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Friday Sep 19, 2014

'What? Me Worry?' Family Medicine Residency Trained Me Well

From the first day of medical school we start a countdown to graduation and cannot wait until we are finished. Then we do the same thing in residency with even more vigor. The most frequently asked question we hear is, "When will you be finished?" We all answer -- with longing in our eyes -- that we are eager to be free, out on our own and liberated from residency requirements. No more checking out to attendings, holding interns' hands, or eating five consecutive meals in the hospital cafeteria.

It wasn't that long ago that I was worried about seeing patients outside the comfort zone of my residency program. Now I am  mentoring David Paxton, left, a fourth-year medical student at West Virginia University.

But there is a point -- near the end of June -- when the end is in sight, and it is terrifying. The elation I thought I would experience (in my head, it always involved singing and skipping through the office past the exam rooms) was replaced by a GERD-inducing, mind-numbing fear that bordered on panic. I kept thinking, "Next week, I will see a patient and have NO ONE to ask to look at that rash or listen to this murmur. I will be alone."

Then, after a couple of weeks of being consumed by the fear of leaving my residency faculty, it was suddenly time to go to work. I had never even met my nurse. I was going to see patients -- MY patients -- who I will follow for the rest of their lives. And although I had my own panel of continuity patients during residency, there seemed to be so much more at stake with these new patients. What if they don't like me? What if I can't figure out what to do with the very first one? It felt like a major case of stage fright.

Much like during my medical school rotations, when the day arrived, I got up, made coffee, and left early ... but not too early because I've sat many a time in a parking lot of an office that wasn’t even unlocked yet. My drive to work is 25 miles on a two-lane state road along a river where there is zero cell phone service and little traffic. About halfway to the office I saw something huge and black leap out of the river and attempt to sprint across the road. I slammed on the brakes and then watched a black bear climb up the side of the mountain that borders the road. All the while I was thinking that no one would believe this. But when I got to work and told my new co-workers about my bear sighting, they were unimpressed. They have all hit bears with their cars or seen them in their yards.

A couple of hours later, it was time to see a patient. My first patient. The front desk gave me an easy case, a walk-in who already had been diagnosed. I finished that patient, struggled through using a new electronic health records system and even submitted billing. I survived (so did the patient) and the world had not ended.  I knew what to do and how to do it.

I looked a few days ahead in my schedule and found some seriously complicated stuff: refractory cases, uncommon or rare diseases, undiagnosed problems and genetic disorders -- lots of all of them. After about a week of seeing patients, I emailed my residency program director at Marshall University to say thanks. I had the training and background to take care of every patient who had walked through the door.

I love my job, and now I feel silly that I was ever nervous. Family medicine residencies are rigorous, and for good reason. We are the primary care workforce, and we have to be well trained and confident to manage complex patients and serve our communities well.

I had multiple patients who reported their reason for visiting was that they had been "waiting for the new doctor to come." These patients had high hopes, and I had to meet those expectations. Although I am not doing obstetrics (there isn't one hospital in the entire county) I have had multiple pregnant patients, so I have to know how to safely treat -- and just as importantly, counsel -- them, so my obstetrics training is well utilized. There are days when I see more pediatric patients than adults, and there are other days that the average age is 70. 

Throughout medical school and residency, I heard every argument that exists against choosing family medicine. The one I can 100 percent discount after just two short months of practice is the concept of getting bored doing primary care. Really? Bored? I could be a lot of things in my office (annoying, loud, messy) but bored is not one of them. Every day is full of amazing variations that I think highlight family medicine as a specialty.  I learn new things, read new articles and teach every day. 

My patients are my favorite part of my job, but my second-favorite part is that I have medical students. I'll never forget my first patient as a student, my first continuity patient as a resident, or my first patient in my new office. And I'll definitely always remember the first medical student who trusted me to teach him family medicine. Of all the awards and achievements I have hanging on the walls, nothing beats having a medical school place a student in my office. 

I remember asking my rural preceptor when I was a third-year medical student why she took students into her office. Did she get paid or have access to university resources? Now I know why she just smiled at me and explained that she thought they gave her an email address.

Obviously, no one asks me when I'm going to be finished with school/residency anymore. But now I have new daily questions that follow a similar theme: Where are you from (and they want a town name because they can already tell that, like them, I'm from West Virginia)? Are you going to stay here? How long do you think you'll stay?

It feels good to be wanted, and it feels good to be a family physician. And yes, it feels amazing to be done with residency!

Kimberly Becher, M.D., is the resident member of the AAFP Board of Directors.

Posted at 04:37PM Sep 19, 2014 by Kimberly Becher, M.D.

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