Monday, February 26, 2007

Case of the Mondays

I am an irritable person. And it was Monday.

Point the first: Today was intro to "Family Medicine". It is no longer PC to call it "Family Practice". I wouldn't think anything of it, but after the lectures we had, it's almost like they're trying to remind the rest of us that FP is "real medicine".

Point the second: Our last lecture of the day was called "Family Medicine", and consisted of a doctor berating us for ever thinking that FP... I mean FM could be a) boring b) dull c) too easy d) too hard, or that family docs don't make any money, citing an example of a doc who works 8 months a year and makes $250k (I'm not sure what planet that doc practices on! The expected median in Houston is $158k).

I don't know why it is that so many family docs (certainly not all, but quite a few) get so freaking DEFENSIVE about family practice. "No, really, it's super awesome! Really! I swear!" I understand that primary care is necessary; I understand how some physicians find it fulfilling. I just find it extremely boring to manage "the same 20 diseases" over and over again. And just because you CAN perform an outpatient procedure, or deliver a baby, doesn't necessarily mean you SHOULD, Mr. "I do all my own procedures". Grrrr.

Point the third: It was an extremely useless day. We had 2 hours of lecture on "Behavioral Change", aka "why you should feel sorry for your patients who smoke." The first hour wasn't too bad: the lecturer was engaging, the topic was new, she made it interactive... The second hour was a rehash of the first, with a repeat of the exercise from the first hour. "Now, when you take a history, you should repeat what the patient says, to show you're listening! You can even repeat it back in DIFFERENT TERMS; it's called paraphrasing!"

I did Sudoku.

Point the fourth: These lectures were followed by a 2 hour lunch break. Why take a 2 hour lunch when you could take a 1 hour lunch and go home at 3 instead of 4? Inquiring minds want to know. We ate outside, and I got sunburned. Curses on my pastiness!

Point the fifth: I went to the gym tonight and hopped on the elliptical machine for a bit. The good ellipticals are hard to come by, so they limit your time to 30 minutes during busy times (like tonight). The machines are packed into a small space, and are therefore only about 1.5 feet apart.

A girl got on the one next to mine, which happened to be next to a close friend of hers (on her other side). He hopped off his machine and spent the next 30 minutes (of my workout) draped over the front end of her machine. Oh, did they have a great talk! I know this, because I could hear them over Nine Inch Nails and Christina Aguilera at top volume on my iPod.

During this time, he kept his leg draped over the elliptical he'd been using, so he was still "on" the machine, even though he was having such a fabulous conversation, effectively keeping everyone else off 1 of the 5 elliptical machines.

To make matters worse, he was all of 5 feet away from me, facing exactly my direction. I am not an attractive gym-goer. My face turns beet-red, I get visible sweat marks, my hair gets soaked, and my whole body jiggles (except what's inside my two sports bras). In other words, I look awful, and I'm extremely self-conscious about it. And I could not get over the fact that he was facing me, not looking politely in another direction, or better yet DOING HIS OWN GODDAMN WORKOUT.

Yes, I'm a cranky-pants, but is it too much to ask that everyone else get hot and sweaty, too, if they're at the gym? If you want social hour, and you're not going to work out while you do it, then go to a coffee shop for pete's sake and let me sweat in peace.

At least when I got home I had an ice cream sandwich waiting for me. Tasty!


Does anyone else's dog or cat like to snuggle while you are on the toilet? J-dog came in with me after I got home from the gym and spent the time licking the sweat off my hand until I gave in and just petted him. What a dog.

It wasn't actually a terrible, horrible, no good, very bad day. I just love that book a lot, and sometimes I remind myself of Alexander. At least I didn't have gum in my hair.


Barbie said...

i was on the bike, and proudly read a 'for fun' book while the MSIII next to me poured over a case files.
my legs hurt now. =(

Allison said...

A) I too turn beet red, get sopping wet, and feel like the nastiest mofo while working out. Everyone else looks like they aren't even trying, while I look like I am about to need medical attention. So I feel for you there.

B) I too had a terrible, horrible, no good, very bad day. I did poorly on not one, but 2 tests! WOO!

C) I learned in my HOM class that there is some kind of cultural bias in medical school that causes everyone to feel the need to specialize. It is because of this that there is a growing shortage of family pra... medicine doctors and the number of specialists is quickly out-pacing "FP". (Look I learned things! Too bad THAT wasn't the kind of stuff on the *$^@&# test!)

And... mmm... ice cream sandwich.

medstudentitis said...

I think that many people are defensive about family medicine/practice ( I don't think it's a taboo word to use) because it is CONSTANTLY berated by specialist colleagues. In Canada we have a different designation for family docs (CCFP instead of FRCSC or FRCPC) and it seems like a CCFP is seen as a lowlier designation by many fellows of the royal college. My med school has all of the lectures given by specialists and the number of times they have stood up in a lecture and inferred that a family doc was stupid for referring a "simple" case to them that "anyone would know how to manage" is unacceptable. There is a respect issue and I think lots of family docs are tired of being seen as lesser physicians.

Many family docs are also really good at the procedures that they choose to do and very good at delivering normal low-risk pregnancies. A simple boil aspiration or toe nail removal by a family doc in the community can free up a general surgeon to do more complex procedures. I'm not saying that family docs should do everything or shouldn't know their boundaries, but to suggest that they shouldn't do deliveries or procedures is ridiculous.

It's true that everyone isn't going to want to go into family practice, going to enjoy family practice, or should go into family practice but having a healthy respect for your family doctor colleagues is always warranted.

Tiny Surgeon said...

I have met many wonderful family docs. (I have also met some who were idiots, but that seems to be true in every specialty). I think primary care is a very necessary thing.

That said, I think in order to be good family doc it's necessary to recognize your own limitations (again, this applies to every specialty). It would be hard to decide where to draw the line of "what I can do comfortably and competently" and "what I'm not comfortable doing, so it's time to refer." I have met some family docs who seem to think they can do EVERYTHING, and some who refer, refer, refer. It's a tough line to draw.

I do have respect for family docs; I too have noticed the lack of respect for family docs amongst the medical community, and I do not mean to propagate it; I was just irritated by this guy going off on everyone in the room about how wonderful his specialty was, giving outrageous examples of how great the lifestyle can be, and berating all of us for not wanting to be family docs.

The Peanut Gallery said...

On my FM rotation as well, they were toting it as the best thing ever. Everyone kept saying "It's not what you think it is." I went in and came out thinking the same thing - you see about 20 or so illnesses. Fifty percent of what I saw was URTIs.

Anonymous said...

If this ding bat that is typing this blog wants to go into psychiatry she has better get used to seeing the same TEN DSM IV's and I hope she does not wet her pants when she has to consult with a psycologist.