Free at Last! Free at Last!

Pemulis

Senior Member
15+ Year Member
May 6, 2004
258
34
Next door to Nibbles Woodaway
  1. Attending Physician
    sophiejane said:
    As Kent continues to say...your experience is NOT typical and anyone reading your posts should keep that in mind. Maybe you should put a little disclaimer in your signature so that people don't assume you are an expert on graduate medical education, because the types of statements you make certainly imply that YOU think you are.

    Speaking as an "outsider" around here (starting MS 1 this year, haven't posted much on this forum before, but am interested in learning more about primary care) and therefore presumably the type of person you might be concerned will get the wrong idea from Panda's posts, I'm not getting this at all. It seems to me from reading some of his previous posts and his blog that Panda:

    1. Respects/likes FM in general
    2. Always wanted to do ER, even before he started FM training
    3. Thinks the FM program at Duke stank
    4. Thinks most other FM programs are perfectly fine
    5. Thinks there's a bit too much PC in the medical world in general, and that it was especially odious at Duke.

    I haven't seen anything in his writings that led me to question whether or not FM docs in general get adequate training, or suggesting the he regards himself as the local deity in matters of residency training.
     

    RuralMedicine

    Senior Member
    Moderator Emeritus
    Verified Expert
    15+ Year Member
    Jan 11, 2003
    414
    51
    1. Attending Physician
      KentW said:
      I didn't say anything about peds. I was referring to his single month of adult inpatient medicine. Peds was not the subject under discussion.
      I'm sorry I thought you were referring to the Duke program in general being substandard across the board. So are you implying that 2 months of outpatient pediatrics and 1 month of well nursery is typical training for FP?

      RuralMedicine said:
      You can't and shouldn't try to be all things to everyone.

      KentW said:
      No? Then explain the attraction of IM-peds.

      Actually for me that kind of was the attraction of Med-Peds. I recognized that attempting to be proficient in Adult Medicine, Pediatrics, OB-Gyn, and Surgery just wasn't a realistic goal for the end of a three year residency. I did see becoming proficient in taking care of adults and children in outpatient inpatient arenas a realistic challenge to undertake over a four year residency. Now in practice I think it was. I love my ability to see the whole family, I enjoy health supervision (more than I thought I might initially) but I also feel very comfortable working through a puzzling diagnostic dilemna without immediate subspecialty backup (this doesn't mean I don't refer but since my patients are traveling 1 hour plus to see the subspecialist I need to do a lot of the initial workup locally), troubleshooting through difficult procedures, and acute stabilization, inpatient care, and critical care of children and adults.
       

      LADoc00

      Gen X, the last great generation
      15+ Year Member
      Sep 9, 2004
      7,048
      1,076
      1. Attending Physician
        KentW said:
        Ironic, as you'll probably be doing more charity care in emergency medicine than you ever would have done in family medicine. :rolleyes:

        I must admit this is likely correct. I fear you may have lept out of the frying pan directly into the fire there Panda guy. As the number of uninsured rises and the inevitable cutback to government funding of illegal immigrants' healthcare, EM will be bear the brunt of the onslaught. Why not something like rads or gas?
         
        About the Ads

        Blue Dog

        Fides et ratio.
        Verified Expert
        15+ Year Member
        Jan 21, 2006
        13,273
        6,985
        1. Attending Physician
          RuralMedicine said:
          So are you implying that 2 months of outpatient pediatrics and 1 month of well nursery is typical training for FP?

          There's no need for me to imply anything. The ACGME requirements for family medicine residency training are available for anyone who wishes to review them:

          http://www.acgme.org/acWebsite/RRC_120/120_prIndex.asp

          There must be a structured educational experience in the care of children that is at least 4 months in duration and involves pediatric ambulatory clinic and inpatient experience with a sufficient volume of patients in each setting. This must include the newborn nursery as well as clinical experience in management of the distressed neonate who may need resuscitation, stabilization, and preparation for transport. The resident should have the opportunity to develop an understanding of the prenatal period, the growth and development of the newborn through adolescence, child rearing, and emotional problems of children and their management. In addition, the resident should be taught to recognize and manage behavioral, medical, and surgical problems of children and adolescents in home, school, ambulatory, and hospital settings.

