Settling in to FMD

6 10 2011

First, I wanted to share this fun cartoon, because it describes how I often feel about the whole student loan thing:

I’m at the end of week 4 of family medicine now, and with only 2 weeks to go I’m having mixed feelings about it.

I had posted a status update on the facebook last week saying that I wasn’t sure family med was for me, and that honestly was influenced quite a bit by my experience to that point.  I hadn’t been able to do much on my own in the way of evaluating patients or doing procedures.  In the last week in particular, things have improved.  Monday was awesome in that I got to do a punch biopsy (complete with my first sutures on a person!), help with an I&D of a neck abscess, and do STD testing (with a speculum exam) on a lady all by my lonesome.  Of course, the residents tell me that this many procedures in one day is not normal, but I’ll take what I can get.

That being said, as thrilling as it is to actually be able to do this stuff, it’s not super pleasant to learn.  All I can say about learning to do a “female exam” is that I am so grateful my school has a great program to teach us that involves learning on real volunteers instead of just plastic models (and, let’s be real, actual body parts hardly ever look like they do on Patty Pelvis).  So by the time I did my first Pap & pelvic on a real patient a couple weeks ago, I at least had some idea of how to work the speculum and, more importantly, it wasn’t as awkward.

The hardest thing is  learning in front of the patient.  You want to project confidence, but still ask the questions necessary to do it right.  Most of the patients at my site are great at allowing students to learn on them, and this is probably because they know the residents are standing by and watching to make sure there’s no serious damage done.

As much as they tried to teach us how to do “real” doctor things in our clinical medicine class, there are some things that no amount of teaching will really help.  Example:  learning to break bad news.  I had to tell a woman today that she had diabetes and what that meant.  The resident was in the room with me, but it was still very unpleasant.  There were lots of tears.  The only other time I have seen bad news given in the clinic was a terrible example: the poor man had a basal cell cancer on his forehead and the attending told him by sauntering into the room, looking at the lesion, and saying “oh, yeah, that’s a basal cell cancer.  It’s okay, that’s the good kind, we can lop that sucker right off.”  Poor form.  The silver lining of those two situations is that both conditions were caught early enough that both can have really good outcomes (for you non-med folks, basal cell cancers are slow-growing and its super rare for them to metastasize).

Part of the reason why my experience overall has improved is that I’m learning how to be proactive about doing things without being aggressive.  It took a while for me to be okay with asking if I can see a patient on my own or do a pap smear or give a flu shot, but most of the time, I’m allowed as long as I ask, and it’s great!  Seriously, the fact that it took me so long to realize this ticks me off just a little, because I could have made the experience better for myself.  Now that I’ve managed to “grow a pair” and gain a little more confidence,  it’s kind of cool to know that a lot of my learning experience is in my own hands.  A significant chunk is in the hands of my residents, too, but why sweat that when I can’t control it?

All in all, there are a lot of things I like about family.  I like the variety, I like that it requires a wide knowledge base, and I really like the hours.  It’s pretty chill, and the continuity of care is great, too.  For me, I’m not sure it’s the best fit.  But we’ll have to see 🙂

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