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Ideal third year student?

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okokok

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I'm one week into third year and have been in an outpatient family med clinic. I feel pretty awkward, as I'm sure is normal, but was hoping for any advice you in the attending role might have for a student like me. I'm put with one physician in the practice, usually a different one each time, and I just feel like I'm in the way. They're so busy, and I don't want to interrupt their flow or talk out of turn to them or to patients. I'm usually pretty funny and outgoing, but I find myself unable to loosen up at the office. I think trying to avoid being the weird/awkward med student has turned me into being the weird/awkward med student. Any advice (other than stop being so self-conscious or worried, because I'm not having luck with that really) or things you wish your students would do? Another thing is, I find myself not really having any questions, even when the preceptor turns to me and suddenly asks for questions.

Also, I feel like one of the doctors I've been with doesn't really listen to the patient or ask the kind of questions it seems like they should. They seem to throw antibiotics at everything and just say that it's not really the correct way to do things but it's just their style. Are my instincts right that as a third-year being graded I should just go with the flow and not question them?

Last question, kind of unrelated - how can I get better at coming up with a differential in my head for a presenting problem? I'm usually told the chief complaint on the walk to the patient room, and I'd like to have a few diagnoses in mind when we get to the patient, but I don't seem to think that fast. Is that just something that will come with more reading and practice?
 

smq123

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I'm one week into third year and have been in an outpatient family med clinic. I feel pretty awkward, as I'm sure is normal, but was hoping for any advice you in the attending role might have for a student like me. I'm put with one physician in the practice, usually a different one each time, and I just feel like I'm in the way. They're so busy, and I don't want to interrupt their flow or talk out of turn to them or to patients. I'm usually pretty funny and outgoing, but I find myself unable to loosen up at the office. I think trying to avoid being the weird/awkward med student has turned me into being the weird/awkward med student. Any advice (other than stop being so self-conscious or worried, because I'm not having luck with that really) or things you wish your students would do? Another thing is, I find myself not really having any questions, even when the preceptor turns to me and suddenly asks for questions.

Also, I feel like one of the doctors I've been with doesn't really listen to the patient or ask the kind of questions it seems like they should. They seem to throw antibiotics at everything and just say that it's not really the correct way to do things but it's just their style. Are my instincts right that as a third-year being graded I should just go with the flow and not question them?

Last question, kind of unrelated - how can I get better at coming up with a differential in my head for a presenting problem? I'm usually told the chief complaint on the walk to the patient room, and I'd like to have a few diagnoses in mind when we get to the patient, but I don't seem to think that fast. Is that just something that will come with more reading and practice?

Oh my god, yes. DO NOT QUESTION THEM unless you have a good rapport with them and know that they would be ok with it.
 
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okokok

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Oh my god, yes. DO NOT QUESTION THEM unless you have a good rapport with them and know that they would be ok with it.
I figured! Everything just feels new & unsure. I know I'll get used to it, but I appreciate any advice

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smq123

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I'm one week into third year and have been in an outpatient family med clinic. I feel pretty awkward, as I'm sure is normal, but was hoping for any advice you in the attending role might have for a student like me. I'm put with one physician in the practice, usually a different one each time, and I just feel like I'm in the way. They're so busy, and I don't want to interrupt their flow or talk out of turn to them or to patients. I'm usually pretty funny and outgoing, but I find myself unable to loosen up at the office. I think trying to avoid being the weird/awkward med student has turned me into being the weird/awkward med student. Any advice (other than stop being so self-conscious or worried, because I'm not having luck with that really) or things you wish your students would do? Another thing is, I find myself not really having any questions, even when the preceptor turns to me and suddenly asks for questions.

Also, I feel like one of the doctors I've been with doesn't really listen to the patient or ask the kind of questions it seems like they should. They seem to throw antibiotics at everything and just say that it's not really the correct way to do things but it's just their style. Are my instincts right that as a third-year being graded I should just go with the flow and not question them?