          Like everything else, different residencies will provide slightly different experiences. Keep in mind that an FP residency also incorporates additional pediatric training as part of the core family medicine component; it is not treated as something separate, as in a dual residency program.
           

          RuralMedicine

          Senior Member
          Moderator Emeritus
          Verified Expert
          15+ Year Member
          Jan 11, 2003
          414
          51
          1. Attending Physician
            lowbudget said:
            Quick question RuralMed:
            So... which one is it? Is your hospital barring FP's from having admitting privileges because they're FP's? Or is it because FP's don't want to admit Pedi's at all? What's the story?

            I just find it funny that the people who weren't even invited to the party in the first place are the same ones who said "Well I didn't want to go anyways." Uh-huh.

            I've been at this hospital for just under a year and this is how things were when I came. I believe that one of the FPs had some issues with his inpatient management and the hospital (and perhaps his malpractice carrier) suggested he not do inpatient pediatrics. This is what I have heard and I do not know specifics. One of our FPs left the community I think primarily because he wasn't comfortable with the resources in a rural community (he also did not have ventilator privileges so during our brief overlap I needed to come in and round in the ICU during his weekends on call--I actually respected his ability to set his limits wherever they were and not be pressured to do things outside of his training but I suppose I might have felt differently over time). The other FP I think largely does see kids as "a favor" to their parents who are his patients. He has never taken PALS or NRP and I think just doesn't want to make the effort to pursue privileges, and from our conversations I think really feels very uncomfortable with pediatrics (he claims he did less than 3 months of pediatrics over his entire residency and it was mostly outpatient) yet he gets very territorial over certain children. Especially when he's noticed that sometimes it isn't just the child who switches providers but they bring the whole family. (Less of a liability with our other pediatrician as he prefers to see ages 14& under)
             

            oldbearprofessor

            Full Member
            Staff member
            Administrator
            Volunteer Staff
            Verified Expert
            15+ Year Member
            Mar 14, 2002
            4,825
            1,191
            1. Attending Physician
              KentW said:
              There's no need for me to imply anything. The ACGME requirements for family medicine residency training are available for anyone who wishes to review them:

              http://www.acgme.org/acWebsite/RRC_120/120_prIndex.asp



              Like everything else, different residencies will provide slightly different experiences. Keep in mind that an FP residency also incorporates additional pediatric training as part of the core family medicine component; it is not treated as something separate, as in a dual residency program.

              Kent: I have no interest as a neonatologist in getting involved in any of this dispute about FP vs Med-Peds, etc. But I do wonder about NRP training. Is this commonly required of FP residents and if not, do you think it should be? I would think that rural FP practice would need this training but am not aware if it is provided by most or all FP programs. I am part of the teaching of the NRP course here (at the Children's Hosp) to both OB and Pedi residents, but have no knowledge of FP training in it around here.

              Regards

              OBP
               

              Blue Dog

              Fides et ratio.
              Verified Expert
              15+ Year Member
              Jan 21, 2006
              13,273
              6,985
              1. Attending Physician
                oldbearprofessor said:
                Kent: I have no interest as a neonatologist in getting involved in any of this dispute about FP vs Med-Peds, etc. But I do wonder about NRP training. Is this commonly required of FP residents and if not, do you think it should be?

                When I was a resident, I maintained certification in BLS, ACLS, PALS, and NALS (now called NRP?) These were mandatory. ALSO was optional, but since I had no interest in OB, I didn't do that one.

                The FP residents on their peds rotation carried the NALS pager and responded to all complicated deliveries and c-sections, along with the neonatologist and/or neonatal NP.

