Today was a full day in Family Medicine. I go to Bethpage Primary Care with Dr. Arcati, who has been a holy preceptor. The entire office is absolutely spectacular; everyone’s just super nice. I love them and they love me =) Dr. Arcati usually previews me which of his patients are “cuckoo” if I go see them and surprisingly, several of his most “cuckoo” were on their better behavior whenever I was with him for the day. I guess that as a guest, I temper his patients down a couple of notches. And many days, I get taken care of with lunches from the various pharmaceutical representatives – Mexican, Italian, pizza, salads, munchkins, you name it. It’s a love/hate relationship with these drug companies; it’s hard to curse them when your mouth’s full of gourmet pizza =/
Most likely, I will not be making a career out of Family Medicine, but I want to maximize my experience nonetheless and enjoy it like a roller coaster ride. When I was on Surgery and Ob/Gyn, I looked forward to a break from daily 5am wake-up call. At the same time, Family Medicine every 2 weeks has been rather, disruptive, to the flow of a rotation. Take Pediatrics now. I’m enjoying this rotation and I look forward to my day. However, each day has been interrupted with lectures and lectures and lectures… stick in Family Medicine in my week of Pediatric Gastroenterology that is already stripped of a productive week, now I have close to nothing. Needless to say, I am not a fan of Stony Brook’s brand new Family Medicine longitudinal clerkship; it’s just plain intrusive.
Now, my complaints aside, I have been lucky with my Family Medicine site. Dr. Arcati makes me feel like I’m part of his family of workers. He lets me see patients with chief complaints, take histories, do physical exams, and formulate an assessment and plan. He also knows how much I love sticking people with needles, so I have the almighty privilege to draw blood and administer flu shots and make people happy and healthy.
People who come into the office have bread-and-butter cases: fever, sore throat, congestion, cough, abdominal pain, etc… Simple. It’s the winter season; many people are succumbing to upper respiratory infections and asthma exacerbations. Nothing interesting.
Two weeks ago, I achieved a diagnostic milestone, times 2! Neither of them were too shocking, so here are the stories. In the first case, a 60-something-year old woman comes in with a “lump on chest.” First thing I thought was, “Oh gosh, I have to do a breast exam…” It’s still awkward for me, as a female AND a medical student, even after doing breast exams and Pap smears not too long ago. I got her history and proceeded to exam the ‘lump.’ Okay, it wasn’t even on her breast; it was smack in the middle of the chest over the sternum. And when I palpated the mass, it was soft like fat tissue. Diagnosis? Benign lipoma. Done.
Next case, a guy comes into the office with his girlfriend because he’s concerned about a “bump on the lip.” Before I went in the room, I turned to the nurse, Rose, and we both nodded our head thinking it’s herpes. So I enter the room and greet the couple. I take my history, and no surprisingly, stumble over sexual history. It’s been 2 years already, and I still can’t bear to bring up a real patient’s sex life. With the girlfriend there, imagine how awkward THAT would be… Needless to say, I bumbled through without uttering anything remotely close to sex, though I was itching to do so because it’s relevant. I took a quick look at the guy’s red ‘bump on the lip’ and inside the mouth too. It did not look like a herpetic lesion (which is a very painful vesicle) or any serious skin infection. Diagnosis? Pimple. Yes, a simple pimple. I presented the case to Dr. Arcati, and I swore he laughed a little on the inside too. This guy comes in worried over a raging red bump on his lip, because we all make assumptions about what lesions on the lip mean… and in the end, it was a simple pimple. His treatment? It got popped. Oomph.
Awkward lumps and bumps aside, today was a unique day. Amidst today’s many appointments of URIs and sickness, one patient came in presenting with “anxiety.” I was sent in to talk to this young women, Foundations-style. For the first time since I started my clinical rotations, I was told I made a difference talking to a patient. I spent a good 15-20 minutes listening to her story: 30-something year old female has been experiencing headaches, crying, difficulty breathing like an “elephant on her chest,” and difficulty sleeping in the past several weeks. The root of her health complaints is coming from marital problems; she complains her husband has become more flat and unloving. They are seeing a marriage counselor to hopefully save the marriage. Her two children have picked up on the tension between the couple. In recent weeks, she has been affected by Hurricane Sandy with the power outage and some stress from work because of possible shifts in the business and lay-offs. During my encounter with her, she started to break down and cry. This is the second time I’ve been left with a crying patient, and I’m not the best at comforting. Today, simply listening to her story and being supportive really helped her situation. I felt a sense of accomplishment as I told her she’s doing the right thing by seeking therapy. But I also added that communication seems to be a key issue in recent years, and that needs to be resolved and maintained. Spending time with her husband when they’re not working or on weekends or with the kids is just as essential. She is lucky to have support from family and friends; she’s doing a good job reaching out to her in-laws for advice and assistance. Most importantly, I told her simply, “Make sure to focus on yourself. You need to be healthy in order to have a healthy relationship with your family.” She needed to relax and rest to be healthy and happy. And she took that advice to heart.
This is an aspect of medicine that is losing ground in the 21st century. Doctors do not have 30 minutes to be with a patient. I’m lucky to have worked with doctors who do spend adequate time with patients, but there are plenty out there who do not, at the expense of patients’ well-being. Today, I experienced the impact I made on patient by simply spending time talking to her. Dr. Arcati even said, “See? You really made a difference with her.” There is hope that patients will get the attention they deserve. You simply cannot let vulnerable people who can be helped to slip out of your hands. In every small way, even as a medical student, you can improve someone’s quality of life =)