One of the truly great things about family medicine
residency is the fact that no two months, let alone
two days, are ever alike! With this is mind,
I have chosen a day from last week to describe as it
is as good as any. I am currently on a rotation
we affectionately call FMC. It is an outpatient
month where we get our own extra clinic time in addition
to really unique shadowing experiences in the community. This
month, I have the privilege of spending time in an
occupational health office as well as observing the
delivery of palliative care through hospice.
This particular day starts with a 6 AM wake-up, which
seems to be pretty standard for non-call months. I
am in a hurry to get to the hospital because I was
informed the night before that I have a clinic patient
in the hospital. Note is on the chart at 7 AM
and the medicine team is at rounds; alas, I have the
resident’s lounge to myself (if only for a few
minutes) to enjoy my morning coffee! This actually
turns into a very productive time of responding to
nursing messages, filling prescriptions, and reading
over my patients for today’s clinic. Today
is my second clinic of second year. Literally
overnight, the number of patients that need to be seen
per hour increases as well as the complexity. Admittedly,
I have some anxiety going into clinic.
It is finally time for clinic and I go outside, instead
of through the tunnel, to cross the street to go to
clinic. It is important to take every chance
possible to build the Vitamin D stores! It is
a beautiful morning and all I am thinking is that I
hope it is this nice tonight as I really want to go
for a run. Anyway, clinic goes remarkably well. In
the 3+ hours, I have performed a well child exam on
a 6 month old. I have seen an OB return patient. There
is a new clinic patient in her 50s with minor medical
problems. I see a 64 year old male with CKD 5
on hemodialysis who is now my patient and I just met
for the first time. Looking over his problem
and medicine list is daunting to say the least. The
time in between is filled with acute visits, some runny
noses, some unknown masses and rashes then finally
leading to my last patient of the day. He is
a hospital follow-up patient turned personal patient
that is unable to be compliant with medications secondary
to cost. It is always a very frustrating and
sobering visit.
It is now lunchtime and I realize that I really like
our new schedule. Instead of noon conference
destroying the lunch hour everyday, we now have ½ day
of didactics on Wednesday mornings all at once. This
is definitely going to be a good move. I grab
a bite to eat, finish as many leftover clinic notes
as possible, and then head to my shadowing experience
for the day. It is with occupational health. We
end up seeing 10-12 patients that afternoon, many acute
injuries being covered by worker’s compensation. In
the end, I was pleasantly surprised by the experience
and enjoyed it a lot. Part of this was due to
the solid neuro and musculoskeletal exams, my two favorite
parts of the physical exam, being performed on every
patient. It also changed my perception of the ‘typical’ worker’s
compensation patient in that I did not feel that any
patient I saw was malingering and all wanted to get
better and get back to work. So for all this,
it was a great experience.
It’s now 5 PM, and we’re finished. I
have a couple notes to finish from my own clinic so
I head back to the hospital. This is easy and
I’m out of there soon thereafter. As I’m
heading to the parking lot, the sun is still out and
it is a solid 80 degrees. In my mind, I know
I am 10 minutes away from pounding the concrete and
then firing up the grill!
Today was a good day!
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