Last question, kind of unrelated - how can I get better at coming up with a differential in my head for a presenting problem? I'm usually told the chief complaint on the walk to the patient room, and I'd like to have a few diagnoses in mind when we get to the patient, but I don't seem to think that fast. Is that just something that will come with more reading and practice?

To be honest, if they only have you shadowing, and not doing anything active, it is almost impossible NOT to feel awkward, and it'll be very hard to avoid that. Asking questions will help break the ice if there is anything to ask about. Sometimes it can be hard to think of a good question to ask if all you're seeing is pretty basic, uninteresting stuff.

It sounds like you didn't have a great office to rotate through, and I'm sorry. They definitely should NOT be throwing antibiotics at everything, and should be teaching you what IS the correct way (instead of just saying, basically, "Do as I say, not as I do.")

As far as coming up with a differential, that will come with time and practice. More reading, of course, helps, but it takes practice above all else. Your preceptor ought to be walking you through their thought process as they come up with a differential, to help you learn, although it sounds like they're not doing that.
 
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cabinbuilder

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Do not ever question a decision in front of a patient. It will make the patient nervous and lose faith in the doctor ability. Always ask behind closed doors unless you are asked openly if you have any questions.
 
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DrBeenThere

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Bring a box of donuts for the staff, this will get you on their good side. Pretend you work there, because if you do act outgoing enough, you just might! Try to befriend the staff and just be nice. Buy a subscription to Epocrates and read about the conditions of the patients you see. Start to learn that common things happen commonly. Act interested even if you're not. Ask the docs what their go-to medications are, the ones they use every day and why they choose to use those particular drugs. Try to make eye contact with each patient even though you are a fly on the wall, and think good thoughts at them. This is just one of many hoops in your near future, focus on displaying a positive attitude, that will get you much farther than brown-nosing. That said, the donuts trick really works, or a veggie tray if they're super health conscious.
 
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JustPlainBill

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I'm one week into third year and have been in an outpatient family med clinic. I feel pretty awkward, as I'm sure is normal, but was hoping for any advice you in the attending role might have for a student like me. I'm put with one physician in the practice, usually a different one each time, and I just feel like I'm in the way. They're so busy, and I don't want to interrupt their flow or talk out of turn to them or to patients. I'm usually pretty funny and outgoing, but I find myself unable to loosen up at the office. I think trying to avoid being the weird/awkward med student has turned me into being the weird/awkward med student. Any advice (other than stop being so self-conscious or worried, because I'm not having luck with that really) or things you wish your students would do? Another thing is, I find myself not really having any questions, even when the preceptor turns to me and suddenly asks for questions.

Also, I feel like one of the doctors I've been with doesn't really listen to the patient or ask the kind of questions it seems like they should. They seem to throw antibiotics at everything and just say that it's not really the correct way to do things but it's just their style. Are my instincts right that as a third-year being graded I should just go with the flow and not question them?

Last question, kind of unrelated - how can I get better at coming up with a differential in my head for a presenting problem? I'm usually told the chief complaint on the walk to the patient room, and I'd like to have a few diagnoses in mind when we get to the patient, but I don't seem to think that fast. Is that just something that will come with more reading and practice?

