Wednesday, April 21, 2010

Me and My Shadow, Part 5

As I mentioned in yesterday's post, I am ashamed to say that I have been sitting on a couple of essays from medical students who rotated with me since 2007-2008. I kept meaning to post them but time just sort of slips away and before you know it, it's the next decade. So with apologies to Erin for the late posting, here are her thoughts on her 5 week rotation with me from 2008:
I did not know what to expect when I discovered that Dr. S’s family medicine practice was a “micro-practice”. I had never even heard of a micro-practice and I assumed it was just another word for “concierge service”. My doctor in the Bay Area recently made the change to concierge service. She does not take insurance and charges $400/month; however she recommends having insurance to pay for labs, hospital stays, etc. ($5000 a year + insurance payments!? Is she crazy?). In my opinion these concierge services cater to the rich – and cater to themselves. Therefore, I had an unfounded preconceived notion about Dr. S’s practice before I even got there. I wasn’t upset about working for this kind of practice, I was excited to see something different, and most importantly, I did not have to drive through traffic to get to his office. 
I was certainly wrong about micro-practices. They are not concierge services. A micro-practice is almost a nice blend between concierge and standard practice. You get the outstanding service that a concierge practice offers and the practicality/price of a standard practice (ie: he takes insurance). Moreover, Dr. S does everything himself.. Answering the phone, billing, scheduling, taking vital signs, etc, etc. It is this aspect of a micro-practice that I do not like. 
Honestly, I was annoyed having to take the blood pressure and the heart rate of most patients. I have never had to do this before. I was also embarrassed at my annoyance. When did I become so entitled? Isn’t it my job as a medical student to do these basic skills and be competent at them? Before I worked with Dr. S, I had maybe taken vital signs myself a total of four times. I had gotten spoiled, I had gotten lazy . . . I really needed this kick to bring me back to earth. I am after all, a medical student. 
Dr. S certainly has patience and it makes me wonder if I would have the patience to do a micro-practice. I really like the idea of a micro-practice, but I don’t know if I could make the sacrifices it takes to start one. It really takes faith. His calendar is often empty at the start of the week. I am a very type A personality, so it drove me crazy not ever knowing when we were going to have patients. I also would get nervous that no one would call. How does Dr. S stay so calm? Inevitably, his appointments would fill – but it was the sense of unknowing that was really difficult for me to handle. 
Despite these problems, overall my training was very rewarding. The most satisfying part of this practice was spending time with the patients. I felt I had a lot of autonomy and I really felt like I was part of the health care team. By the end of my time there I was confident in diagnosing and managing basic family care problems. I really loved that I could spend 30 minutes with a patient. I loved not feeling rushed and not having to constantly check my watch and think about how late I was with my appointments. Educating a patient is a very rewarding task. I have never had the opportunity before to really educate the patient about their disease and help them understand what was wrong. Doing this really involved the patient in his or her own health care – which I think is a vital step to success. I actually felt good about myself after many encounters – which is funny because it was almost as if the patient was helping me just as I was helping them. 
In terms of medical training, I think his practice is a fantastic learning environment. There are some down sides that medical students have to accept: the quantity of patients seen is low compared to other practices (however, the quality is equal if not better). If you are a student that learns by seeing the same thing over and over again, then perhaps this is not the best practice for you to learn at. However, if you are a student that learns by discussing the case afterwards in extraordinary detail and following up on it with textbook and literature searches – then his practice is ideal. We always had time to discuss each patient. I really felt like I understood WHY I was prescribing a particular treatment because we would compare the possible options and use evidence based medicine to re-affirm our decision. I really enjoyed this because I felt like I was not blindly giving out treatments because of recognition pattern, but that I was rationally choosing them. I was never afraid to ask a question and the best part is that he always had an answer. 
After my five weeks with Dr. S I am certain about one thing: when I am no longer stuck using student health insurance, I will only go to a micro-practice family medicine doctor. This type of practice is the best option for a patient. The service and quality of care cannot be beat. The uncertainty lies in whether I would ever run a micro-practice. It is definitely a possibility and ideally I would want to. However, idealism and practicality are two different things. Call me in 10 years and I will let you know.

Erin Atkinson, MS3
A belated thanks for your thoughts and insights, Erin.

One positive consequence of posting this 2 years late is that I can look up what has happened to Erin since then. Upon graduation from the USC Keck School of Medicine last year, she was honored with the American College of Physicians Regional Student Award. She is now finishing her 1st year of internal medicine residency at UCLA. Congratuations, Erin! Only 8 more years to go to find out if she has her own micropractice.

Tomorrow: Me and My Shadow, Part 6: Analisa's Clerkship