13, which correlates to a blood sugar level of 320ish mg/dL over 2-3 months. Also, it turns out the farmer doesn't really care about his fingers and just wants to be "patched up." After picking out the random bits of whatever from his wounds the farmer is "patched up" and informed of his probable diabetes. The farmer politely says thanks, but I'm just here for my fingers. You make at least one more attempt to talk about diabetes, however the farmer is happy with his biscuits covered in chocolate gravy and has ZERO desire to change. If his wife had been with him, you might of had a shot.😉 Once the awesome farmer leaves you go back to the drug seeker that "knows" exactly what pain meds will and will not work for them. A few weeks later you see the farmer and his wife at Walmart, he waves a 3 fingered hand and you notice the cart filled with biscuits, whole milk, bacon, etc. You smile and imagine a very narrow left anterior descending artery.

@cabinbuilder
I grew up in a town of 300(yep, just two zeros). When somebody said that were going to the Doctor, the really meant THE Doctor, as in just one of them. I can't speak for the rest of the world, but in my community, physicians are highly regarded. They are treated with respect, have a relatively high level of autonomy, and have relationships with patients that you just can't have in a non-rural setting. I am probably biased, but I think rural medicine is amazing and hats off to those of you who pursue it.

 

[cabinbuilder]

@hallowmann
Do it! I'm just a premed, but I have worked in a rural medical environment for >3 years. I think it is awesome, you might have a farmer bring in a couple of his fingers in a plastic bag. The best part is he waits patiently to see the triage nurse, while the drug seeker won't stop complaining. While doing the history you find out the farmer has no primary and has had some problems with frequent urination. This eventually results in the discovery of an A1C of 13, which correlates to a blood sugar level of 320ish mg/dL over 2-3 months. Also, it turns out the farmer doesn't really care about his fingers and just wants to be "patched up." After picking out the random bits of whatever from his wounds the farmer is "patched up" and informed of his probable diabetes. The farmer politely says thanks, but I'm just here for my fingers. You make at least one more attempt to talk about diabetes, however the farmer is happy with his biscuits covered in chocolate gravy and has ZERO desire to change. If his wife had been with him, you might of had a shot.😉 Once the awesome farmer leaves you go back to the drug seeker that "knows" exactly what pain meds will and will not work for them. A few weeks later you see the farmer and his wife at Walmart, he waves a 3 fingered hand and you notice the cart filled with biscuits, whole milk, bacon, etc. You smile and imagine a very narrow left anterior descending artery.

@cabinbuilder
I grew up in a town of 300(yep, just two zeros). When somebody said that were going to the Doctor, the really meant THE Doctor, as in just one of them. I can't speak for the rest of the world, but in my community, physicians are highly regarded. They are treated with respect, have a relatively high level of autonomy, and have relationships with patients that you just can't have in a non-rural setting. I am probably biased, but I think rural medicine is amazing and hats off to those of you who pursue it.

Just awesome. I totally relate. I understand = I grew up in a town 500 (yep, just two zeros) too. In the middle of Alaska. I get it. I love it. Rural people are just amazing.

Just like the 80 y/o guy with no PCP, on no meds, I see in urgent care for rectal bleeding. Wants me to "patch him up". Has to be convinced to see the general surgeon for a scope to find out why. H/H was good. Guaiac Positive. Looked fine. He f/u for scope. All was good.

 

[AM508]

Good to see there are a few small town folks here. I grew up in a community with 600 people, myself. I am really excited about rural medicine. After spending a career as a paramedic in a rural area, now I have the opportunity to attend medical school. Thank you for the great information @cabinbuilder .

 

[Shinobiz11]

@iWillOneDay
Please don't get banned, you are so entertaining.

Thanks for the input @cabinbuilder . I love when ACTUAL physicians offer insight into these discussions.

 

[deleted407021]

Congratulations on the acceptance!

I'll probably be rehashing some stuff that's already been said, but here you go.
Underserved populations are underserved for a reason. Usually, that's because - among other things - they fall somewhere under the poverty line and have a lot of trouble securing even basic care. Expect more people on charity and Medicare/Medicaid than on insurance, though that is changing a bit with PPACA. Especially with charities such as free clinics, there are limitations to what can be done. Often, only basic primary care can be established: diabetes management, HTN control, COPD treatment, sometimes epilepsy management and lab work, along withother low cost medical care. Often, people with more complex conditions - even disabling ones like carpel tunnel syndrome - have to be turned away because the limited resources have to be allocated in such a way as to benefit as many as possible.

