Third year began with the familiar anxiety that accompanies each transition in life. In my case, the transition from sitting in my apartment studying constantly to the clinical environment. It’s truly amazing how in the span of a few weeks away from medicine, you can go from feeling like you know so much during dedicated to feeling like a complete idiot when you show up on day one of your first rotation.
While I’m currently on surgery, I started with family medicine and I thought it’d be a good idea to write a little review of each rotation after completion. I’ll include comments about the rotation, my experience/strategy for studying for shelf exams, as well as memorable quotes and interactions (inspired by the “overheard on X rotation” posts on Reddit).
Okay, so we just took Step 1 and learned a bunch of stuff that we’ll never actually see, and now it’s our job to incorporate the useful/common information into the clinical environment. What is expected of us? Like all of you, I want to perform my best, learn and soak up as much medicine as possible, and earn good grades.
However, we certainly don’t know everything. We actually don’t know much at all. But the way I see it, there are three things we always have control over:
- What time we show up. Always be early. Attending gets there at 7:30? Show up at 7. Look over the schedule. Check out what patients/complaints you’ll be seeing. Read until they arrive.
- How we treat others. Treat everyone with respect and kindness. Be friendly. Introduce yourself. Do your best to remember names (“a person’s name is to him or her the sweetest and most important sound in any language” – Dale Carnegie). Always ask if there is anything you can help with. Ask how someone’s weekend was. Ask how their kids are.
- How hard we work. Again, you’ll quickly realize that you have a lot to learn about the actual practice of medicine. This ain’t Step 1 anymore. Zebras are zebras. You’re going to get pimp questions wrong. You’re going to feel stupid at times. That’s alright. Brush it off and study. That’s all you can do. Master the most common conditions treated by a given specialty. In family medicine, learn the hell out of hypertension, hyperlipidemia, diabetes, etc and how to manage these conditions. You won’t be expected to know everything. You will be expected to put in effort and try to learn as much as you can.
End of Rotation Review: Family Medicine
I was lucky. I’ve always considered myself as someone who tends to have bad luck in a variety of situations, but third year has been amazing to me so far.
My attending: I was able to start my clinical education with the best attending I could possibly ask for. Admittedly, I was pretty nervous to start; I’ve heard of/read countless stories of students getting stuck with unpleasant, jaded doctors for a rotation. Conversely, my attending was not only a phenomenal teacher, but he was empathetic to the medical student experience. He was excited to teach. He enjoyed his work. He wanted to ensure that I enjoyed my time on the rotation. And I absolutely did.
Lastly, my attending’s comfort, charisma and patient manner were inspiring and qualities that I wish to emulate in my own career. Great guy.
Daily routine: I’d show up at seven every day and he’d come in around 7:30. I’d see the patients, do a focused H&P, then present to him. Next, we’d both go in and see the patient together. Afterwards, he would hit me with some quick clinical pearls before seeing the next patient. We’d do this until around lunchtime/early afternoon, when he’d send me home with one principal learning objective for the day (eg, diabetes management, skin hypersensitivity reactions, and so on). I’d go home, work out, do some reading, and hang out with friends.
Shelf Exam: Yeah, I didn’t really know how to study for my first shelf exam. I read the Ambulatory chapter in Step Up to Medicine, did UWorld questions, watched some Online Med Ed, and memorized the USPSTF screening guidelines. And I did quite a bit of Googling. I did well, but the exam was a total crapshoot of randomness, and I’m not sure how I’d even approach it if given another opportunity. It was nice having family med first because it covered such a wide range of topics that forced me to think back to Step 1 studying. I’ll have actual advice for future shelf exams when I settle in and get the hang of it.
Family Medicine: I sadly have a pathologic love for the operating room and I’ve never really considered family medicine, but to those that are interested in primary care, I must say that I think it’s a great choice. To me, the cons are well visits (yawn), lack of acuity, and losing all of the super interesting cases to specialists. But on the plus side, I admired the longterm patient relationships and the control over lifestyle.
Obviously this experience is anecdotal, but my attending has made a pretty damn good life for himself. He enjoys his work. He only comes in four days a week. He goes to all of his son’s baseball games. He lives in a very nice neighborhood. And he provides a valuable and honorable service to the community. Don’t ever let anyone shame you away from going into family medicine if it’s what you want to do. Don’t be a sucker for prestige or ego.
