Nice

I just finished yet another rotation, this one in family medicine. There are so many core attributes of family medicine that totally resonant with my values and beliefs about how health care should be delivered. Continuity of care is, in my mind, one of the best parts of family medicine - the fact that a doctor will follow a patient over many many years, in some cases also taking care of their children and/or their parents. It reminds me of my own small town Rutland physician who took care of my grandmother, my family, all my aunts and uncles, and my countless cousins. Dr. Wolk was a staple part of our family's life, and my early childhood is full of memories not only of daytime visits for colds or immunizations in his office right next to the hospital, but also dark nighttime home visits with him shrouded in black, carrying the black bag from which he was soon to pull a huge syringe from. He was there for me when I had weird heart sounds as an adolescent, and did a cardiac echo so that I could be cleared for school sports. He was there when I had an accident at age fifteen that scarred my face and knocked my front teeth out. And much later, I would find out that he was there for my birth, and was the one to transport me from the arms of my birth mother at three days of age, into a car that drove me to the new home of my adopted parents.

So I totally understand what it means to have continuity of care, and how this is one of the foundations of family medicine. But there are other aspects of this choice of careers that are unique to family medicine. These physicians have an incredibly broad scope of practice - that is, anything could walk through their door, on any given day, and they need to know how to recognize and treat whatever shows up. It could be someone with a cough or sore throat thinking they have the flu, someone coming in to check their lipids or sugars to manage their high cholesterol or diabetes, someone with a sprained ankle or sore shoulder from too much yard work, someone with suspicious looking dark skin spots on their face, someone newly pregnant and needing a prenatal ultrasound to confirm the expected delivery date, someone with low back pain, or depression, or headaches, or rashes, or.......the list can go on forever.

That's the cool thing about your family physician - they know about most everything the human body can suffer from, and can treat the most common conditions with compassion and solid understanding of disease mechanism. Of course, if they need too, they can consult a specialist, someone with more depth in one organ system, or a more specialized physician who can handle more complex cases of a disease.

If I had to sum up the family physician with one word I would say he or she is......Nice. Now I know that word is kind of blah, but I can't think of another that so adequately describes how easy it is to work with them, and furthermore, wouldn't you want your family doctor to be, at the very least, Nice? I couldn't say the same about surgeons; a word for them would be....blunt, just like the instruments they use for their operations. And for psychiatrists.......tweaky, allowing them insight and acceptance into mental illness. And for pediatricians.....smooth, giving them the power to assure an overanxious parent, or the ability to look at the eardrums of a screaming sick child. (A cool trick I saw to do this smoothly was saying something like "I think there's a little bird in your ear, chirp chirp, can you hear it? let's see if I can find the little bird...).

I have heard it said that medical students don't really choose their eventual speciality in medicine, that the specialty chooses you. What I think is meant by that is that you figure out who you are (nice? blunt? tweaky? smooth?) and then go into that specialty because you are surrounded by people that have similar temperaments. What happens when you can't decide, or fit into more than one category of personality? Then I guess you just have to work much harder at making a decision about which direction to turn. This is something that all students in my class are currently thinking about, even though we still have a year and a half of medical school left, processes are in motion that will determine what we will do for the rest of our medical lives. In 3 months we will give the dean's office our requested schedule for our fourth year, which begins next June. This schedule will need to have electives of one's own choosing that will hopefully give the students some good letters of recommendation for our residency applications which are sent in on September 1st of 2010.

So far about 30% of our class feels pretty confident of what type of physician they'd like to be, while the rest are struggling between two or three different choices. The frustrating part of this is that we still have not yet even finished our required third year clerkships, which are designed to introduce us to the different types of physicians. As for me, I feel pretty confident that I will end up going into physical medicine and rehabilitation, although I have gotten great feedback from all of my rotations thus far indicating that I would be a good pediatrician, psychiatrist, family physician, and I even saw in my surgery rotation the line "She will make a good surgeon someday!" Obviously on that rotation I was quite effective at hiding my intense dislike of the schedule and personalities associated with the "blunts." I know that I could be a family physician, pediatrician, or a psychiatrist, but the question is whether or not they would make me happy. And that's part of the internal growth process medical school forces you to undergo - who are you, what's important to you, what do you like doing, and what do you dislike? There are a few things that I do know about myself, and know that I will need in my chosen line of work. I get bored easy so I will need to be busy, and I will need some complexity or an intellectual process of figuring out what's going on with a patient. I need to use my hands, and so will have to practice something that allows me to touch my patient (psychiatry is out therefore), and some sort of procedures. I don't have to do procedures all the time (like surgeons), but at least some of the time. I have to have interactions with patients (radiology and pathology are out), and I need sleep (surgery is out, and most likely OB/GYN). What I know so far about physical medicine and rehabilitation fulfills all of the above, and I'm set to learn more as I begin a rotation in Bend in this area of medicine in just two short days. Here's to another exciting time of my education, the discovery of where I fit in best! Cheers!