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Observations in Family Practice

March 19, 2010

I’m on my Family Practice ‘Block’ time right now, which means I’m in the office most days, as well as doing rounds in the hospital. This affords me the ability to experience a bit more of what it is like to be a GP, but it’s not the entire experience. It’s different in a few ways. Firstly, I get longer appointments with my patients.This is fantastic because it gives me the time I need to do a thorough history and physical, do some patient education about the illness or therapy, and if I need to, ask my supervisor for additional advice or guidance. My notes are still fairly comprehensive, a luxury that may not last.

Life is a bit fragmented since I may be rounding (i.e. seeing admitted patients in hospital) with one preceptor, then spending the day in clinic with a different preceptor (or two!). I also work at two different clinics since my main site doesn’t do prenatal care or obstetrics. Things are different from full practice in that I do not work fully independently, reviewing most of my cases with a supervisor. I also don’t get paid on a fee-for-service basis, which is probably a good thing since I see relatively few patients and don’t understand the finer points of billing, yet! I’d probably earn $20 000 a year tops based on the way I’ve been working, haha! Another downside is that I am not entirely responsible for my patients; the results of the lab tests and imaging studies I order will go to the patient’s main doctor (one of my supervisors). Though I make an effort to look back at the results, for example, to see how a pap test turned out, there are many cases in which I do not have the opportunity to check in with the patient and see how our diagnostic/treatment plan fared. In this way, I function much like a locum tenens. We are working at changing this in our clinic, as continuity, responsibility, and feedback are essential to my becoming a reasonable GP – as is the uncomfortable circumstance of learning from mistakes.

Working closely with a preceptor is a great way to develop. It’s hard to beat one-on-one teaching, especially when it’s with a variety of dedicated doctors who each have a different styles. Their time is probably the most valuable resource I have access to. Working within a team in some ways also mirrors group practice and might be good preparation for the real world.

I still have so much to learn, but there are a few occasions where I feel I know better. It’s not about being ‘cocky,’ but rather, about trying to do what I think is ‘the right thing.’ I greatly respect the experience of my superiors, but I also have a duty to the patient and to myself. It’s hard to know if I’m being narrow-minded or maybe don’t fully appreciate the circumstance, but sometimes I feel I do know what I’m talking about. Most of my formal learning has been quite recent, and on occasion, my understanding of the patient’s psychosocial context may be more complete simply because I’ve  been able to spend more time with them. I do not have the benefit of years of experience and well-backed ‘gut instinct,’ however. It is a rare occasion that my views are conflicting with those of my supervisor – and often, they are able to help me understand the justification of their approach – but in the cases where I cannot see things from their point of view, I worry a little. I cringe when I am asked to put my name on an order in the chart that I don’t agree with.

It’s natural for members of a team to have differing opinions.Nurses, for example, must often take a position that is contrary to that of the physician in order to ensure the patient has the best care possible. Part of my learning will be developing a tactful way of advocating for patients when I feel that the course of treatment selected may not be in their best interests; even as a working physician, I will encounter times in which it is necessary to voice my concerns. I’ll also have to know when to listen to the views of others when they feel my actions are not appropriate.

Overall, I’m enjoying my time in this Family Practice rotation and starting to feel the ‘good feelings’ of a job well done and of developing a continuous relationship with a patient. When a person tells me “thank you for taking the time to explain that,” “it was so comforting to have you at the delivery,” or “I was really worried about today, but that Pap was painless” I feel like I’m doing what I set out to do so long ago. I still make mistakes and always will. Some patients won’t like me and won’t like the plan we work on together. Fortunately, the successful encounters outweigh the ones in which I could not satisfactorily help someone. There’s so much more to learn, but I’ve got some great teachers and the rest of my life in which to do it.

4 Comments leave one →
  1. April 6, 2010 2:01 am

    I like your blog and your thoughtful considerations around the decision making process. I think that’s quite admirable. Good to hear you’re doing well. Thinking of you! ❤

    • April 13, 2010 1:23 am

      thanks hun!
      I like your blog eve though it’s way over my head (especially in terms of the amount of ambition) 🙂 Sounds like you are a real go-getter these days!

  2. April 13, 2010 2:01 am

    😀 Thanks! I guess I’ve been saying ” I’m going to be a famous artist” long enough that it’s starting to affect my actions!

    And, results! woohoo!

  3. April 27, 2010 7:01 pm

    Oh, damn, but it is good to hear your enthusiasm! Mine is buried so far under ICD-9 codes and abnormal potassium results that I have trouble finding it sometime. Keep up the good work, seriously, and dig your toes into every second you have with a patient. When the going gets tough, when the charts become stacked higher than you, when the mindshare between home/patients/hospital/work makes you want to set your hair on fire, there is always that little spark of magic between you and the patient.

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