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Family medicine is probably the core rotation that I am most curious about. I’m curious about how I will feel working in it for a relatively extended period of time and I’m curious if what I’ve envisioned working in primary care could look like is the reality (I keep rereading that sentence to see if it makes sense). Primary care is kinda the whole reason I decided to go into medicine. I loved the idea of having loooong-term relationships with my patients, to really get to know them, to be the person they trust above all other doctors. I want to be the doctor that my patients come up to while I am with my family in Costco just to say hi. I want to be able to prevent my patient from getting disease, not just treat it when it happens. I want to be able to teach them about their bodies, and work with them depending on their individual situations, life experiences, world view, to figure out a plan that aligns with their goals and values. Today, I got a glimpse, and I’m excited to see more.

The morning was all just orientation. Getting my badge, doing paperwork, learning how to sign-in to the EMR, etc. Apparently I get free lunch at the primary medical center which I took advantage of after orientation especially since I won’t be going there often. I got a bit of a tummy ache with the pasta, but the lunch ladies were all so nice maybe I’ll go back just to say hi.

After lunch I had a little extra time and got some studying done at Starbucks and then made my way over the clinic to meet my preceptor for the day at 1 PM. When I go there I really had no idea what the plan was so I just checked in at the front desk and was told they would notify the administrator and they would come get me soon. I waited about 15 mins, at which point I went back to see what was up, concerned that the doc was expecting me. The MA at the desk said, “Oh they are in a provider meeting, someone will come out when they are done.” In my head, I was just like “??? you couldn’t have told me that earlier so I’d have some idea of a timelines.” I just went back to studying in the waiting room. Couple minutes later someone came out, one of the administration assistants and I guess the head EMR guy there, he said he would give me a tour of the facilities while the provider meeting was going on. The medical plaza was impressive for what it was. There was relatively high capacity for primary care (at least it seemed that way) as well as on-site availability for labs, specialty care, and some imaging.

We finished up the tour and I was introduced to my preceptor who apparently was only finding out in that literal moment that I would be working with her that afternoon (she was having difficulty moving due to some apparently extensive sun burns down her legs which was a repeat source of some [sympathetic] comic relief throughout the day). She was very nice and welcoming, and I was told during the tour she was one of the family med docs who also specializes in high risk OB which I thought was interesting. Turns out she’s a whole ass badass (a WABA^TM if you will). I mostly followed her through the afternoon, but in that short time we basically did everything. Pediatric well-child checks, hypertension follow-up, OB superimposed on a neuroendocrine disease, severe eating disorder, low back pain with narcotic addiction, she was even consulted by the other doc there for management of some lactational mastitis. I was a whirlwind and she handily dealt with it all, jumping from patient to patient, knowing their stories and their situations. For one of the well-child checks she gave birth to this patient and watched him grow up and works with both the parents. She still takes call to do deliveries and even performs C-sections.

Oh and did I mention half the patients were Spanish-speaking and to my untrained ear she sounds basically like a native speaker (which I don’t think she is but I could be wrong).

It was really impressive to watch her work and to work with her (she also really reminded me of my aunt who is also in family medicine and has a similar way with patients and is multilingual). I don’t think I’ve ever been this impressed with a provider. All the one’s I’ve worked with in the past have been good and knowledgeable, but just the sheer breadth of what she is able to do and manage with the competence was really remarkable. No only does she have to know a lot of medicine, but she has to actually apply all of it on a daily basis. What I saw today was why I came into medicine and why I envisioned myself in primary care. I came out of the clinic more motivated than ever. I guess we’ll see how it holds up over the next 5 weeks and working with a few different physicians.

There’s been a culture shift in medicine in which individuals and systems have been making self-care and self-compassion more of a priority. Whether or not the interventions to that end have been effective is another story, but given the levels of burnout, depression and suicide among healthcare workers I think we are at least moving in a good direction.

