Category: Clerkship

Family Medicine: Closing Thoughts

As of last Friday, I finished my Family Medicine rotation.  In my opening thoughts about it posted previously, I mentioned how I loved exploring the therapeutic relationship, forming bonds of trust with patients, and having to know a little bit of everything.  Throughout the 6 weeks, I would say that these were definitely the core concepts I encountered.  As said before, I definitely did enjoy them.

However, I encountered much more than these core concepts as well.  An interesting part of family medicine is that you can ‘specialize’ within it, even though it is so broad.  As examples of this, I spent a few shifts working within Emergency, I spent an evening working with a doctor at a Transhealth Clinic, and I spent a day shadowing at a Methadone Clinic.

So, at a tertiary care centre (a big ass hospital), most of the doctors you will encounter in an ER are Emergency Medicine doctors, which is another type of specialty.  In a smaller centre, you may have some ER doctors, but you will also have family doctors who either have extra training in Emergency, or have spent enough time working in the ER that they are considered qualified for it.

Long story short, I loved my shifts on ER.  It is an entirely different experience compared to clinic.  In general, the problems are much more acute, they require fast-ish follow-up and treatment, and you often get to send people home within a few hours.  I loved the adrenaline rush of this.  Also, strangely, I found that the fact that the patients were around for hours actually gave me more of a sense of connection to them then I sometimes got from clinic, in which 20 minutes was my average.  I am definitely looking forward to my Emergency Medicine rotation after these encounters.

Another exposure I had was to Addictions Medicine.  Now, it is important to note for both this one and the Transhealth clinic that within the scope of the clinic, the physician is not serving as the client’s family doctor.  This is due to the funding model of both of these clinics.  Never-the-less, it is a family doctor who is serving these roles.

To put it simply, for both the Addiction Clinic clients, and the Transhealth Clinic clients, there is a lot that I could say.  And a lot I will say in future blog posts.  Although very very different in nature, both of these populations are generally down-trodden, judged, and forced to live on the outskirts of society.  As you can guess, being treated this way is not good for your health.  If we truly wish to progress as a society, then it is those who we force down that we must focus on helping.  But that is a story for another time.

One of my initial complaints about the rotation had been the simple fact that it wasn’t quite accurate in terms of how actual family medicine feels.  When I watched a patient come in and talk to my preceptor, the doctor already knew that patient’s medical history, social history, etc etc.  This was something that was impossible to emulate, as it only comes with time and familiarity.

Well, because of the 6-week nature of the rotation, I did get to follow-up with a few patients throughout.  To put it simply, it feels rewarding to actually remember a patient from before, and to continue talking to them about their ongoing medical problems, and life in general.  This part of family medicine is definitely something that appeals to me.

So, scattered thoughts need to be summarize.  My final thoughts on Family Medicine:

1) Family Medicine is awesome.

2) I absolutely love the long-term thereapeutic relationship that comes with family medicine.

3) The ability to sub-specialize into different aspects of family medicine allows you to practice medicine as you want, and really seems to breath new life into your practice as well.

4) Family Medicine is definitely not crossed off of my list.  If anything, it is now ranked very high up there.

 

And now, onto my psychiatry rotation.

 

TWS

Of Pain and Suffering

If there is one thing that I have learnt in my 24 years upon this Earth, it is this: Never trivialize another’s pain. Never act like it is less than it is, never dismiss it, and never ignore it. Pain can be crippling, life-destroying, and can suck the joy out of life.

Despite this, sometimes doctors (and medical students, and members of the healthcare team) have no choice but to inflict pain upon those we’re supposed to be healing and helping. Vaccinations require the pain of the needle to protect from future illness. Painkillers may be withheld if the risk of addiction is too high. And sometimes, bad news must be shared.

The other day, I had to hurt somebody. I had to give them some bad news. And to be completely honest, (language warning) I feel like I fucked up.

 

It had already been a long day. A number of complicated patients had already come through, with numerous problems, presentations, and plans made for them. My mental feet were beginning to drag. Worse, my emotional feet were getting tired. A new patient was sent to my room. I introduced myself as usual, explaining that I was a medical student, that my preceptor would come in to talk to them after, and what could I help them with today? They were in to get some test results. And well… the test results weren’t good.

If I could have re-done this, the major change would have been right here. If I could re-do this (as I have 100 times in my head since), I would have left to get my preceptor. To this patient, I was a stranger. I did not have the same bond of trust that he had with my preceptor. But at the time, they wanted to know their results, which I had in front of me. I tried to prepare them, I tried to ready them for the bad news as I had been taught to in a class.

And then I dropped a bomb in their life. I told them. I hurt them. I caused them pain. At the same time, I could feel my own heart ripping from it.

 

Devastation. Have you ever seen true devastation upon another’s face? The type of devastation that causes a person to immediately deny what they were just told? I have, and it is not something that I can forget. What do you say in the face of something like that? What can you say?

All of my so-called training in ‘giving bad news’ was forgotten. Human to human, I tried to console them. I tried to apologize that they were put into the situation that they were. I tried my best to just be there for them. But I was a stranger, who had just given them bad news.

