Does a skewed patient population push people from primary care?

[GoodmanBrown]

A lot of my time in clinic in med school has been with patients who sometimes are a bit hard to empathize with, e.g. smoking COPDers, chronic pain patients, dubious disability patients.

Is this a skewed patient population from private practice? If so, does this make primary care look unappealing to medical students? If not, how do you maintain a positive attitude? Sometimes I feel like I'm pushing against a huge tide when counseling a 58yo male who wheezes getting on the exam table to try to cut down from 1 1/2 packs a day to 1 pack... Thanks for any input!

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[smq123]

A lot of my time in clinic in med school has been with patients who sometimes are a bit hard to empathize with, e.g. smoking COPDers, chronic pain patients, dubious disability patients.

Is this a skewed patient population from private practice? If so, does this make primary care look unappealing to medical students? If not, how do you maintain a positive attitude? Sometimes I feel like I'm pushing against a huge tide when counseling a 58yo male who wheezes getting on the exam table to try to cut down from 1 1/2 packs a day to 1 pack... Thanks for any input!

Yes, don't base your expectations of clinical medicine off of your time in a med school affiliated clinic. As residents, we would often rotate through the cardiologist's or dermatologist's private practice office, and the difference between their patients (private insurance) and our patients (Medicaid, no insurance) could be startling.

Even so, as Blue Dog likes to say, this isn't an issue just with primary care.

 

[DIce3]

A lot of my time in clinic in med school has been with patients who sometimes are a bit hard to empathize with, e.g. smoking COPDers, chronic pain patients, dubious disability patients.

Is this a skewed patient population from private practice? If so, does this make primary care look unappealing to medical students? If not, how do you maintain a positive attitude? Sometimes I feel like I'm pushing against a huge tide when counseling a 58yo male who wheezes getting on the exam table to try to cut down from 1 1/2 packs a day to 1 pack... Thanks for any input!

A primary care physician can do alot of good for the lower SES class that tends to doctor at the teaching clinic. People are people. If you are in training... get over it now and take care of these patients. Focus on being the best physician possible and providing optimal care. If you don't like it... drop out.

While I now take care of the upper middle class, I actually prefer the teaching clinic population of patients.

 

[cheruka]

While I now take care of the upper middle class, I actually prefer the teaching clinic population of patients.

Hmm... This is kinda' confusing. Don't you think it is kinda' hypocratic to say this?

 

[DIce3]

Taking care of uninsured patents does not pay overhead. In training, overhead is not a variable.

 

[Dusn]

You'll be amazed at how much you appreciate your medschool patients after you've taken care of some really high maintenance, self-important upper class patients. To some of those patients, you're not their doctor, you're their highly educated servant.


Also, it has nothing to do with choosing primary care.... unless you were debating between a non-patient-interaction specialty like rads or path .

 

[survivordo]

You'll be amazed at how much you appreciate your medschool patients after you've taken care of some really high maintenance, self-important upper class patients. To some of those patients, you're not their doctor, you're their highly educated servant.


Also, it has nothing to do with choosing primary care.... unless you were debating between a non-patient-interaction specialty like rads or path .

While I agree that you can find patients that have abused themselves in all fields, it does seem to take on a bit of a different feeling when you are their primary care doc and know you are going to have to deal with them year after year. During med school my time spent in a private primary care office was much more enjoyable than the clinic, it was nice to have patients actually interested in working to get better, not just desiring a pain pill..

Survivor DO

 

[MedicineDoc]

Welcome to medicine. You can thank your patients who abuse their bodies for your job because if they didn't the vast majority of the healthcare industry would disappear. On the bright side you can always see pediatric patients and get your empathy fix that you seem to need and focus all your negative feelings on their parents. If that doesn't work you can attend some caring workshops to try to relocate your empathy zone sweet spot.

 

[DIce3]

The initial poster had some good comments, which I appreciate. MedicineDoc said things much better than I. We have a good job in part because patients inject themselves with drugs and get disease, smoke and get disease, and eat way too much and get disease. I happen to like to treat the diseases from these bad habits.

 

[GoodmanBrown]

You'll be amazed at how much you appreciate your medschool patients after you've taken care of some really high maintenance, self-important upper class patients. To some of those patients, you're not their doctor, you're their highly educated servant.

Also, it has nothing to do with choosing primary care.... unless you were debating between a non-patient-interaction specialty like rads or path .

At the risk of re-stirring the pot, my post never mentioned SES and that was honestly not hugely on my mind re: my OP. I was more thinking about how many people have chronic pain issues, and medicine doesn't have great solutions for that.

In reality, the whole post was probably me publically mulling over the idea that I'm more engaged in the hospital setting rather than office-based work. I am getting close to application season and probably getting a bit angsty...