                If that isn't the way it is everywhere, it should be. Those were great learning experiences.
                 

                mike0001

                Membership Revoked
                Removed
                10+ Year Member
                Jun 12, 2006
                2
                0
                  I graduated from a large urban IM residency program in CA. I can't speak for other training institutions, but at the training institution where I was at FP residents are considered to be maggots by other specialties (OB/Gyn, Surg, EM, IM, Peds). The FP residents are only good for scut work. :eek:
                   

                  RuralMedicine

                  Senior Member
                  Moderator Emeritus
                  Verified Expert
                  15+ Year Member
                  Jan 11, 2003
                  414
                  51
                  1. Attending Physician
                    oldbearprofessor said:
                    Kent: I have no interest as a neonatologist in getting involved in any of this dispute about FP vs Med-Peds, etc. But I do wonder about NRP training. Is this commonly required of FP residents and if not, do you think it should be? I would think that rural FP practice would need this training but am not aware if it is provided by most or all FP programs. I am part of the teaching of the NRP course here (at the Children's Hosp) to both OB and Pedi residents, but have no knowledge of FP training in it around here.

                    Regards

                    OBP

                    Seeing it as FP vs. Med-Peds seems to shortchange the medical community. I think there is a role for both and in some areas FP might be the route to go (ie suburbs of a metropolitan area).

                    As far as the NRP certification (which stopped being NALS in 2000 ?or even earlier perhaps) I think FP programs are mixed on what they require based on my own experiences researching as a student and friends in varied FP programs across the country. The FP residents at the institution I trained at did not do either PALS or NRP (although their only inpatient Peds rotation until recently was a month of NICU?--this was phased out part way through my residency and I actually think that their lack of NRP was given as the official reason--although there were other subsurface reasons) but I don't consider them representative of strong FP programs. Personally I think if you take peds call at an institution that does OB you should maintain active certification in both NRP and PALS. You might argue that if you're at a tertiary center where Neonatology is always inhouse and ready and waiting and wanting to go to every delivery this is obsolete. I'd also think that if you were doing OB at a community hospital without inhouse pediatrics or neonatology that NRP would be a good course to have.
                     

                    RuralMedicine

                    Senior Member
                    Moderator Emeritus
                    Verified Expert
                    15+ Year Member
                    Jan 11, 2003
                    414
                    51
                    1. Attending Physician
                      sophiejane said:
                      I can't speak for the rest of the country, but in my (very large) state, the one and only meds-peds program has gone belly up.

                      I'm not sure why...but I don't think the idea of the "super specialist" (FP-EM, Meds-Peds, FP-IM, etc.) is really catching on.

                      And to answer anxietypeaker's question further...I think the vast majority of people who go into IM do so because they want to specialize, not because they get superior training.

                      I'd be interested in what state you're from. In my experience Med-Peds is still somewhat regional with stronger programs more concentrated in the Northeast and Midwest. I have former residency colleagues who met some "turf resistance" when trying to go back to the west coast to practice. I was told by a hospital recruiter (and appreciated the honesty) that although he thought Med-Peds was a great fit he had already wasted the time of another dynamic Med-Peds canidate and that "Med-Peds just wasn't happening there until a few of the good old boy FPs retired".
                       
                      About the Ads

                      skypilot

                      2K Member
                      15+ Year Member
                      Dec 15, 2002
                      2,377
                      135
                      Beantown
                      1. Attending Physician
                        RuralMedicine said:
                        They also do not have peds privileges at our hospital (a combination of hospital policy and their desire to have less call) so I (or the other pediatrician) do end up doing their inpatient work but since they usually don't ask for help until everything else has failed and the kid needs to be admitted they usually end up eroding the parents' confidence to the point that they end up switching to a pediatrician at which point the FPs get very defensive and claim that they should be allowed to take care of kids and it isn't fair. In reality if we could communicate I wouldn't mind doing their inpatient stuff and trying to then transition the child back into their outpatient practice. We could discuss what patients should go back to them and what patients perhaps should have a pediatrician following them. This continues to be my approach but instead I often get caught in between the frustrated parents and the angry FP. No one can do everything, recognize your limits, ask for help when you need it, and communicate

                        Knowing when to refer to a specialist is a critical skill for any primary care provider. It sounds like you have some extremely stubborn FPs in your area. That is not a function of being an FP and is not a reflection on their training either, just their shortsightedness. :)
                         

                        Blue Dog

                        Fides et ratio.
                        Verified Expert
                        15+ Year Member
                        Jan 21, 2006
                        13,273
                        6,985
                        1. Attending Physician
                          RuralMedicine said:
                          In my experience Med-Peds is still somewhat regional with stronger programs more concentrated in the Northeast and Midwest.