In my experience working with impoverished patients, compliance has been a consistent problem. This may be an issue with all populations, but toucan definitely expect people to skip critical labs, miss appointments and not take their meds properly, or at all.

Many of these economically disadvantaged individuals are poorly educated and a few may be intellectually disabled. It is often a challenge getting them to understand their conditions, treatments, lifestyle issues and the importance or urgency of the care they are receiving.

Most of these people are very sweet, genuine and concerned patients who try to do their best in working with the providers to get the best possible care. Thankfully, in my experience, these are the majority.

 

[iWillOneDay]

I am going to post one more time and call it done with SDN. Apparently, I'm not welcomed here.
First of all, I like to thank many people on SDN, whether they are actually who they say they are or not. You have all helped me during my pre-med years and hopefully I can help others in the future myself. Especially @Goro since you basically live on SDN giving out advice and sometimes criticism/sarcasms that levels Dr. Gregory House.
I learned about about medical schools and the process it takes to become a physician through you people. I also have read hundreds, if not thousands of your posts in past few years and they helped tremendously. And thank you @cabinbuilder for changing clindamycin to abx. I would not have any problem with it if that was the original.

And please read the following with an open mind (if you are going to read it at all) and don't just think "Oh it's that IWillOneDay again. Let's see what more stupid things he is going to say."

Of course I lack experience (if I have any at all) and yes, I do not have a medical degree. I haven't even got accepted anywhere yet...
However, I'd like to think that I, like many of you, know one thing or two about medicine. Again, I don't intend to offend anyone but if you get offended, I don't really care...

1) Generalizing and why it can be "bad"
From my experiences, the happiest and most satisfied patients were those who physicians actually sat down to talk to them. Listening to their problems and giving personalized care. Sometimes, that is almost impractical. The least happy and least satisfied patients were those who physicians saw for 5 minutes and just wrote prescriptions or referred them to someone else because they have a common symptom or something. I'm not saying you should take everyone into consideration when posting on forum like this but isn't saying "everyone take medication A for symptom A" a bit 'wrong'?
Am I the only one thinking this? Maybe I am.
Why do we take histories on patients? That because everyone is unique and different, which is part of the osteopathic philosophy we love so much and endure.
(This is kinda unrelated but Bill Maher and Sam Harris has been on news recently because they said something along the lines of "all Muslims are bad." They generalized the entire population of 1.5 billion muslims because of a small group's actions.)
I'm not saying I don't get your points about having to generalize or whatever but I just want you all to see how generalizing can be bad.

2) That pre-med who thinks he is a physician already
-I don't think I'm a physician (Actually, I know I'm not and I think we all know I'm not. I haven't even got accepted anywhere yet...) but just because I don't have a medical degree doesn't mean I can't ever correct a physician or whoever.
Let me give some examples:
When you watch an NFL game and see a quarterback throw a pass to a receiver A but receiver A can't catch it, don't you sometime curse or yell saying how easy the throw was to catch or how easy it was to throw the ball to receiver A? Don't you sometime watch youtube videos and comment saying "he should have caught that" or "He should have turned left"? (Maybe you don't... I know I do.)
Now, are all of you professional football players? Do you have a degree in NFL to make such comments and criticize professional athlete? I highly doubt it but almost (if not all) do it from time to time.
-When the president send our troops into unnecessary wars or sign a bill that seem stupid to us, don't you sometime criticize the president and other politicians? But do you have a degree in political science or warfare to make those claims?
We all do this. We all are not experts in certain areas but criticize those who are.

My point is, just because someone is an expert in something doesn't mean their actions are always correct, perfect, or do not have things to learn from the "newbies."
And just because you are a "newbie" doesn't mean you should stay quiet and follow what the "higher" people say. Are we in North Korea or Cuba or something?
Just because doctors have a medical degree doesn't mean they can't learn a thing or two from a pre-med student (or even a homeless person, no offense to homeless people). Are doctors gods? What is up with all the god complex on this forum?
Are all school admission staff or faculty correct in their judgement and choices? (I hope so but I doubt it.)
If I became a physician, I would welcome feedbacks from patients, other members of the medical team, students, and others. Why do we fill out those evaluation forms at end of semesters? If you think you know it all because you became an expert in something, you are make a big mistake.
Just because you are older doesn't mean you can't learn something from a younger person.
Just because you are a physician doesn't mean you can't learn something from a pre-med student.

Of course, I get it. I get that it may be annoying, seem disrespectful, and/or w/e hearing things from people with less experience and less knowledge. I do myself from time to time also. And I apologize if that's how you took my original message. I'm not trying to tell you how to practice, but pointing out the problems I see. I'm not great with words (obviously). Stop saying "stop questioning attendings" and stand up for what you think is right. Because sometimes (not all the time) you may actually be right.

