Thursday Born

The everyday life of a medical student (who was born on a Thursday).

Primary Care Shadowing

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I’ve mentioned our Practice of Medicine course a few times before. It’s a bit misleading to refer to it as one big course, because while it is in theory, it covers a very wide range of class types. It is basically the “everything else that isn’t basic sciences” course. Ethics, Clinical Skills, and… misc? It is in this class where we have the most small group discussions, and where we get a lot of hands on, practical experience. It is very much a mixed bag varying from “Here’s how you do an eye exam” to “How do you think it feels to be an asthma patient?”.

One component of this class was to pair each student up with a Primary Care provider, and have us shadow the doctor four times this year (each visit ranged from 2 to 3 hours). We had our last visit yesterday. Overall, I enjoyed the experience. I enjoyed yesterday a lot more because I actually brought my phone with me and had something to do during the 10-15 minute waits in his office between patients. I realized that I wasn’t enjoying the visits as much because of the down time, but once I could keep myself occupied, I had a much better positive opinion of the whole thing. I half wish I’d signed up to do a summer primary care preceptorship instead of applying for research (yeah… I caved).

There are many aspects of Primary Care that I do like, and while sometimes I was not very excited about having to go, it was overall a worthwhile learning experience. My Preceptor brought up an interesting point today, which was that in medical school teaching hospitals, you see a lot of sick patients. You don’t get to see a lot of the well patient visits, or quick chronic care check ups, that come through a private primary care practice. He apparently has about 4000 patients, which while surprising, I realized makes sense, as he sees most of his patients only once or twice a year, some once every three months. His practice is in the midst of switching over to Electronic Medical Records, and it was fun seeing how happy he was with learning the system and getting to play around with his new tablet pc that he takes his notes on. Apparently, among the doctors in his practice he’s the furthest along in learning the system.

It’s interesting how the doctor you were assigned to shadow colors your opinions. I talked to a friend yesterday and he said that the experience made him not want to do primary care, because his preceptor was so angry. He never yelled at the patients, but after seeing them, he would yell over the phone and one time even threw a pen across his office. Imagine what he must be like when he doesn’t have a student following him around! My doctor, however, never seemed to get particularly riled up. Disappointed, yes, a bit frustrated, yes, busy and overworked, yes, but he maintained an okay though not cheery mood throughout it all.

My medical school has not always been very good about teaching us anything clinical during the first two years, but they’ve been ramping it up the past year or two. I think my year is different even from last years. We’ve definitely had a lot more than the current third or fourth years had at this point. We’ve been learning physical exam components by practicing on each other first, and then we get a chance to practice interviews and physicals on both Standardized Patients (4 opportunities so far; I think 2 more to go this year) and on real patients in the hospital (Seven times so far; for sure 1 more, maybe 2). I really enjoy working with both the SPs and the real patients. I can be shy and/or quiet during social situations, but I actually do have decent people skills, so interviewing (especially when I get feedback after) is often a wonderful ego boost and I always feel really good after. I’m a listener by nature (or by growing up with three loud older brothers? Honestly, I think by nature), which also helps.

Some people say there’s little value in clinical exposure during the first two years of medical school, which in a way, is true. I will probably learn more during the first few weeks of third year than I will these two years preceding it. However, for someone like me who’s straining at the bit to be “done” (you’re never really done) with classroom learning, these are a nice way to refresh my motivations for learning this material. Why am I learning this biochemical pathway again? Oh right! So I can legally and safely talk to and treat patients!

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Written by Aba

April 9, 2010 at 12:29 pm

Posted in Uncategorized

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