Unsure about my Future and Slightly depressed (MS-3)

[PrimaryCareDOToBe]

Hey all, I just need to vent, thanks for taking the time to read if you do:

So, as my name implies, I have been balls to the wall, all-in to shooting for primary care since I scribed for an IM PCP before medical school. I specifically chose DO because I enjoy hands on manipulation as well and thought this could be a neat part of a practice. But now, I'm currently on my Family Med rotation, and I'm just so miserable; the only problem is, I can't tell if its the specialty... if it's the doctors... if it's the patients... I'm not sure exactly what it is. I just know that I leave work every day feeling super defeated and depressed.

I left all my other rotations incredibly uplifted (I only have IM and Surg left) and I really felt like I had actually done something, even if it was something super tiny. I would always call my spouse or mom after each shift and relay cool stories I had from any of the rotations. I have never had that feeling so far on this rotation and we're 6 weeks in.. and I'm getting anxious/nervous because this is what I was so excited for...and now I just come home and don't even wanna talk about work.

In all my rotations so far I would always be able to confront my attendings to give a thorough yet concise H&P and even relay my DDx and treatment ideas, and they all appreciated my thoughts and ideas. I have never been nervous talking to patients in the past... and I always seemed to be able to focus on something during a visit. Suddenly on this rotation, I just feel so incompetent. I stumble over my words when I talk to patients, I feel like I can't concisely depict why any of these patients are coming in, and half of them don't know why they're there either. Even if I do talk to a patient about a sick/urgent/acute complaint, I can't seem to even put together a DDx. The attending will ask me to hurry and see a patient but I go in the room and they're seeing a bajillion specialists and are all on 20 medications and when I try to ask them about which ones they're still on, none of them know, they haven't heard of half the medications that are on their list, and whatever conversation we were in gets cut short anyways by the attending coming in the room, but even when I do come out in good time to present, they're in such a rush and seem so uninterested I can't seem to even relay my pertinent positives or negatives, and it always seems like we're on completely different brain waves so they ask me many questions of things I didn't do/didn't feel like were indicated in the room, so I can never get out like what I actually did or think it is, and sure enough, when we go in the room, the attending begins to ask all the things I already did but couldn't relay because they' just zip away to go see them, and I just follow like a little shadow. Which I get, even if I had relayed these things to the attending, 100% I still want them to do what I did to verify, but I feel incompetent because I couldn't even relay to them that indeed I did do a Straight Leg Raise to r/o herniation.

I'm not posting this looking for sympathy. I understand we don't all have great rotations, I understand that we won't enjoy every single Doctor we work with, and sometimes we won't jive with the work environment or culture. But, I am posting this because I'm unsure what my takeaway should be. With COVID, I unfortunately have very limited options in terms of actually continuing to pursue other interests. I have this horrible feeling in my gut that I could end up doing FM or IM and being miserable and feeling trapped. I enjoyed my time with the IM PCP scribing before, but I was also so young and inexperienced. He was an old school doc and he did a lot for his patients, and maybe it's just a different ideology or culture or time... I'm not really sure what to think.

I'm just disappointed. All in all, I understand my experiences in my rotations have been highly enjoyable, and I consider myself very lucky because there are students who every single rotation is probably frustrating with attendings who don't enjoy teaching. But, given this was the one specialty I've really always wanted... and for it to be the only thing I am absolutely hating..... I'm just wondering if this is a super big red flag....and no other doctors unfortunately are taking on additional students for shadowing or learning.

I am hoping my IM Rotation next which is inpatient will be more eye opening, and hopefully if I enjoy that, I can always choose to be on the inpatient side of things.... I was just hoping I'd have an "Ah ha!" moment with my rotations that would direct me to my future specialty, but instead, I seem to have liked everything but the one thing I thought I would.


Thanks for reading my long rant if you made it this far. I'm really hoping that it's just this specific office I'm not jiving with, and maybe in the future I can slip into something and know for sure if this is what I really want to do or not.

 

[Osmosis_JonesDO]

I had the same experience with a specialty this year. I went in to third year thinking I would 100% do one specialty and ended up hating it, and I am now pursuing something completely different. What I have realized about choosing a specialty is that if you have to convince yourself you like something, then you probably don't enjoy it very much. Also you can think you like something all you want, but clinical experience is the only true way to tell.

It could just be that you are having a bad experience at this one office, but having had a few outpatient medicine rotations I can tell you that no matter where you go, primary care is always filled with patients on a million meds, with a gaggle of consulting specialists following them. Now there may be offices where the doctors handle more on their own and refer less out, and nothing would stop you from practicing like an old school doc and doing it all yourself, but if you don't enjoy the nature of the work it will be a very long career. Props to all those who go into primary care it definitely takes a special person, but it isn't for everyone, especially me lol

 

[CocoMelon0531]

Some people will never have that ah ha moment. Most common experience is to hate certain specialties and cross those out, and find out which specialties you can tolerate the bull for the next ten years in which you’re competitive for based on your board scores. No worries.

 

[hmockingbird]

I had the same experience with a specialty this year. I went in to third year thinking I would 100% do one specialty and ended up hating it, and I am now pursuing something completely different. What I have realized about choosing a specialty is that if you have to convince yourself you like something, then you probably don't enjoy it very much. Also you can think you like something all you want, but clinical experience is the only true way to tell.