I just want people to question things and not accept everything that they are told or see. Sometimes, it will be annoying and bothersome, but it's the best way we can correct wrong things and improve.

Isn't over prescribing abx a problem in medicine currently?
Isn't over prescribing pain medication a huge problem currently in medicine? Isn't death by overdose on prescribed medication a big issue?
Isn't giving medical advise online a taboo?
Aren't there unethical doctors who commit crimes?
Even Albert Einstein got things wrong...

You guys are welcomed to ridicule me all you want just as I have all the right in the word to say what I want (unless it's against the law somehow or threatening or something).
I don't know everything and I am not trying to say I do (whether you take it that way or not it your problem), but I will say what I think it's right (whether you think so or not and whether it is actually right or not).
Maybe I'm too liberal for you guys...



Goodbye SDN. I had a blast.
I don't expect to change anyone's mind but could at least one person understand where I am coming from???
I'll leave all of you with this clip of one of my favorite experts in the world. Medicine is also science.

 

[Goro]

And cue the Billy Joel!



Fave line: "I once believed in causes too; I had my pointless point of view".

Billy Joel grew up not far from where I grew up.

I am going to post one more time and call it done with SDN. Apparently, I'm not welcomed here.
First of all, I like to thank many people on SDN, whether they are actually who they say they are or not. You have all helped me during my pre-med years and hopefully I can help others in the future myself. Especially @Goro since you basically live on SDN giving out advice and sometimes criticism/sarcasms that levels Dr. Gregory House.
I learned about about medical schools and the process it takes to become a physician through you people. I also have read hundreds, if not thousands of your posts in past few years and they helped tremendously. And thank you @cabinbuilder for changing clindamycin to abx. I would not have any problem with it if that was the original.

And please read the following with an open mind (if you are going to read it at all) and don't just think "Oh it's that IWillOneDay again. Let's see what more stupid things he is going to say."

Of course I lack experience (if I have any at all) and yes, I do not have a medical degree. I have even got accepted anywhere yet...
However, I'd like to think that I, like many of you, know one thing or two about medicine. Again, I don't intend to offend anyone but if you get offended, I don't really care...

1) Generalizing and why it can be "bad"
From my experiences, the happiest and most satisfied patients were those who physicians actually sat down to talk to them. Listening to their problems and giving personalized care. Sometimes, that is almost impractical. The least happy and least satisfied patients were those who physicians saw for 5 minutes and just wrote prescriptions or referred them to someone else because they have a common symptom or something. I'm not saying you should take everyone into consideration when posting on forum like this but isn't saying "everyone take medication A for symptom A" a bit 'wrong'?
Am I the only one thinking this? Maybe I am.
Why do we take histories on patients? That because everyone is unique and different, which is part of the osteopathic philosophy we love so much and endure.
(This is kinda unrelated but Bill Maher and Sam Harris has been on news recently because they said something along the lines of "all Muslims are bad." They generalized the entire population of 1.5 billion muslims because of a small group's actions.)
I'm not saying I don't get your points about having to generalize or whatever but I just want you all to see how generalizing can be bad.

2) That pre-med who thinks he is a physician already
-I don't think I'm a physician (Actually, I know I'm not and I think we all know I'm not. I haven't even got accepted anywhere yet...) but just because I don't have a medical degree doesn't mean I can't ever correct a physician or whoever.
Let me give some examples:
When you watch an NFL game and see a quarterback throw a pass to a receiver A but receiver A can't catch it, don't you sometime curse or yell saying how easy the throw was to catch or how easy it was to throw the ball to receiver A? Don't you sometime watch youtube videos and comment saying "he should have caught that" or "He should have turned left"? (Maybe you don't... I know I do.)
Now, are all of you professional football players? Do you have a degree in NFL to make such comments and criticize professional athlete? I highly doubt it but almost (if not all) do it from time to time.
-When the president send our troops into unnecessary wars or sign a bill that seem stupid to us, don't you sometime criticize the president and other politicians? But do you have a degree in political science or warfare to make those claims?
We all do this. We all are not experts in certain areas but criticize those who are.

