FPs and social issues

[patapon]

Hey FP residents/attendings,

I'm trying to decide between FP and IM. How often do you deal with social issues in clinic patients? It seems to me that one of the most stressful things about internal medicine is dealing with social issues like stopping a patient from leaving AMA, or trying to send a patient home when he wants to stay, or coming up with a sound ethicolegal plan (with the assistance of pts' family members) for patients who lack capacity for one reason or another, etc.

These are issues that are relevant to the hospital setting. My feeble mind can't imagine similarly frustrating situations in an FP clinic (I certainly didn't see any during my rotation). Please enlighten me.

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[Leukocyte]

My feeble mind can't imagine similarly frustrating situations in an FP clinic (I certainly didn't see any during my rotation). Please enlighten me.

Why?

In FM you deal with "social issues" in the in-patient and the out-patient setting. Have you worked in FM residency (medicaid) clinics? You will not be working with "social issues", but rather social dysfunction.

As FM residents, we deal with social dysfunction all the time, in-patient and out-patient.

 

[lowbudget]

Stop a patient from leaving AMA? Psshh. If a patient wants to leave AMA... BYE! Nothing makes me smile bigger and brighter than to hear the alarm clock go off, come to work before the rest of the civilized world is awake, and hear during handoff that some IDIOT left AMA. I love it, I love it, I love it. Keeps my teeth white.

 

[Leukocyte]

Stop a patient from leaving AMA? Psshh. If a patient wants to leave AMA... BYE! Nothing makes me smile bigger and brighter than to hear....during handoff that some IDIOT left AMA. I love it, I love it, I love it. Keeps my teeth white.

Me too. I LOVE those in-patient AMAs, and clinic no-shows.
One time, a patient said to my attending, "I do not want to be here"...my attending responded, "believe me, we not not want you here" I loved it.

 

[lowbudget]

What? Can't deal with social issues? Radiology? Pathology? Yawn...

I had an OB attending who told a patient IN LABOR that if she's going to refuse all of the medical care that she's about to receive, that it's her decision, it's Against Medical Advice for her and the baby's well-being, and that she can get dressed, go back downstairs, and "have your baby by that red light." Documented the conversation in the chart (benefits, risks, blah blah). Handed her the AMA form. Walked back to the call room.

Fierce. Love it.

(Are you kidding me? You can't make this kind of stupidity and social dysfunction up! Jerry Springer's got nothing on residency training. If you don't think that's hilarious, wait until you talk to General Surgery and Emergency Medicine colleagues.

Go ahead, leave AMA. I want to see the face of that Nurse Practitioner working that Retail Clinic when you show up with your CHEST TUBE still in place... talking about how patients are "customers" and the "customer" is "always right"...)

 

[patapon]

Seems like even FP suffers from the general social malaise that so many other fields suffer from, even though they target the younger and healthier population (leaving the very complicated ones to the IMs).

Alas. Now I know why people do anesthesiology .

 

[secretwave101]

FP and IM are the same thing without the kids.

We get all the social crap too. Mostly about narcs. And sex. Lots of drugs + sex = babies (and still drugs). Have fun, doc.

 

[tcpro]

Seems like even FP suffers from the general social malaise that so many other fields suffer from, even though they target the younger and healthier population (leaving the very complicated ones to the IMs).

Alas. Now I know why people do anesthesiology .

i think you don't quite have it right. people are people. the same social issues apply for both specialties equally. The difference is that as secretwave pointed out is in IM you see NO newborns to 18yo's (usually healthier in general) and no OB patients (which believe me are usually the easiest part of your day! young healthy couples who really learn to trust you as their doctor. half the time it's just chatting). IM will usually get the more "complicated medical patients" but definately not the more complicated socialy difficult patients.

remember though, w/ the baby boomers all retiring and the HUGE shortage of geriatricians, FP docs will be seeing more and more "internal medicine" patients in their practice. so the big question is... do you want to treat kids?? i said YES! if a FP doc doesn't see kids... after 10 years you will have an IM practice.