                          We have a med-peds doc in our group. She's practicing pretty much like an FP, except she has made a concerted effort to recruit peds patients, which is something that most of the rest of us haven't bothered to do to any large extent. She has hospital privileges for peds, too.

                          Also, a married couple whom I went to med school with both did med-peds, and have a practice not far from here. Interestingly, their practice is named "Family Medical Care." They're not doing any hospital work, either.
                           

                          Apollyon

                          Screw the GST
                          Lifetime Donor
                          Verified Expert
                          15+ Year Member
                          Nov 24, 2002
                          22,594
                          8,474
                          SCREW IT!
                            lowbudget said:
                            (Most ER residents would say, who cares? But this guy is very conscientious.)

                            Thanks for yet ANOTHER specialty putting a dig on mine. By the way, every group has a right to be called by the name they prefer, and I am diligent to say "FM" - as you are - but you say "ER" in the same vein. It shows that you look down on us - both by using a name YOU prefer, and grossly implying that most EM docs are not conscientious.

                            And I am the one who brought up Med/Peds, and, as people have supported, it DOES bring out the snob in people.

                            sophiejane said:
                            If fuzzy is bad and you aim to avoid it in the ER, then perhaps Duke prepared you better than you thought for your new career, where the whole object of the game appears to be getting patients the hell out of the ER as fast as possible.

                            If that's all you see, then you are missing it. The "whole object" for most EM docs (as is the case for most doctors) is doing the right thing for the patient - but, when there are the outliers, such as the EM doc who dumps, or the FM doc who refers EVERY PATIENT to the ED after 3pm on Friday, or the otolaryngologists who will operate on their patients, and refer them to the ED for complications, but do NOT take call (so won't admit), this is what people think of.

                            Timely disposition is key - but, if you equate "timely" to "fast", you are wrong. "Timely" means "at the right time". Sometimes, it is emergent - acute STEMI, GSW to the abdomen, leaking triple AAA, acute CVA; sometimes it is straightforward - demented with fever, cloudy, foul-smelling urine, and SaO2 of 90% (new) on RA - you know they are infected, just not where, or DVT after U/S from the waiting room. Sometimes it is after the patient is chest-pain free, or after the pelvic in the miscarrying vag bleeder that I have pulled the clots and sac from the vagina, stopping the cramping, but also after the V/Q for the chest pain that is "vague" - period - is high prob for PE (and THAT patient - needing D&C with a PE - is an OB-attending level decision).

                            We do aim for a disposition in 4 hours - but that does NOT mean the patient out the door at 4 hours, since forces beyond our control (like bed availability, or ICUs being at capacity, or social issues) often affect what we do. At the same time, do you REALLY THINK - HONESTLY - that patients say, "Boy, I wish I could stay in the ED for more time!"? I've had at least one hundred patients ask me if I would be their doctor upstairs or could I be, and probably about 25 that - verbatim - said that their doctor was "an dingus" and wish I could be their doc, or that, if they had to come back, they hoped they would get me (and I have one patient stalker).

                            I don't MF Duke FM (although I have anecdotes), because I see the faithful efforts put forth by the providers, and judge them by that and not by their failures, and, as someone else on SDN said (paraphrasing), "Doctors that insult other doctors are dinguses". If you need to feel good by putting someone else down, you need to examine your own perspectives.
                             