My point is, just because someone is an expert in something doesn't mean their actions are always correct, perfect, or do not have things to learn from the "newbies."
And just because you are a "newbie" doesn't mean you should stay quiet and follow what the "higher" people say. Are we in North Korea or Cuba or something?
Just because doctors have a medical degree doesn't mean they can't learn a thing or two from a pre-med student (or even a homeless person, no offense to homeless people). Are doctors gods? What is up with all the god complex on this forum?
Are all school admission staff or faculty correct in their judgement and choices? (I hope so but I doubt it.)
If I became a physician, I would welcome feedbacks from patients, other members of the medical team, students, and others. Why do we fill out those evaluation forms at end of semesters? If you think you know it all because you became an expert in something, you are make a big mistake.
Just because you are older doesn't mean you can't learn something from a younger person.
Just because you are a physician doesn't mean you can't learn something from a pre-med student.

Of course, I get it. I get that it may be annoying, seem disrespectful, and/or w/e hearing things from people with less experience and less knowledge. I do myself from time to time also. And I apologize if that's how you took my original message. I'm not trying to tell you how to practice, but pointing out the problems I see. I'm not great with words (obviously). Stop saying "stop questioning attendings" and stand up for what you think is right. Because sometimes (not all the time) you may actually be right.

I just want people to question things and not accept everything that they are told or see. Sometimes, it will be annoying and bothersome, but it's the best way we can correct wrong things and improve.

Isn't over prescribing abx a problem in medicine currently?
Isn't over prescribing pain medication a huge problem currently in medicine? Isn't death by overdose on prescribed medication a big issue?
Isn't giving medical advise online a taboo?
Aren't there unethical doctors who commit crimes?
Even Albert Einstein got things wrong...

You guys are welcomed to ridicule me all you want just as I have all the right in the word to say what I want (unless it's against the law somehow or threatening or something).
I don't know everything and I am not trying to say I do (whether you take it that way or not it your problem), but I will say what I think it's right (whether you think so or not and whether it is actually right or not).
Maybe I'm too liberal for you guys...



Goodbye SDN. I had a blast.
I don't expect to change anyone's mind but could at least one person understand where I am coming from???
I'll leave all of you with this clip of one of my favorite experts in the world. Medicine is also science.

 

[iWillOneDay]

And cue the Billy Joel!:



Fave line: "I once believed in causes too; I had my pointless point of view".

Billy Joel grew up not far from where I grew up.

Sorry, this is my last post:

Cool song bro.
This is mine:

 

[AlteredScale]

Sorry, this is my last post:

Cool song bro.

It's just amazing that you had to basically shake this thread to pieces because you just couldn't deal with the fact that @cabinbuilder used a specific ABX instead of stating "abx". Let's note that 1) this is a pre-medical forum, so most of us don't even know what that drug specifically does and 2) most medical students and physicians reading this thread understand the fact that she was generalizing. No one is consulting their management plans over SDN.

Also for the question regarding if anyone can simply state they are a physician (you've obviously found that out since your status says "attending physician"), there is a verification process to confirm authenticity: https://help.studentdoctor.net/entries/465337-doctor-verification

 

[casexyouxloose]

I work exclusively with rural populations. Many times I am the ONLY PROVIDER they have ever seen or will ever see.
Some of my personal rules:
1. Expect that they cannot afford the medication your prescribe. I always give an antibiotic shot in the office so I know they got something until payday.
2. Even in urgent care I don't use the "only one complaint rule". I have found lots of bad things by listening to that elderly person with their "list". You would be surprised how many times item 5 or 6 has been a major issue. Had a lady one time list "purple feet" at item 5, she had gangrene and went to surgery that day. Be mindful of that.
3. Many people don't have running water or just the basics. Many times I have given showers in the clinic. Got food from the cafeteria. Ride vouchers or rides from local police, etc. due to cold, rain, or snow conditions.
4. Expect at least 5-10 dental/tooth pain/dental caries a week. If you can learn a dental nerve block you will be the hero - you tube will show you. Treat with antibiotics at any sign of facial swelling. Don't be stingy with pain medication for dental folks. These patients can get septic quickly. I filed down a broken tooth once with a diamond ronjour. I got a bunch of strange looks from staff but the patient left happy.

DO yourself a favor and LEARN all procedures you can and expect that folks will not or cannot get to a specialist unless they are going to die - an sometimes that doesn't even work. Learn to reduce fractures without conscious sedation or just with a pain shot/pill. be able to cut out lesions, even on the face if you have to. Be able to splint and cast - you may be the only "ortho" around. Be able to read your own xrays and CT scans to at least know if you need to ship or hold for now. Be able to inject/drain any joint/bursa. Be able to do a good belly exam without a CT scan as you may not have one and know who is urgent and who can wait. Abdomen xray is great for determining constipation. Many times people say they are and the film is normal.

