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Tuesday Nov 20, 2018

Bustling Clerkship Shows Family Medicine Is Never Boring

Not only was family medicine the first specialty I was ever interested in, it was my first third-year clerkship in medical school, too. Although I started medical school thinking family medicine was the specialty for me, it wasn't until my clinical experience during third year that I really knew this is exactly what I want to do with my career.

[physicians walking quickly through corridor]

The first few days of my clerkship were split between the clinic and the classroom, with lectures and workshops on a variety of topics. The second and third weeks of my rotation (and the weekend in between) were spent on the family medicine inpatient service, where my team rounded on patients in the pediatric wards, the adult medicine floors, the critical care unit, the medical intensive care units and even the neuro intensive care unit.

Along with all the new medical acronyms floating around in my head, the same thought kept playing over and over again: "How in the world am I supposed to learn all of this for my exam at the end of this rotation?"

Even more than that, the residents and attending physicians with whom I rounded acted like it was completely normal to walk all over the hospital, to different buildings, through badge-access-only doors, up and down stairs, and back again. To say I was overwhelmed would have been an understatement. It was impressive that these doctors were not only treating patients of all ages, with all different diseases and in all stages of disease processes in the hospital, but some of them were also going to clinic after rounds each day to see a totally different all-ages-and-stages patient panel and offering broad-scope services that included prenatal and obstetrical care, as well as a variety of office procedures.

After surviving two weeks of hospital wards and three weeks of family medicine residency clinic, it was time for my rural family medicine experience during the last three weeks of the rotation. The family medicine clinic was next to a small hospital in a rural town about an hour away from the medical school campus. Three family physicians and one nurse practitioner staffed the clinic, but their practice was a little bit different than what I had seen back at the regional medical campus. The doctors in this rural practice had full clinic schedules, and they would go to the hospital before, during and after clinic to see patients they had admitted a few days earlier or maybe to check on a newborn that had just made her way into the world.

On Wednesdays, I'd spend the morning with one of the family doctors in the endoscopy suite, where we'd do several endoscopy and colonoscopy procedures. On Thursdays, I'd go with one of the other family doctors to do cardiac stress tests. These family docs were accustomed to doing a lot of procedures in their clinic, but one day, a man walked in with a blood-stained towel wrapped tightly around his hand, and I knew things were about to get interesting.

The nurse quickly shuffled the man back to the procedure room as I followed one of the doctors to go check on him. We carefully unwrapped the towel and exposed the patient's hand. He had cut it with a box blade while trying to open a large box. Blood started pumping across the room to the beat of the man's pulse. Yes, he had nicked a small artery, and here he was in the family medicine clinic!

This was my first experience suturing a live human being -- and he was awake for the whole thing! The doctor injected some lidocaine, placed the first suture, then let me finish the job. As I worked, I talked with the patient to try to calm my nerves a bit. He told me how much he appreciated these doctors and how it had saved him so much time and money not having to make a trip to the ER. The man was in and out of the clinic in about an hour, which never would've happened in the emergency department, he said.

As my rotation was coming to an end, I had the same thought that I still have about family medicine: There is never a dull moment! What an amazing opportunity my eight-week rotation had been. I couldn't believe the variety of medicine that I'd seen in such a short time, and I am so thankful for the wonderful family physician mentors who taught me along the way. It is my goal to one day mentor students just like I've been mentored during the past three and a half years, and I hope every medical student in the country has a full-scope family medicine clerkship experience like mine.

If more students knew the full potential of a family physician, we wouldn't have the primary care shortage that we do. The existence of a link between scope of practice exposure during clerkships and match rates into family medicine isn't farfetched, after all; a recent study(www.stfm.org) showed a tie between the two. For the health of our communities, our medical schools should be doing more to ensure that students have rewarding family medicine clerkship experiences and that they have them early on.

As a student, you can advocate for yourself to see the full scope of medicine in your rotations. Talk to your family medicine department's clerkship director about your interests so they have a better idea of which sites might be a good fit for your goals. You can also give yourself a head start on your family medicine clerkship if you attend the AAFP's National Conference of Family Medicine Residents and Medical Students in your first or second year of medical school and stay active in your family medicine interest group on campus. Both actions will help you discover what you like most about medicine overall as they allow you to explore so many different areas: maternal care, procedures, sports medicine, adolescent medicine and a lot more.

Picking family medicine as my first clerkship might have been going a little bit against the grain. After all, most students tend to feel like they should save it until they've gotten more clinical experience to draw on, but it was a decision I definitely do not regret. It helped me see that the opportunities I had were truly endless. I'm excited to continue learning what it means to practice family medicine, and I can't wait to see where my career takes me. I'm proud to be a (future) family physician!

Chandler Stisher is the student member of the AAFP Board of Directors.

Posted at 01:30PM Nov 20, 2018 by Chandler Stisher, M.D., M.P.H.

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