                            sophiejane

                            Exhausted
                            Moderator Emeritus
                            7+ Year Member
                            15+ Year Member
                            Sep 18, 2003
                            2,778
                            9
                            Waco, TX
                            1. Resident [Any Field]
                              Apollyon said:
                              If that's all you see, then you are missing it. The "whole object" for most EM docs (as is the case for most doctors) is doing the right thing for the patient - but, when there are the outliers, such as the EM doc who dumps, or the FM doc who refers EVERY PATIENT to the ED after 3pm on Friday, or the otolaryngologists who will operate on their patients, and refer them to the ED for complications, but do NOT take call (so won't admit), this is what people think of.
                              (I fixed your open quote tag, sophiejane, that's all. -KentW)

                              You make a good point. I will certainly give you that. I guess it's just that in my ever so short career so far, I have seen this attitude more in the ED than anywhere else. It's very predictable. I've been fortunate enough to work with great FPs, however, who make appropriate referrals only when necessary and really do take call when it's their turn.

                              My favorite example was a patient who was clearly in DTs admitted to the psych ER, so the attendinding sent him to the medical ER as soon as the dx was made. He got sent back downstairs to the medical ER and back up again THREE times before the poor bastard got his fluids and benzos. The ER doc was refusing to treat him because he was a "psych" case. Just like any woman who is in the slightest bit pregnant gets punted to OB triage no matter WHAT is wrong with her.
                               

                              RuralMedicine

                              Senior Member
                              Moderator Emeritus
                              Verified Expert
                              15+ Year Member
                              Jan 11, 2003
                              414
                              51
                              1. Attending Physician
                                KentW said:
                                We have a med-peds doc in our group. She's practicing pretty much like an FP, except she has made a concerted effort to recruit peds patients, which is something that most of the rest of us haven't bothered to do to any large extent. She has hospital privileges for peds, too.

                                Also, a married couple whom I went to med school with both did med-peds, and have a practice not far from here. Interestingly, their practice is named "Family Medical Care." They're not doing any hospital work, either.

                                It sounds like you're making the point that Med-Peds might be a great route to family medicine. Personally I think you're right. I don't think Med-Peds obligates you to do hospital work (although I think it does prepare you well if you like it and a lot of suburban hospitals seem to be recruiting Med-Peds as hospitalists), I have a residency colleague who has all of his inpatient work done by the local hospitalist and does outpatient Med-Peds only. He's very happy with this arrangement. We're all different, I would miss the continuity (and it's a moot point in my community as hospitalists are nowhere to be found). However, knowing this person I suspect he make a real effort to maintain continuity by communicating in a timely fashion with the hospitalist so I think you can work to maintain the continuity if you don't desire to do any inpatient work.
                                 

                                RuralMedicine

                                Senior Member
                                Moderator Emeritus
                                Verified Expert
                                15+ Year Member
                                Jan 11, 2003
                                414
                                51
                                1. Attending Physician
                                  skypilot said:
                                  Knowing when to refer to a specialist is a critical skill for any primary care provider. It sounds like you have some extremely stubborn FPs in your area. That is not a function of being an FP and is not a reflection on their training either, just their shortsightedness. :)

                                  I completely agree with this, and I don't believe it is limited to FPs, just that the FPs in our community provide an example of this. In my original post I wrote that I still thought a collaborative approach could/would work with different physicians. One thing I would say is that I think that at times the super FP "I can do anything a pediatrician, internist, obstetrician, or surgeon can do and do it better" mentality pushes individual practitioners to be unrealistic in where to set their limits. I worked with some great FPs as a medical student who were pretty comfortable with where there limits were and did some great work within those limits. I also worked with a few who tried to convince me that considering pediatrics was a waste because I could still do anything a pediatrician could do as an FP. These providers practiced outside of their limits, frequently got into trouble, and were dependent on someone else bailing them out at the end of the day/week. I had no disillusions that they were representative of FPs in the USA or that I should try to be like them and in a way I suppose they helped me by indirectly encouraging me to take the time and critically assess the field and what my ultimate practice goals were.
                                   

                                  secretwave101

                                  Senior Member
                                  10+ Year Member
                                  15+ Year Member
                                  Dec 14, 2001
                                  679
                                  16
                                  48
                                  Bruchmulbach, Germany
                                  1. Attending Physician
                                    sophiejane said:
                                    Correct me if I'm wrong, but in EM it seems to me that you will be doing urgent care/FP type medicine 90% of the time, unless you are in a big trauma center.

