Family Medicine - Week 1 Done
- Hesham Hassan, M.Sc.
- Jul 30, 2017
- 7 min read
What a busy week full of many patient encounters and new experiences. It has been an interesting first week, and I definitely cannot see myself in Family Medicine as my career choice. However, I do appreciate the applications of screening and preventative medicine that are incorporated into FM. The first week of any rotation feels very busy as you are trying to learn a new system for whatever office or hospital ward you are in, and you are trying to learn the preceptor's expectations.
Monday:
Read about Monday in my First Impressions: Family Medicine post.
Tuesday:
This was an interesting day. We started with grand rounds at the hospital, and this was the first time I attended a grand rounds session. I expected it was rounds with all the interns similar to what you would see in an episode of Scrubs. However, grand rounds is a chance to hear presentations from attendings and residents with case presentations and discussions. I got to learn about medical billing and coding for an hour and a half (which actually helped me with my clinical approach believe it or not), then to residents talk about obstetrical complications as it pertains to FM, and finding and approaching cases of autism spectrum disorder. It was an informative morning to say the least. Grand rounds lasted until lunch time.
After lunch, it was back to the clinic for a half day from 1 to 5 PM...which turned into 6:30 PM because someone showed up for their 4:45 PM complaining of chest pain. And this is when I learned how to perform an EKG. This was a great experience for sure.
Wednesday:
This morning also started with a lecture, but we were to be at a different clinic at 8 AM for a student presentation. We are all expected to present on a case, and this morning we got to learn about autoimmune diseases and alternative approaches to treatment. This was the first time I have ever heard of legumes being high in gluten, and I want to research this more before I personally ever recommend to patients to cut those out too. I think there are so many different trends and fads out there that complicate the ability to recommend a healthy diet to others. Personally, I am still a fan of the In Defense of Food approach: If your great-great-great grandmother would not recognize what you eat as food, can you really consider it food or a food product with less nutritious value? And, as a medical student I really cannot give up coffee so that advice was lost on me.
Then, I was prepared to head to the clinic I am placed for our long day. We started seeing patients at 10:15 AM and the clinic accepts patients until 7 PM...after being there until 7:45 and taking one hour to get home...there was not much time after clinic for studying to prepare for my FM shelf exam. This is when I started to question what resources can I actually fit in during this rotation, and talking to other students about what works best...I'll likely write a post about resources once I feel confident in being prepared for the exam.
Thursday:
Today was probably one of the lighter days of the week. By the end of the day I was ready to go home and sleep. The days in FM feel long, and I am genuinely committed that FM or primarily outpatient practice is not for me. I have been able to do some cool procedures like injections, auditory testing, perform x-rays, do EKGs, and perfect my physical exam skills. However, as many happy patient encounters I had, I also had a frustrating one. When I confronted a mother who believed vaccines cause Autism (they definitely DO NOT), I became heated and had difficulty rationalizing with this parent. I ended up recommending to this mom to continue to do research and look up YouTube videos on what children with polio or measles suffer through until death. I also recommended to this mother to consider what difference a dead child and a child would autism would look like because heard immunity cannot work if the heard continues to thin out who gets vaccines. There have been outbreaks across our country thanks to the anti-vaxer movement and I have a hard time with parents making decisions for children that do not appear to be in the child's best interest. FM has helped me cross of FM and Peds in my future.
I also had to, in the same day, hold down a screaming and scared 2 year old so she could get her vaccines....and I almost think you could make the argument that if the child doesn't want the vaccine then wait until they are older but doing it because the parent doesn't like it seems illogical.
Friday:
Ah, TGIF...even for a medical student, Friday can be a little bit of a reprieve. However, in FM it is a day for families to overwhelm the clinic because making a Friday afternoon appointment seems to be when many families can get off of work. This was a busy day, and I got to learn how to give an injection into the joint capsule of the knee. It was all very cool.