In the end, most rural folks live out in the sticks because they want to. Don't take it personally if they refuse treatment at a larger facility. Do what you can and be content with what you can offer. They appreciate you being there. It's ok for someone to tell you that they want to die at home. It is not a failure to let them. Hope that helps. I love what I do every single day.

thank you for your insightful response. This is very informative and I am seriously considering working in an underserved area because it sounds like so much fun, I love small communities where I can know my patients at a personal level and see them everyday at grocery stores, restaurants, movies, etc. Physicians working in rural areas have to be creative to deliver quality healthcare with limited resources. I will definitely keep all this in mind during med school. I apologize on behalf of iWillOneDay.

 

[cabinbuilder]

thank you for your insightful response. This is very informative and I am seriously considering working in an underserved area because it sounds like so much fun, I love small communities where I can know my patients at a personal level and see them everyday at grocery stores, restaurants, movies, etc. Physicians working in rural areas have to be creative to deliver quality healthcare with limited resources. I will definitely keep all this in mind during med school. I apologize on behalf of iWillOneDay.

Never apologize for some idiot you cannot control. Ignorance is not taught. Just like the guy in my med school class who tried to convince me that Alaska is an island. Really? I laugh and move on because in some instances I'm just that right. HA. Keep on keepin' on.

BTW, Clinda is the drug of choice for dental issues. True some folks are allergic, but they are few. Consult your Sanford guide or Uptodate in that circumstance.

 

[W19]

I don't get it... @iWillOneDay keeps saying that he/she is not a physician, yet his/her status says 'attending physician'.

 

[ciestar]

Never apologize for some idiot you cannot control. Ignorance is not taught. Just like the guy in my me school class who tried to convince me that Alaska is an island. Really? I laugh and move on because in some instances I'm just that right. HA. Keep on keepin' on.

BTW, Clinda is the drug of choice for dental issues. True some folks are allergic, but they are few. Consult your Sanford guide or Uptodate in that circumstance.

While working as a pharmacy tech, I've definitely noticed the trends with dentists prescribing clindamycin. Another common one seems to be Keflex, have you noticed that at all in your practice?

 

[67552931811]

I don't get it... @iWillOneDay keeps saying that he/she is not a physician, yet his/her status says 'attending physician'.

Bro isn't.

 

[cabinbuilder]

While working as a pharmacy tech, I've definitely noticed the trends with dentists prescribing clindamycin. Another common one seems to be Keflex, have you noticed that at all in your practice?

Keflex is used against MRSA. I like bactrim as that is what I learned to use. Keflex is not a sulfa based but is 4x a day. Bactrim is sulfa but only 2x a day. Pick what is easier that won't give an allergic reaction.

 

[ciestar]

Keflex is used against MRSA. I like bactrim as that is what I learned to use. Keflex is not a sulfa based but is 4x a day. Bactrim is sulfa but only 2x a day. Pick what is easier that won't give an allergic reaction.

Do you also use bactrim most in the treatment of UTIs? That and cipro seem to be the favorites, at least the prescribing docs near me.
(A lot of people seem to have sulfa allergies too)

 

[hallowmann]

Again, no one said not to listen to and interact with your patient and cater care, but whether you want to accept it or not generalizations exist in medical treatment (and they exist for a reason). Somebody has X condition, you give them Y drug, you run Z tests to verify/differentiate. Again, you might modify it slightly, "oh patient has a sulfa allergy", "oh patient can't afford x drug", "oh patient has x, y, z comorbidities". Obviously you'll take these into account, but you're fooling yourself if you think there isn't already some level of established care associated with each condition. That is part of medicine. The bread and butter is still bread and butter.

Also, it wasn't that people were scared to challenge authority, its that there was nothing to challenge. This very helpful physician was laying out her strategies and what she does, and how she has to improvise in the rural setting (you know, she was answering the question). Rather than look at it for what it was, you decided to take the statements to an extreme, and then argue about how those statements taken to an extreme are wrong.

 

[Dr.Tao]

"From my experience, rural patients are typically polite and thankful. They are, in general, a pleasure to work with. Inner city underserved populations are the exact opposite."

Interesting. I found entitlement attitudes and rudeness "normal" in the OVERserved/wealthy places I've volunteered in medical settings.

 

[W19]

Bro isn't.

Lol... What a tool! A premed telling an attending what to write about patients' interaction and treatments... @cabinbuilder was just giving an example, she was not making a blanket statement...

 

[bcurtis]

This thread went from being informative, to inspirational, to down right funny, and back to inspirational again.

Keep it up people lol

(And just as a disclaimer, I think rural medicine urgent care is exactly what I want to do)