It could just be that you are having a bad experience at this one office, but having had a few outpatient medicine rotations I can tell you that no matter where you go, primary care is always filled with patients on a million meds, with a gaggle of consulting specialists following them. Now there may be offices where the doctors handle more on their own and refer less out, and nothing would stop you from practicing like an old school doc and doing it all yourself, but if you don't enjoy the nature of the work it will be a very long career. Props to all those who go into primary care it definitely takes a special person, but it isn't for everyone, especially me lol

Agree with this!

If you want more ownership of your patients it can be possible, so I would consider that. Can be a style thing as well as the area. I had a rural rotation with an awesome FM doc who also did hospice, suboxone (needs a special license), and really only referred out complicated cases. In that case the specialists were an hour+ away so it didn’t make sense to refer unless they REALLY needed it. A lot of times in more urban areas it can be the norm to refer almost as professional courtesy, although this isn’t going to be universal between urban and rural areas. But hard agree that there’s always gonna be complicated patients (though you’ll know them more as the primary), patients who are undereducated, etc.
Second thought what about outpatient Peds? Less complicated patients, less referrals, long lasting relationships, etc.
If it turns out outpatient primary care isn’t actually your thing, that’s ok too! I went through something somewhat similar, in that the reality of the subspecialty I was planning on pursuing didn’t fit the lifestyle I wanted. It’s ok to change and learn things about yourself. Better to figure it out now!

 

[futureapppsy2]

Consider doing another FM rotation to get more data on whether it’s the speciality vs. this specific rotation site.

 

[PrimaryCareDOToBe]

Agree with this!

If you want more ownership of your patients it can be possible, so I would consider that. Can be a style thing as well as the area. I had a rural rotation with an awesome FM doc who also did hospice, suboxone (needs a special license), and really only referred out complicated cases. In that case the specialists were an hour+ away so it didn’t make sense to refer unless they REALLY needed it. A lot of times in more urban areas it can be the norm to refer almost as professional courtesy, although this isn’t going to be universal between urban and rural areas. But hard agree that there’s always gonna be complicated patients (though you’ll know them more as the primary), patients who are undereducated, etc.
Second thought what about outpatient Peds? Less complicated patients, less referrals, long lasting relationships, etc.
If it turns out outpatient primary care isn’t actually your thing, that’s ok too! I went through something somewhat similar, in that the reality of the subspecialty I was planning on pursuing didn’t fit the lifestyle I wanted. It’s ok to change and learn things about yourself. Better to figure it out now!

Thanks for your thoughts. To be honest, it isnt the fact that their med lists are so long, I actually enjoy the complicated patients and teasing out those minor details. The problem is more cultural/institutional that leads to charts being extremely out of date - which, obviously can be confusing to both the patients and to any other doctor who sees that patient next. Had their previous Doc who left just remove even the Penicillin from the chart that was prescribed in 2012, 9 years later, the list wouldn't be so chaotic and all over the place and irrelevant to the patient.

I think inherently, Primary Care is an awful rotation for students because the medicine takes way longer than the 8 weeks we are allotted. I look forward to the "Acute Visits" because it is there I can actually start fresh in my thinking about what's going on with a patient - It's hard to know where to start when I've never seen a patient before and they don't know anything about anything and I don't know anything about anything and don't have access to the EMR to even see previous notes for the purpose of their follow-up and what they're trending like. I did enjoy my Peds rotation, but that was because the they were so uncomplicated, I could jump right in and see what was going on with them, but, at that site, I also happened to have access to the EMR - And that really helped too.

 

[sunshinefl]

Thanks for your thoughts. To be honest, it isnt the fact that their med lists are so long, I actually enjoy the complicated patients and teasing out those minor details. The problem is more cultural/institutional that leads to charts being extremely out of date - which, obviously can be confusing to both the patients and to any other doctor who sees that patient next. Had their previous Doc who left just remove even the Penicillin from the chart that was prescribed in 2012, 9 years later, the list wouldn't be so chaotic and all over the place and irrelevant to the patient.

I think inherently, Primary Care is an awful rotation for students because the medicine takes way longer than the 8 weeks we are allotted. I look forward to the "Acute Visits" because it is there I can actually start fresh in my thinking about what's going on with a patient - It's hard to know where to start when I've never seen a patient before and they don't know anything about anything and I don't know anything about anything and don't have access to the EMR to even see previous notes for the purpose of their follow-up and what they're trending like. I did enjoy my Peds rotation, but that was because the they were so uncomplicated, I could jump right in and see what was going on with them, but, at that site, I also happened to have access to the EMR - And that really helped too.

yeah if you don't have EMR access its going to make any rotation pretty awful.

 

[hmockingbird]

yeah if you don't have EMR access its going to make any rotation pretty awful.

Yeah, between that and other details it honestly sounds more like an issue related to the rotation/practice not necessarily the specialty. Complicated patients who don’t understand their illnesses are par for the course, but not having EMR access or another method of sign out is not gonna be your reality as an attending and many practices are more organised. It also becomes easier to just pick up a complicated patient’s chart and know what to do next as you progress through training!