Wednesday, May 9, 2007

The Full Experience

For all the loan money I have invested into my medical education, I am finally beginning to cash in on the returns with a full hands-on medical training experience. While staying at the house of the doctor who is overseeing my Family medicine clerkship seemed at first like a terrible, "I must always be on my best behavior at all times," freedom restricting idea, I have come to realize that there couldn't possibly be a more complete "family" medicine experience.
Today, my morning began with a rude awakening, not from the alarm clock set for 7:00 am, but from the phone ringing at 5:45am to herald the news of a woman in full contracting labor (aka, we need a physician, promptly). I sprung out of bed, hair unkempt, mouth nasty tasting, sleepies still caked around my eyes, threw on a pair of scrubs, and met big boss Bedell in the hallway as instructed, "like Batman and Robin, should the phone happen to ring at night." Practicing medicine as the only family doc in town means that you are continuously committed to the care of your patients, be it morning or night, in the rain or shine. Rural medicine can transform unpredictably from a chill, laid back clinic day to a hectic "get your gloves and gown bloody, we've got lives to save" kind of day. My day began with the assistance in the delivery of a healthy 38 week old, small for gestational age infant, and didn't end until I had successfully performed an excisional skin biopsy of a possible melanoma, applied two Voler splints to probable distal arm fractures, sugar-tong splinted a man's compound wrist fracture/dislocation after unsuccessfully attempting to reduce his radius and ulna bones back into place from their "jagged bones protruding from skin" orientation, and performed two venipunctures to start up IV lines, meanwhile running back and forth from the clinic and ER to work-up scheduled clinic patients for pharyngitis, acute COPD exacerbation, recurrent yeast infection, and acute alcoholic intoxication, among other diagnoses.
To date, my apprenticeship in Family medicine has afforded me the opportunity to sew up lacerations, perform nerve blocks and steroid injections, surgically remove ingrown toenails, order labs and imaging tests, write prescriptions, verbally dictate notes for medical transcription, and most challengingly of all, to defend my clinical decisions with confidence and reason. Dr. Bedell makes me work responsibly hard and expects me to assume the full care of the patients that I see, including the initial work-up, deciding on which labs/tests to order, following-up on those tests, and deciding on a treatment plan of care. He allows me the chance to see his patients before he does and encourages me to justify my findings and assessment with confident reasoning. We'll spend a few moments talking over my treatment plan, at which time Bedell offers a few recommendations, then tells me to make the final call, including writing the prescriptions, filling out the imaging/lab order form, and proceeding with the plan of care. Whenever I remain unsure of my decisions or hint that I am still vacillating between two treatment plans, Bedell will respond by saying "I dont know man, he's your patient. You've gotta decide and tell the nurse what you want done. They're not going to listen to me. I've told them that you're calling all the shots." So it really forces me to be confident with my clinical decisions. When we go in together to see the patient together, Dr. Bedell is always saying stuff like "Andy decided to start you on this antibiotic" or "Andy has decided to order these tests for you," or 'Andy will give you a call this afternoon to inform you of the results of the tests he ordered," which always surprises me a little, but makes me feel like I am actually a part of the care.

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