Since starting college, I thought I was pretty good about being compassionate towards myself. For a variety of reasons, I stopped placing all my self-worth in my grades and academic performance. I was forgiving of myself for my shortcomings, and I was good about taking time for myself when school was getting overwhelming. From then to starting medical school, I continued to focus more and more on myself; getting to know myself, being more reflective, and really understanding my personal values.

But at some point, I think I overshot. I started justifying unhealthy habits by writing them off as “self-care.” Self-care and self-compassion doesn’t mean taking a nap, playing video games, catching up on your backlog of unconsumed media or “treating yo self” every time you meet resistance in your work or feel tired, which has been becoming a pattern for me over the past year.

When thinking about compassion in general I like the Dalai Lama’s description in The Book of Joy and how he differentiates in from empathy. He says that empathy is liking finding someone stuck under a giant boulder and then chillin’ under the boulder with them, whereas in compassion you get under the boulder with them, but then actively work with them to remove it.

In the case of self-compassion, both the person under the boulder and the bystander are you, and the boulder is suffering. Using the word suffering sounds so dramatic, but suffering can take a lot of forms, but the way different people experience suffering is often similar or can at least feel similar (does that make them equal?). Subjecting myself to tedious work or “boring” work can feel like a form of personal suffering and watching a video about how Mantis Shrimp strikes create generate enough force to boil water at the bottom of the ocean relieves that suffering.

However, the guilt of not reaching my potential and of not doing work that will help me one day better serve others is also a form of suffering. The question I need to ask myself is which of these is this rock really made of.

It’s not about protecting life. It never has been.

It’s not about protecting the Constitution (which in itself is an idiotic reason).

It is and always has been about control and about power.

It’s about a system of government that disproportionately caters to populations who already hold most of the power and who have used that power to keep it that way.

It’s about politicians who desperately need to maintain their seats in Congress in order to stroke their fragile egos, so they pander to those populations despite what they personally believe and despite what the majority of their constituents may believe.

It’s ok for people to have fundamental differences in what they believe, and it’s ok to fight for what you believe to be right in your own life, but that should not come at the expense of other people’s ability to make decisions for their own lives. For what it’s worth I’m confident many of the politicians who are gleeful about the Supreme Court’s decision don’t give a shit about m0rality, they are interested in what’s going to keep them funded and in office next year.

It’s really curious to me that most lectures start out with providing the learning objectives. I think it kinda represents the backwards way in which we approach education.

If I am trying to teach something, the objective should be self-evident. It’s ok to have learning objectives, but to say them explicitly upfront is cheating.

By the end of a “lesson” we should be able to ask participants what they learned or what they think they were supposed to learn and those things should track with the learning objectives.

And if people aren’t walking away able to identify the undisclosed learning objectives intended by the educator, then it should be on the educator, not the students (or at the very least equally on both), to rethink how they deliver the material. That said educators who take their craft seriously should also want to make changes that benefit their students and not be afraid to critically evaluate their teaching for their students’ sake.

I don’t want this to come off as an indictment or a generalization on educators because they do some of the hardest and most important work, and in general teachers are overworked and underpaid. I will say that all my favorite teachers have been one who have challenged traditional styles and went out their way to create meaningful experiences for us as students to better understand the material. And as someone who plans to take on an educator role in the future, this is something I aspire towards.

Today was my last day of the rotation. It was a little bittersweet. Honestly I wouldn’t mind coming in for a little while longer. Maybe that a cringey thing to say, but it’s true, at least at this moment in time. Though part of it is probably the fact that I’m under no obligation to stay there the whole day, I don’t have any actual responsibility there, and the residents are all so cool and fun to work with. Maybe also because I really don’t want to take my Shelf exam. Another part is when I learn in the hospital or in the clinic it feels like my learning is actually connected to something that matters, not just a red X or a green checkmark.

Anyways it’s over whether I like it or not and I’ll just have to appreciate it for what it was. Overall it was a very positive experience and I’m definitely now leaning more towards working in peds in some capacity.

