Wednesday, July 20, 2005

Me and My Shadow

These days my solo practice has actually been getting, well, busy, which has not been the case for the preceding 16 months. Busy for me is seeing as many as 8 patients in a day, although I am averaging 17 patients/week. It may not sound like much but since I usually spend an hour with new patients (sometimes longer), it is a full schedule for me. Plus I have to do all the scheduling, intake, scanning, charting, collecting copays.

As a result of seeing more patients, I have decided that I am busy enough to precept medical students again, as I used to do at Kaiser. At Kaiser, there was never a shortage of patients for medical students to see. In my solo practice however, I would discourage 3rd year students who called asking if they could do a rotation with me because up until lately I didn't think there would be enough cases for them.

Recently a second year medical student from Albany Medical College, Gladys Ng, spent 2 weeks shadowing me in my office as part of a summer family medicine preceptorship. Apart from spending time in her father's Ob/Gyn practice, it was her first experience rotating in a doctor's office with real patients. For those unfamiliar with the concept, shadowing means that the student usually stands quietly in the room observing the patient-physician encounter, i.e. being a shadow. Usually I invite the student to take part in some aspects of the physical examination, such as listening to the heart and lungs. When they get proficient enough, I ask him/her to take the patient's vital signs. If the patient and schedule permits, I may ask the student to interview a patient on their own, getting a chance to "practice" their interviewing skills on a real person. Gladys got a chance to do all those things while she was with me.

At the end of her rotation, I asked her to write a short summary of her experience with me and this solo-solo practice model. She has allowed me to post it here:
I was very excited when Dr. S agreed to let me shadow him, but had mixed feelings when he proceeded to describe his current solo practice. I thought, how could he do all of that by himself (be the receptionist, nurse, doctor, biller all at one time)? This is when I thought that this experience will be interesting, I could either be stuck with the phones and office work, or get a chance to do/see everything that the doctor does. Fortunately, it was the latter.

As Dr. S is still in the growth phase of his practice, the most patients we saw a day was five and this left me ample time to ask questions and have informative discussions on the ever changing or hopefully, evolving practice of medicine. These discussions and accounts of real life experiences really brought home some of the issues that were discussed in some of our classes at school. It was good to hear Dr. S’s reflections on his previous experience at Kaiser.

What really impressed me upon our first patient encounter was the length of time that was spent with each patient. In a typical patient encounter, especially new patients, Dr. S would spend 20-30 minutes speaking with the patient to get a complete understanding of the person. He would start off the whole session with the broad question of “what can I help you with today?” and then gently direct the conversation to draw out pertinent points of information. There were many encounters in which I was amazed by the willingness and the many aspects of the patient’s life discussed and their indirect relevance to the patient’s chief complaint. I learned to let the patient do most of the talking, to employ useful moments of silence, and to listen while maintaining eye contact.

Important to any “one-man show” is the concept of efficiency. Armed with a cell phone on the belt, a sleek Powerbook, and a speedy scanner on his desk Dr. S has paperless set-up, a practice without any patient charts. All necessary paperwork, such as those requiring signatures, are signed and then immediately scanned into his computer while the paper is left for the recycling bin. Also, instead of taking notes on paper while seeing the patient, Dr. S directly types the information into his computer. The benefits to this system were clear to me- save space and time, information is kept in one organized central location, and the chance to be environmentally friendly.

As I have just finished my first year of med school with my head still in the books and the science of medicine, it was a great experience to shadow Dr. S as well as to partake in the practical aspects of clinical medicine. Patience and compassion are two imperative qualities to being a caring physician and it might be hard to convey that to patients in today’s practice of medicine that focuses on the number of patients seen. I am ultimately inspired by Dr. S’s courage and drive to recreate a conducive environment in which his genuine intentions to help and get to know his patients are conveyed in actions as well as words.

I hope that experiences like this can inspire someone to someday become a family doctor, or at least spread the word that there can be a kind of medical practice that isn't driven by productivity and time limits. Also, I strongly encourage other physicians to volunteer to precept a medical student. Not only is it fun, it is educational since my "shadows" always teach me a thing or two. Thanks, Gladys!