1) We've all been there as students -- right now, you really don't know enough/haven't seen enough to know what questions to ask -- your preceptors have likely been seeing these patients for a while which factors into the equation.
2) DO NOT EVER question anything the attending does in front of the patient -- you have no idea of the patient history, personality, previous treatments/workups, family situation or any of all the other factors that goes into making a treatment decision. That's a good way to get put down, hard. There was one person in my class who went on to a surgical residency that openly questioned and then argued with the attending in front of the patient on hospital rounds -- the residents and other students slowly moved against the wall and there was an embarrassed silence from them. The attending told the chief resident to go to the nurses station as he had to finish up with the patient --- he came out of the room, went to the nurses station where the gaggle of residents and students (including this clown) were standing -- and then proceeded, without raising his voice, to take this whelp apart, piece by piece, refuting every aspect of the students argument and then calmly informing him that if he EVER pulled that stunt again, the attending would ensure that his medical career was OVER. don't be that guy/gal.
3) As far as throwing antibiotics at everything, recall that some people aren't going to be happy unless they get an abx -- it's the common American McDonald's mentality -- I paid good money (copay) for this visit, I feel like crap, I want something done and to feel like I got my money's worth --- some will actually get belligerent when you tell them it's a virus, use OTC meds, some will go home and wait until the afternoon or next morning to light up the phones requesting abx for a viral -- in my area, most providers will send out a ZPack for those cases and guess what, Ringo Rangers -- the symptoms will magically disappear at the end of the ZPack -- 5 days plus 2 days before being seen -- and virals take 7-10 days usually before improvement -- so obviously, the problem was not that it was viral but that the patient needed a ZPack and if the doc would have just prescribed the ZPack in the first place, the poor patient would not have had to suffer -- why just ask WebMD ---- some days, it's just not worth gnawing through the restraints.....pick your fights....
 
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okokok

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After being a couple weeks in, I see you guys are completely right. I learn so much every day. I appreciate everyone's input!

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mark v

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When you're in seeing a patient, understand that you are holding up the works for the whole office. As have been said, we have all been there and remember what it was like. You'll be treated cordially but if you're taking 20-30 minutes with each patient, you'll wear out your welcome quickly. When students shadow with me, if they can take 10-15 minutes with a patient, hit the high points and then come back and go over everything in a brief logical fashion I'm more than happy. Not every patient needs a MMSE, mole check and full neuro exam. If something warrants a more thorough exam then by all means.
 

Blue Dog

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When you're in seeing a patient, understand that you are holding up the works for the whole office. As have been said, we have all been there and remember what it was like. You'll be treated cordially but if you're taking 20-30 minutes with each patient, you'll wear out your welcome quickly. When students shadow with me, if they can take 10-15 minutes with a patient, hit the high points and then come back and go over everything in a brief logical fashion I'm more than happy. Not every patient needs a MMSE, mole check and full neuro exam. If something warrants a more thorough exam then by all means.

I only let first- and second-year students see acute complaints solo, and I usually coach them before I send them in with a patient (e.g., "they're here for a URI, so do a FOCUSED history and exam.") If they're an MS-1, I'll review some of the common things to ask and look for so they don't flail. Then, I'll see one (sometimes two) other patients while they're in the room. It really doesn't slow me down at all.
 
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okokok

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I only let first- and second-year students see acute complaints solo, and I usually coach them before I send them in with a patient (e.g., "they're here for a URI, so do a FOCUSED history and exam.") If they're an MS-1, I'll review some of the common things to ask and look for so they don't flail. Then, I'll see one (sometimes two) other patients while they're in the room. It really doesn't slow me down at all.
Do you mean first and second year of medical school? Third year is the first time we get any clinical experience at my school (there's a ton of interviewing/examining patient actors but nothing real).

What @Blue Dog is describing seems to be the routine my attending and I fell into. I know I spent longer than I should have with patients (he'd specify "spend about 5 minutes" but it'd take me a little longer usually--he would go see other patients of course rather than wait for me), but with practice I got a lot better at getting info in 5 minutes by the end of my time with him.

I wish he had given me more specific feedback, but I understand he's busy etc etc. All in all, I ended up loving my time in the office, learned so much, and at this point am leaning heavily towards going into FM.

Thanks again for all the advice. I'd love to hear more about FM/M3 in general if anyone has any.
 

Blue Dog

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Do you mean first and second year of medical school? Third year is the first time we get any clinical experience at my school (there's a ton of interviewing/examining patient actors but nothing real).

Med students here learn history taking and physical examination starting their first semester, and practice on standardized patients. The course I'm part of is called the Longitudinal Generalist Mentorship (LGM), and involves 6-8 half-day rotations per semester in a primary care office with a preceptor.
 
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