                                    Speaking of opinion...here's mine about EM:

                                    EVEN at a big trauma center. Maybe more so at a big trauma center. EM is the most overrated specialty in medicine. It's the housing bubble of medical specialties. At the big places, the trauma surgeons won't let the EM guy near the exciting, bleeding cases. EM is drunks, schizo's, the rare chest tube and central line and some sutures. The rest is CYA and a bunch of outpatient FM with zero patient continuity.

                                    Oh, and 1.5x the pay with double the litigation.
                                     

                                    secretwave101

                                    Senior Member
                                    10+ Year Member
                                    15+ Year Member
                                    Dec 14, 2001
                                    679
                                    16
                                    48
                                    Bruchmulbach, Germany
                                    1. Attending Physician
                                      oldbearprofessor said:
                                      I am part of the teaching of the NRP course here (at the Children's Hosp) to both OB and Pedi residents, but have no knowledge of FP training in it around here.

                                      We have to get our cert in NRP during orientation, before internship even starts. That it's a requirement for us isn't even in question.
                                       

                                      Farbar

                                      Junior Member
                                      10+ Year Member
                                      Apr 26, 2006
                                      40
                                      0
                                      1. Resident [Any Field]
                                        secretwave101 said:
                                        Speaking of opinion...here's mine about EM:

                                        EVEN at a big trauma center. Maybe more so at a big trauma center. EM is the most overrated specialty in medicine. It's the housing bubble of medical specialties. At the big places, the trauma surgeons won't let the EM guy near the exciting, bleeding cases. EM is drunks, schizo's, the rare chest tube and central line and some sutures. The rest is CYA and a bunch of outpatient FM with zero patient continuity.

                                        Oh, and 1.5x the pay with double the litigation.

                                        Great. More spots for those of us interested in EM. I hated FM but I am glad so many people like it. It is a very important specialty. Thanks for your broad view and respect of other areas of medicine. Now, I must go and work on my drunk, schizo, chest tube and central line skills.
                                         

                                        secretwave101

                                        Senior Member
                                        10+ Year Member
                                        15+ Year Member
                                        Dec 14, 2001
                                        679
                                        16
                                        48
                                        Bruchmulbach, Germany
                                        1. Attending Physician
                                          Farbar said:
                                          Great. More spots for those of us interested in EM. I hated FM but I am glad so many people like it. It is a very important specialty. Thanks for your broad view and respect of other areas of medicine. Now, I must go and work on my drunk, schizo, chest tube and central line skills.

                                          Seems there's a fine line between negative opinion and disrespect. I intended the former. Apologies if I overdid it.
                                           

                                          WatchingWaiting

                                          Full Member
                                          7+ Year Member
                                          15+ Year Member
                                          Mar 7, 2003
                                          637
                                          0
                                            secretwave101 said:
                                            Speaking of opinion...here's mine about EM:

                                            EVEN at a big trauma center. Maybe more so at a big trauma center. EM is the most overrated specialty in medicine. It's the housing bubble of medical specialties. At the big places, the trauma surgeons won't let the EM guy near the exciting, bleeding cases. EM is drunks, schizo's, the rare chest tube and central line and some sutures. The rest is CYA and a bunch of outpatient FM with zero patient continuity.

                                            Oh, and 1.5x the pay with double the litigation.

                                            I'm not sure how you're managing to compare this to the housing bubble. Emed guys work less and get paid quite a bit more than primary care guys for precisely the reasons you're describing. It's not stressful in the ER/tv drama sense of such exciting/challenging cases, but it is stressful in the nature of the stuff that walks through the door, the fact patients are often sue-happy, and the amount of time you have to deal with it. The relative lack of nurse practitioners doing Emed as compared to the number of nurse practitioners in the primary care fields also certainly has an impact.