We had a new attending today, and he brought with him a first year medical student (who I’m pretty sure lives on my floor) and an undergraduate student. They came on rounds with us and so we did a little extra teaching with each patient. When we got to my patients I felt a little more nervous than usual and I wonder if the youngers could tell I had no idea what I was talking about (ok I had some idea). That said, and I think I mentioned this before, I do enjoy teaching and I could see it as a part of my future, but first I need to gain more mastery of all the material. Seeing them though, and thinking about how I was once in both their shoes was motivating.

I think it’s really time for me to really dial in on a Plus Ultra attitude.

Since it’s been a few days since I’ve had to be in the hospital, a lot of new patients, but I had to just jump right back in. I got assigned my usual URI picture kind of patients. They seemed somewhat straightforward at first, but were a little more complicated when we started digging a little deeper. One of them had these mysterious hives and constellation of symptoms that weren’t super consistent with anything in particular, but were suggestive of a few different things, so it was hard to say whether what they were experiencing was just a reaction to viral illness or something a little more serious underlying.

Later that day I saw my first in-patient constipation case and I realized how little I know about management of serious constipation. The kid was really plugged up. This was the first time I really felt an abdomen that distended. Also, part of the discharge plan is to make the family watch a video called “The Poop In You.”

My last day of my last full week on in-patient. It’s gone by pretty fast. I’m partially relieved, but also a little sad because I really like my team and I honestly do like spending time in the hospital (when there are things to do). Today pretty much all the patients I was assigned were planned to be discharge later that afternoon including my osteomyelitis kid who was there for a while. It’s going to be whole new patient list when next time I come in. New folks to meet, hopefully some new pathology. We had a couple medical mysteries come in the past couple days and it’s been really interesting seeing the residents and attendings trying to piece together diagnoses for them, it’s very House-esque.

It’s really crazy to think how much experience my senior residents and especially my attending have. Sometimes when we are standing around in the hallway and they are having conversations about what antibiotics to use for what bacteria and the mechanisms of why they should use this one and not that one, but what about this one, is just kinda wild when I take a step back. It’s all pretty standard stuff that you learn in med school (not that I am anywhere close to mastering it), but when I see them actually applying it to feed real people real pills or shoot a medication into someone’s vein, I am just in awe.

At the same time, I see how overworked they all are, and despite seeing deep down how lovely the medical team I’m work with is, I can also see the cracks in the armor. It’s sad because most of the time I see how much they love their work, but the burnout is pretty apparent sometimes. I like to think I’m a pretty resilient person, but I’m sure there have been people stronger than me who have been worked to the ends of their wits. I guess the only thing I can do is be cognizant of it and, when possible, incorporate wellness practices into my daily routines.

Today was a long day, and I did my first solo in-patient admission H&P. My seniors historically have been really nice and done them themselves or done them with me (I think also because they want to make sure it gets done properly the first time). H&P are the one thing though that I feel pretty confident in, is the assessment and plan parts that I need to develop more. Luckily this was another bronchiolitis vs reactive airway disease (baby asthma) patient which I’m pretty comfortable with doing assessments and plans at this point, so it felt nice to kind of be able to run the whole thing for this patient (as much as I am legally allowed to).

Definitely feeling more confident and also like an actual part useful of the team these days. Hope that only increases as I start my last week there.

It was a longer day today, but there was some good learning that happened. Something tells me the attending hasn’t been impressed with me thus far. Maybe not disappointed, but not impressed, and she communicated that with the residents. I only say that because today one of the residents worked especially close with me on my presentations for rounds today. It was undeniably super helpful, and I think I did an ok job. Sometimes when I get praise, I can’t tell if it’s genuine for if people are just trying to be nice. Regardless, like I said yesterday, being in the hospital motivates me to study more, but also it just takes so much out of me that it’s hard to come afterwards and study. I think I need to avoid coming home right after work and just try to get work done outside of the house.