Finally, finally, I realized what I should have done from the start. I went to go and get their doctor. Together, the doctor and I went back in. Thankfully, I think that my preceptor was able to give back some hope to this patient. The doctor was able to come up with a plan to investigate and to help however we could. Some of the damage from the bad news was treated.

I think that my preceptor noticed that the encounter had left me exhausted and drained. They gave me a break, told me to go get some food and come back. I never told them how much that last encounter hurt, and they never told me that they could tell. And yet, somehow, I know that they knew. And I know that that is why they gave me that half hour.

So I went home. I thought about the encounter. I screamed into a pillow for a little while. I tried to take what lessons I could from it. I acknowledged the pain and sadness I was feeling, and that helped me. Not to overcome it, but to incorporate it.

 

I decided, then and there, that I want to do everything I can to minimize pain for patients who need to receive this bad news. I want to do everything I can to be there for them, and to try to help them retain hope.

I went back to the office after that break, and I saw more patients. I tried to help them with their problems. I tried to reduce their pain.

I tried, and am still trying, to learn what it is to be a doctor.

 

TWS

First Impressions: Family Medicine

I’m 2 weeks into my rural family medicine rotation, and I am loving it so far.

For those of you unaware, family medicine is something in Canada that is similar but different than a general practitioner in most countries.  Like a GP, they are the doctor that you will see for your check-ups, and at walk-in clinics.  Unlike a GP, they have a large focus on prevention and are considered a ‘specialty’ as they do undergo additional training after obtaining their MD.

To explain it as simply as possible, Family Doctors specialize in illness prevention, harm reduction, and the therapeutic relationship.  They get to know their patients, they form an ongoing doctor-patient relationship with their patients, and they use this relationship to either prevent their patients from getting sick (lifestyle advice, smoking cessation, etc), or to reduce the harm that might result from their patients getting sick (screening for disease early, or treating illness before patients become sick enough for the emergency room).

I love this aspect of family medicine.  I love talking and forming that trust with people.  I love learning about their lives and their context.  I love being able to help them figure out ways to stay healthy or get healthy.

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So what are my problems so far?  Well, #1 would be that I am realizing how much I don’t know.  And that sucks.  Family Medicine is extremely broad in scope.  It has “99 core topics”, ranging from abdominal pain to stroke to depression.  To put it simply, there is a lot to know.  You have to know a little bit of everything to be a good family doctor.  And as this is my first rotation, I basically know a little bit of nothing.  Or so it feels.

So I spend a lot of my time realizing how much I don’t know, looking up my knowledge gaps, then realizing that I still don’t know enough, rinse and repeat.  That is my life right now.  So it sucks but I feel like I’m constantly pushing and learning.

The other thing I’m struggling with is time management.  Of course, I’ve been told that as a student, that is totally normal.  They don’t care how long I take, as long as I get all the information.  I understand this, but still… I wish I wasn’t quite as slow as I was.

And then there’s the situations that I just can’t help with.  The complex social situations that you know is contributing to people’s health struggles, but simply seem to fall outside the scope of a family doctor.  Things like poverty, racism, and cruelty.  I can offer support, but how can I go about changing things like the structural poverty that many face?  It’s extremely frustrating and sad.  Obviously moreso for the person dealing with it, but unfortunately I can’t close my heart to things like that.  It’s tiring and draining and so hard.

So, that is my first impression of Family Medicine.  Definitely something to love, definitely something that I’m interested in doing.  In a few weeks, I’ll post an update, since I have some exciting novel encounters coming up including shifts at the Emergency Room, TransHealth Clinic, and Addiction Clinic.

 

Until next,

TWS

 

 

Terricited

It is the beginning of my next journey. After 2 long years of study and work (and 1 year of a sabbatical of volunteering and work), I am finally at the beginning of clerkship. Never before have I been so excited, nor so terrified. Terricited, if you will.

For those of you reading who may not be familiar with medical school terminology, ‘clerkship’ refers to the last 2 (or around 2) years of medical school in Canada where we assume clinical responsibility. Whereas the first two years is mostly theory with some clinical practice, the last two years is mostly clinical practice with application of that theory that we desperately learnt during the first two years.

For the first two years, the worst thing that can happen is that you fail an exam. The thing about that is that the consequences begin and end with you. If you fail an exam, then you re-write it, and learn that information that you might not have known well enough.

In clerkship, however, the consequences do not end with you. You are responsible for patient care. Although you should be getting overseen by somebody more responsible and knowledgable than yourself, mistakes can happen. Things can slip through the cracks. You can hurt somebody. That is terrifying beyond measure.

However, it is also so much closer to real medicine than the first two years. Finally, you are practicing and experiencing medicine. You can talk to patients, and help them cope, and maybe catch something that might have been missed. You can spend time with patients, and learn their stories, and be there for them. That is exciting beyond belief.

I begin my first rotation tomorrow. This is the beginning of my clerkship journey.

 

Now, before I leave, a disclaimer of what this new section of the blog will be, and more importantly, what it won’t be.

This will be a blog where I share my thoughts, my reflections, and my beliefs. This will NOT, however, be a blog that will contain ANY details of any patients, doctors, classmates, or anything else identifying of anybody I meet. The only exception to this will be if I have the absolute and ethical permission of those involved.

Hope you have fun reading.