                                            In short, the field is probably perceived as much sexier by the public than it actually is, but there are pretty sound econonmic reasons of supply/demand justifying the compensation, just as there are pretty sound reasons for the crappy compensation of the primary care fields (namely, the fact that someone who can do 90% of what you can do and is willing to do it for 1/2 as much).
                                             

                                            WatchingWaiting

                                            Full Member
                                            7+ Year Member
                                            15+ Year Member
                                            Mar 7, 2003
                                            637
                                            0
                                              sophiejane said:
                                              Is this what they were teaching at Duke? If so, it's another nail in their coffin, and it also discredits pretty much all of your broad declarations about how family physicians are trained in the US, because it underscores how atypical and dismal was your experience as an FM resident.

                                              As Kent continues to say...your experience is NOT typical and anyone reading your posts should keep that in mind. Maybe you should put a little disclaimer in your signature so that people don't assume you are an expert on graduate medical education, because the types of statements you make certainly imply that YOU think you are.

                                              I don't think this is the case at all. I'm a med student, so certainly no expert on this, but our family practice month was by far the most worthless experience of my entire third year. It was nice time-commmittment-wise (lack thereof), but we did spend at least 20 hours doing the kind of patronizing, insulting, unteachable stuff Panda Bear is describing. I think this stuff is very much a part of what the "great minds" of family practice think is going to reinvigorate their field. Actually, it's probably more a function of faculty in family medicine departments not having any real research to do and so having to fixate on cultural competency/sensitivity and the like as kind of vapid areas completely non-amenable to any kind of real research, but very amenable to low-effort, low-funding fluff pieces.

                                              If you want culturally competent, empathetic doctors, give them 30 minutes for a primary care visit instead of 15 minutes. The time stress in the current practice environment is the probelm and the hours of B.S. spent exploring feelings and doing other touchy/feely crap will certainly have no impact on making more medically competent physicians and probably have no effect on making them more sensitive either. It just kind of makes the field a joke.
                                               

                                              Blue Dog

                                              Fides et ratio.
                                              Verified Expert
                                              15+ Year Member
                                              Jan 21, 2006
                                              13,273
                                              6,985
                                              1. Attending Physician
                                                WatchingWaiting said:
                                                If you want culturally competent, empathetic doctors, give them 30 minutes for a primary care visit instead of 15 minutes.

                                                Nice idea, and I'd certainly vote for it, but I'm not holding my breath.

                                                In the meantime, you might be surprised at just how many of your classmates could use a few lessons in empathy and compassion, particularly if their posts here on SDN are any evidence.

                                                The public has demanded that medical schools incorporate these subjects. They're usually taught independently of any core family medicine component (at my school, we had a class called "The Doctor, The Patient" or something like that). However, the expectation that primary care physicians possess these traits is far greater than it is for most other specialties, and so the subjects have become intertwined at some medical schools.

                                                That being said, I think there are limits to how much you can actually teach this stuff. My preference would be that people who have a problem with empathy and compassion or don't see how it's relevant find another field to practice in. I don't wish to be guilty by association.
                                                 

                                                Blue Dog

                                                Fides et ratio.
                                                Verified Expert
                                                15+ Year Member
                                                Jan 21, 2006
                                                13,273
                                                6,985
                                                1. Attending Physician
                                                  WatchingWaiting said:
                                                  In short, the field is probably perceived as much sexier by the public than it actually is, but there are pretty sound econonmic reasons of supply/demand justifying the compensation, just as there are pretty sound reasons for the crappy compensation of the primary care fields (namely, the fact that someone who can do 90% of what you can do and is willing to do it for 1/2 as much).

                                                  Most medical students do, in fact, hold a general view of emergency medicine that I think is over-romanticized, just as their view (expressed so typically by yourself, thanks) of primary care is slanted the other way.

                                                  EM docs do, in reality, work harder than most FPs, and are compensated accordingly. In my opinion, they're not paid enough. Of course, neither are we. ;)

                                                  Incidentally, economic laws of supply and demand do not determine how much one makes in primary care. I only wish it were so.