I also had a young female teenager come in for abdominal pain. She looked as though she were going to throw up, and I encouraged her to throw up in the room before I started the abdominal exam because seeing the vomitus would aid in diagnosis. Well, she affirmed that she did not have to vomit so I began the abdominal exam. Before I could even get half way through the light palpation, guess who got to be in the splash zone of a very exorcist-like explosion? Yep! It was pretty cool honestly, as I handled that experience like a champ. We cleaned up the mess, and luckily she has only been able to have water for 12+ hours due to the nausea and pain so it wasn't as horrible as chunky bits would have made it. I continued the exam, and elicited peritoneal signs before completion of the abdominal exam. Basically, it was time to get her to an ER ASAP because she had appendicitis. If you are in rotations, and you get thrown up on, maybe you too will look back and think, "Hmm, this was a very good day."
I got out of clinic this day around 5:15 PM, which was my earliest time to leave so far. My friend rotating in the same place and myself had become more efficient and handled the patient load well which I noticed based on how we were getting out earlier and earlier each day. I made it just in time for rush hour complicated by a wreck, so it ended up taking me 1.5 hours to drive home....and this is when I decided that listening to FM podcasts that prepare you for the shelf was a great idea. I found a couple to subscribe to and I will be using my drive times to increase my frequency of studying.
Saturday:
We all have to work one weekend day during our rotation in FM, and I was fortunate enough to get the first Saturday clinic. It was a different experience because the staff was dramatically reduced, and so were the hours. The clinic is open from 8:30 to 1:30 to see patients, but we had been overbooked with patients due to some emergency visits. I saw 17 patients, stayed until 2:30, given 6 injections, performed 1 chest x-ray, discovered a cervical mass, diagnosed an ear infection, recommended medications, performed a prostate and genital exam, performed a physical on a patient with cerebral palsy, and pushed the boundaries on how long I could hold my pee.
Side story from Saturday:
I also got to meet an interesting couple that warmed my heart. You could tell they enjoyed every minute of life, and were truly happy to be with each other. They reminded me of how my wife and I are when we go to her OBGYN appointments together to check on our baby. I listened to their story, and the history of the patient. She presented for medication refill, as she is being followed for pain management. This patient has brain cancer that has metastasized to the brain stem so it cannot be resected further. She has had much of her frontal lobe removed already, and her personality has changed according to her husband but "she's still the same to me." Her prognosis is poor, and is not predicted to live much more than five more years. They have five children with the youngest being 10 years old and the oldest being twenty. Although the story is sad because we know how this ends, they do not care. The live every moment together, and they focus on making each other smile and laugh. J.K. Rowling had a point, “Do not pity the dead, Harry. Pity the living, and, above all those who live without love.” This couple had a palpable love, and it is likely because they have found a way to cherish the short amount of time they have left. I love you Danielle, and I hope we get to spend at least 45 more anniversaries together ;)
Back to Saturday:
This was a busy day and flew by the fastest because of how pressed for time it felt having less staff. By the time I got home, it was time to go grocery shopping with the family so we could prepare dinner. We decided to watch a movie as a family with "The Lizzie McGuire" movie being our Netflix selection. We were in bed by 9 PM because of how wiped out we all seemed to be. I missed out on my boys getting a hair cut today, but otherwise I have been thankful that I still have a good quality of work/life balance in this rotation. Although I am not able to clean the house as often during the week, we spent Sunday morning as a family tackling chores together so it was very nice.
Sunday:
Ah, an off day! Whew. With a 5 year old and a 2 year old, I felt blessed to sleep in until 7:30. We got up and I made pancakes for breakfast. We cleaned up the house together. Now, it's about 10 AM and I am writing this post before I start studying for my shelf exam. Ethan is next to my desk playing watching Trolls on a tablet (for the 100th time). Danielle is next to me catching up on Big Brother (which I halfway pay attention to since I feel invested in the outcome anytime she starts watching these shows, and I tune in occasionally to follow the plot line). Eric is playing in his room since he is 5 going on 15, and gets annoyed by Ethan sometimes as a big brother should. I am fortunate that I get to enjoy the little things every day and I look forward to another week of FM, as I will be another week closer to finishing my degree.
Thank you for reading another post, and I look forward to any questions or feedback. Enjoy the day, and don't forget to live life!
Comments