- It is easily the broadest field of medicine a person can go into. Everyone needs a primary care physician (not that we all go, but that's the theory at least), so FM docs see everyone. Chronic conditions and acute illnesses; young and old; every part of the body; every stage of illness.
- By the very nature of your patients and the standards for their care, the people you see most are the ones who are least compliant and least likely to change. The other side of that coin is that the patients that actually take care of themselves, you rarely see.
- When someone with interesting complaints comes in, either with a new acute problem or new complication of a longstanding condition, you get to briefly attempt to be Dr. House and diagnose what's going on. But you are not an expert in anything, so unless you are supremely confident in your ability to treat whatever it is, the most you can do once you have an good idea of what's going on, is refer the patient to a specialist or to the ER.
- If you really want a lifelong relationship with your patients, this is the field for you. As each generation comes in, you get to know the whole family and, in a way, become a part of it yourself.
TuesdayIL: Even though there is nothing we can do other than encourage further physical therapy for patients recovering from Bell's palsy (unilateral facial paralysis), giving those patients positive encouragement regarding how much they've progressed since we last saw them does wonders. We saw a woman on Tuesday who was two months into recovery from a fairly severe case of Bell's palsy. She had regained some movement, but it was still very noticeable that her face was not moving symmetrically. She essentially came in just for reassurance and quickly broke down in tears. But having a doctor and medical student both emphatically comfort her that not only was she still early in the process, but she looked fantastically improved from the last time she was in the office put a smile right back on (most of) her face.
WednesdayIL: Standardized patient scenarios are not always totally inaccurate portrayals of the medical experience! Wednesday we had a couple of patients with complaints that somehow seemed exactly like the ones we hear from our standardized patients. At first, I didn't realize what it was that gave them this quality; I just had a visceral response and felt like there must be a hidden camera watching my performance. Then it clicked - these patients each had one non-specific symptom with no associated symptoms or physical exam findings.
Pt: I've have dry mouth for 2 months.
Me: Any other symptoms?
Me: Have you been sick, with a cold for example, in that time?
Me: Do you feel sick now?
Me: Has this ever happened before?
Me: Huh... Do you think you've been drinking the same amount of fluids as usual?
Me: Have you changed any medications in that time?
Pt: I don't take any medications.
Me: Did anything else in your life change around the time this started (e.g. new job, pet, house)?
Me: Ooo! [getting excited because I remembered the one condition with dry mouth, Sjogren's Syndrome, and its associated finding...] Have you by any chance had dry eyes during this same time?
Pt: Um... [YES?!?] No.
BonusFridayIL!: Apparently, the National Board of Medical Examiners (NBME) does not have enough servers. Relatedly, some poor IT guy/gal at the NBME had the worst day of his/her career on Friday as the testing servers for medical school exams went down across the country. My 200+ fellow classmates had to awkwardly sit around and not look at anything on our computers, not turn on our phones, and not talk about medicine - which is surprisingly difficult - because any of that could be construed as cheating and we were half-way through an exam. It all worked out in the end. I'm pretty sure most of my classmates made their riskily scheduled flights home and, more importantly, I made my Star Wars show time.
This will be my last post until I return from winter break in early January. Happy holidays and season's greetings!