                                                  Since you mentioned physician extenders, I should add that you'll find them nearly as prevalent (if not more so) in emergency rooms these days as in primary care. They're no more capable of running the entire show there than they are in family medicine. Lots of people can follow a recipe, but that doesn't make them a great chef. ;)
                                                   

                                                  skypilot

                                                  2K Member
                                                  15+ Year Member
                                                  Dec 15, 2002
                                                  2,377
                                                  135
                                                  Beantown
                                                  1. Attending Physician
                                                    WatchingWaiting said:
                                                    I don't think this is the case at all. I'm a med student, so certainly no expert on this, but our family practice month was by far the most worthless experience of my entire third year. It was nice time-commmittment-wise (lack thereof), but we did spend at least 20 hours doing the kind of patronizing, insulting, unteachable stuff Panda Bear is describing. I think this stuff is very much a part of what the "great minds" of family practice think is going to reinvigorate their field. Actually, it's probably more a function of faculty in family medicine departments not having any real research to do and so having to fixate on cultural competency/sensitivity and the like as kind of vapid areas completely non-amenable to any kind of real research, but very amenable to low-effort, low-funding fluff pieces.

                                                    If you want culturally competent, empathetic doctors, give them 30 minutes for a primary care visit instead of 15 minutes. The time stress in the current practice environment is the probelm and the hours of B.S. spent exploring feelings and doing other touchy/feely crap will certainly have no impact on making more medically competent physicians and probably have no effect on making them more sensitive either. It just kind of makes the field a joke.

                                                    Maybe the skills can't be taught but it is critically important to your patient's outcome that you have them. I think the courses are just trying to make you aware that you need to work on these things ie. learn them on your own. This is not obvious to all med students! :) All of the patients who come to PCPs for Hypertension, Diabetes, Cancer screenings etc. think those skills are one of the most important parts of a doctor's job. Any many of the failings and missed diagnoses are due to a lack of communication.

                                                    If a patient doesn't think you're are listening or caring, or trustworthy, they probably are not going to tell you the things you need to make the diagnosis.
                                                     

                                                    sophiejane

                                                    Exhausted
                                                    Moderator Emeritus
                                                    7+ Year Member
                                                    15+ Year Member
                                                    Sep 18, 2003
                                                    2,778
                                                    9
                                                    Waco, TX
                                                    1. Resident [Any Field]
                                                      WatchingWaiting said:
                                                      I don't think this is the case at all. I'm a med student, so certainly no expert on this, but our family practice month was by far the most worthless experience of my entire third year. It was nice time-commmittment-wise (lack thereof), but we did spend at least 20 hours doing the kind of patronizing, insulting, unteachable stuff Panda Bear is describing.

                                                      Then this represents a deficiency at YOUR school. Many medical students have very satisfying and enjoyable FM rotations. On my FM rotation, I was suturing, taking care of hospital patients, doing I&D's and spending a lot of very quality clinic time where I learned a lot.

                                                      Keep in mind that if YOU think you are being insulting and patronizing, you probably are. If you can't listen empathetically and be genuine about it, you better not go into EM either. Patients have to tell their story, and the more you can pick up from what they say and how they say it, the better care you will be able to give them and the better your outcomes.

                                                      I'm also a 4th year, with limited experience. But keep in mind that we know very little at this point. I try to keep that in mind, but like you, I sometimes overgeneralize about things I know little about (see my previous post about turfing in the ED). SDN can be a place to have your horizons broadened if you are open to it.
                                                       
                                                      About the Ads
                                                      This thread is more than 15 years old.

                                                      Your message may be considered spam for the following reasons:

                                                      1. Your new thread title is very short, and likely is unhelpful.
                                                      2. Your reply is very short and likely does not add anything to the thread.
                                                      3. Your reply is very long and likely does not add anything to the thread.
                                                      4. It is very likely that it does not need any further discussion and thus bumping it serves no purpose.
                                                      5. Your message is mostly quotes or spoilers.
                                                      6. Your reply has occurred very quickly after a previous reply and likely does not add anything to the thread.
                                                      7. This thread is locked.