Family Medicine

(Some medical schools have a formal Family Medicine rotation while others have a regular continuity clinic that runs concurrently with your other rotations in third and fourth year. Osteopathic medical schools hit Family Medicine and primary care like a pimp with his biaches, that is, hard and often.-PB)

Your Real Responsibilities:

Nothing.  You’re a medical student  You don’t count.  When you first get started your continuity patients who have at last found someone to listen to their long and incredibly boring back-pain epics will get the kind of rush that made them become professional patients in the first place.  So if you have any responsibility, it is to put the teeth into your school’s empathy indoctrination.  Relish this time because it may be the last chance you have to fritter away forty-five minutes exploring every detail of a patient’s life like your non-physician empathy instructors told you to do.

Your Pretend Responsibilities:

If you rotate on an inpatient Family Medicine service, it will be pretty much what you did on your Medicine rotation except the census will be smaller and your patients will generally not be as sick.  Traditionally, Family Medicine only admits their clinic patients, not everybody who shows up like Medicine, so while the service is small, usually consisting of an attending an intern, and an upper-level or two, the pool of potential patients is even smaller.  This will probably be a pretty relaxed rotation as you will not be seeing many patients.

In clinic, you will pretend to evaluate patients who you will present to your attendings.  Eventually your attendings might start to trust you with the minor stuff (and there is a lot of minor stuff) so you may run the whole encounter with a brief social visit by the attending to verify that it is indeed a post-nasal drip and not a raging esophageal cancer.

Things You Should Learn:

Three words: Routine Health Maintenance.

Learn when your patients are due for their shots, their mammograms, or their screening colonoscopies and you will be the Golden Child, the Wunderkind who will bring unity to the primary care force.  Trust me.  You will finally get an interesting patient who looks like undiagnosed lupus and you will be on fire presenting this amazing discovery when your attending will interrupt to ask when she had her last pap smear.  Routine health maintenance is just one of those important defining features of Family Medicine.  It’s their niche and they live for that sort of thing, taking the same satisfaction in getting their patient’s medical house in order as I get in discharging a drug seeker without the narcotics he was looking for.

There are also a few common conditions that will account for almost all of what you see.  A medical student, for example, who understands diabetes, how to manage insulin regimens, and what oral hypoglycemics to prescribe (and why) will double-secret pinky honor the rotation.  If he understood Asthma, Hypertension, and COPD he will walk on water.  If he believes in Fibromyalgia they will proclaim him Family Medicine Material and the full court press will be on to keep the other, more lucrative specialties from seducing him with their promises of interesting work and high salaries.

Things that Will Suck:

The complaining.  Family medicine is a specialty in the midst of an identity crisis and the angst of being the lowest-paid and least respected specialty is going to come through, loud and clear.  Somewhere, the specialty took a wrong turn and decided that social work and many other non-medical functions were part of it’s purvue which has only added to the confusion.

The key problem is that the “Family” is not an organ system which can be treated medically. Since we treat individual patients and not groups, to treat the family, Family Practice physician need to be internists, pediatricians, and OB-Gyns at different times during the day. Since there is no way to roll these three unique specialties into a three year residency, many Family Physicians feel as if they have become nothing but clearing houses for referrals to specialists which can be demoralizing and explains the quest for job justification.

But other than that philosophical crap which you may or may not care about as you hope to become an ophthalmologist and be above those kinds of concerns, if you don’t like routine medical conditions and predictability you will intensely dislike your family medicine rotation.  It’s as simple as that.

Oh, and the grading for the rotation, if you worry about this kind of thing, is more subjective than usual.  The best student in your group will barely pass if he can’t conceal his distaste for the pace and concerns of the specialty.

Cool Things About the Rotation:

I think everybody likes to play doctor which is pretty much what you will do on the rotation.  Family Medicine is what most of you imagined medicine to be like, at least those of you who have not been anal compulsively pursuing a plastic surgery fellowship since the eighth grade, and the immediate risk to the patients is so low that you have the time (as a medical student, that is) to really get to know your patients.

Call:

Bogus, as usual, but since you will only do call if your hospital has an inpatient Family Medicine service, you might slide out of it.  Since the census is small and you are unlikely to be attending medical school where the Family Medicine residency program is unopposed, your duties on call will probably be light and the admissions will be infrequent and fairly straight-forward.  Many Family Medicine services, for example, do not admit and follow critical care patients.

You will certainly not take home call like the Family Practice residents who, in addition to their regular duties, have a panel of pregnant patients threatening to pop at any time.  The logistics of this would just be too complicated.

Slacking Potential:

Terrible.  Clinic goes all day and you will have to be there.  And it can be a slacker’s nightmare as you may have to shadow an attending leaving you with no opportunities for hiding and sliding.  Still, if it’s a clinic rotation it will be a nine-to-five sort of thing so I wouldn’t worry about it too much.