FP and med students... gah.

[Mumpu]

I just want to vent. I'm on my family medicine clerkship right now and it's so frustrating. I'm in a great practice with tons of patients, very good preceptors, etc. But what maniac thought that FP practice would be a good place for medical students? With 10-15 minutes per appointment, my preceptor barely has time to see patients himself, not to mention letting a med student go in first and present. I don't terribly mind just tagging along all day because we are so busy (25-30 patients a day) but it's so low-yield. In IM, I could learn new things for days from a single patient. Here, a mere third-year med student is able to come up with diagnosis and complete A/P for 99% of what walks through the door... without even cracking open a book. I'm also frustrated because I can't do complete H&Ps like I could in IM. I have no difficulty doing an appropriate focused H&P but I'm thorough (not to be confused with "anal") by nature and I'm never satisfied with the encounters from that respect. Then there's the feeling that I'm intruding into the private relationships between my physicians and patients. With many patients I definitely do not get the same personal access I did in the inpatient setting. How do I know? Because when my preceptor walks in he gets the other half of the story and I'm left feeling like a tool. It's exactly like trying to eat lunch with kids you never hang out with in middle school. Plus I'm in some freakin' boondocks now. There is an FP clinic affiliated with the school a block away from my house. Instead, I'm seeing exactly the same types of patients but also spending $35 a week on gas (not to mention the wear and tear on the car) of which I get reimbursed for $10.

One week down, four and a half to go. 🙁

p.s. I'm not ragging on FP as a profession. I just think it doesn't work well for med students -- little learning, few challenges, and no benefit of forging long-term relationships with patients.

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[Jaded Soul]

This is the nature of the specialty and you just have to deal with it. You should not even try to be thorough because you will only set yourself up for frustration. Family Med focuses heavily on health promotion and disease prevention, so it may seem that the A/P is always the same as the previous visit. The best Family Med experience will have a good blend of "routine follow-up" patients and walk-in patients who have acute issues.

I would have been ecstatic if I got reimbursed anything at all for the cost of driving to and from the FP clinic where I worked.

 

[lowbudget]

Sounds like typical frustration in outpatient medicine clerkships. It was like that in my FM and Pedi rotations, but it was WAY better in the FM than in Pedi.

Do not see 25-30 patients a day. Period. Try to see 10-15. While you're seeing one patient, you preceptor needs to be seeing the next patient. By the time you're done, he'll be done and will ready to see your patient. By the time both of you are done with your patient, there should be 2 patients in their rooms. Pick the one that came in later. This will give you a little bit more time to see the patient and think things through. Make sure you talk to your preceptor about expectations for the clerkship. Don't feel bad if your preceptor gets the other side of the story. After the encounter, ask him how he knew to ask certain questions or how he performed other physical exams. Also, if you order labs or images on a patient, write it down on a piece of paper so you can follow up on that the next day or 2. You'll learn a lot that way. It's ok to be thorough with your H&Ps. Think about all the systems that can be involved and all your findings together. Remember, these patients are your textbooks. Learn from them. Here's your chance to see a lot of normals too. You see so many patients in one day that it really drives home some key findings and helps you set a baseline.

 

[banner]

At least now you know what it's like to really be an attending and you now can make an educated decision about your career.

 

[Mumpu]

The clinic is actually very chill. My preceptors dictate so I don't have to write anything. I get through the story by the time I reach the room and we talk about A/P with the patient. Don't mind seeing 25 patients a day -- most issues are very minor. I do use the advantage of having more time with patients who need counseling or just someone to talk to.

Banner, attending looks like a fun job (at least IM hospitalist) -- you see patients, you teach, you go to bed at night while interns and residents do your dirty work. 🙂

 

[Blade28]

That's kind of the nature of a busy FP practice...lots of volume, and many common complaints - musculoskeletal strains and sprains, sore throats, rashes, BP/DM checks, etc.

Hey, at least you're getting a little reimbursement! I had to drive 50 miles round-trip every day for my FP rotation (6 days a week, 7 weeks). Gas is $2.40/gallon for my car. 🙁

 

[DOSouthpaw]

I'm loving my FP. We are an outpatient clinic that is attached to the hospital. Since we are the only clinic in town that accepts new patients, all admits from the ER are ours too. I go up to the unit in the morning to check on my guy on the vent, then see my cancer patient, then go to my 700+ guy (BMI >80), then go down to the clinic to manage hypertension, peds patients, patients for OMT, diabetes, all sorts of crazy and depressed folks, remove moles, toenails, lipomas (actually just watch those lol) and have a good old time!

 

[Blade28]

...remove moles, toenails, lipomas (actually just watch those lol) and have a good old time!

I can relate. 🙂 Though I also thoroughly enjoyed my FP rotation, I had the most fun doing I&Ds, laceration repairs, packing and wet-to-dries, etc. 👍

 

[Gene Queen]

I agree with everything that has been said so far. If nothing else, you are learning about how the specialty works, and you are learning about what kind of work YOU enjoy!

Also, I really must echo what was said about seeing "normals." SO important because normal can come in so many different variations! Look in every kid's ear (even for a sore toe!) and listen to every adult's heart (even for a headache) and you will get lots and lots of practise! 👍