Lastly, while there were many medical teaching moments, the most valuable lessons came from the down-time conversations about life. Always, always, always be sure to soak up wisdom from your elders. They know more than we do. We’re not only here to learn medical knowledge, but also to pick up on the subtleties and nuances of life in general so that we can shape our own the best we can.
And now, here are a select few of my favorite quotes from my time in family medicine. Some made me smile, some made me laugh, while others made me think.
- [Attending tells me to go home at noon on the third day in a row]
- [Dr]: You can take off now. You’ll learn more by going home and reading than you would staying here until five seeing the same patients.
- [JS]: You sure? I can stay and help out if you want.
- [Dr]: There is plenty of time in your life to be miserable, Jordan. You’re not going to be miserable this month.
- [Dr]: I can accept stupid. If you’re stupid, well… you know. Now if you’re lazy– that’s a choice.
- [Dr]: Doxycycline. If you’re ever on a desert island, that’s the drug you take. The plague. Chlamydia. It’s great.
- [Dr]: Listen, always listen to the patient. But don’t let them talk you into shit.
- [JS]: Patient is –
- [Dr]: Jordan, I don’t want a story. Save that stuff for IM. Diagnosis & treatment. That’s it.
- [JS]: Contact dermatitis. Oral steroids.
- [Dr]: Now you’re thinking like a doctor.
- [Dr]: I always tell people: Don’t look for trouble – it’ll find you soon enough.
- [Child screaming and crying in hallway]
- [Nurse walks over]
- [Nurse]: Who was that?
- [Dr]: It was Jordan. It’s his last week here and he’s starting surgery next so he’s been really sensitive lately. Be nice to him.
- [On the topic of vague recurring abdominal pain]
- [JS]: So, what do you do?
- [Dr]: Me? Oh, I say nice things. I smile.
- [Walking into patient room]
- [patient]: Ohhhh… I’ve got a list for you.
- [Dr]: Ohhhhh do youuuu? Wow. That’s great.
- [On the topic girlfriends & my breakup]
- [Dr]: Were you sad?
- [JS]: Umm… uh.
- [Dr]: It’s ok. It’s normal to be sad.
- [JS]: I mean, yeah. I guess. A little.
- [Dr]: Good. Sociopaths shouldn’t be doctors. You’ll do fine.
- [On the topic of ordering expensive and sometimes unnecessary tests]
- [Dr]: I’d rather a patient come back in and chew me out for ordering an expensive test when they were fine than hear someone tell me, “you could have saved my dad”.
- [Doctor on lunch break looks out the window and sees a patient trying to find a spot in the full parking lot]
- [Dr]: Jordan, go.
- [JS]: Should I–
- [Dr]: Go go go! See you tomorrow.
- [Doctor counseling patient on the importance of taking BP meds]
- [Patient]: If it causes you to be different than God created you, you shouldn’t take it.
- [Dr]: God also created someone smart enough to invent blood pressure medications so that you can live a longer and healthier life.
- [Nurse]: Oh is Jordan staying a full day for once?
- [Dr]: No, he was just leaving. He has things to do. He has to study. He has to work on his golf game. He has a hot date tonight. Don’t you, Jordan?
- [JS]: She said that smoking weed is the only thing that really helps.
- [Dr]: Do you think smoking weed is good for you?
- [JS]: I, umm… I don’t know.
- [Dr]: So you’re telling me you’ve completed two years of medical school and you haven’t figured out that inhaling hot combusted smoke is actually not good for your health?
- [JS]: *nervous laugh*
- [Any time my attending is trying to wrap up a patient interaction]
- [Dr]: HA, yeah I’ll tell ya, that’s really something.
- [Patient trying to convince Dr. he has a very rare, almost unheard of side effect from a common drug]
- [Dr]: Well yeah – somebody has to win the lottery, right? It’s probably not you, though. Trust me.
- [on the topic of opiate/heroin addiction]
- [Dr]: So I said to this addict, I said, “so what do you think when you see people on the news dead in their car, with a needle in their arm?”
- [Dr]: You know what he said to me? He said, “you don’t get it. All I’m thinking is where did they get that shit? Must be good stuff”.
Hope you enjoyed this post – I’ll stick with the current format for my write-up on each rotation. I’m currently on surgery now, which I’m absolutely loving, so stay tuned.
Follow me on Twitter at @JordanSoze for the latest.
See you next time.