Thursday, April 22, 2010

Me and My Shadow, Part 6

My last two posts have been what medical students have been saying about my micropractice. Now, a short commentary about medical students and the future of family medicine. It has been well documented that fewer and fewer medical students are choosing to enter primary care specialities, such as family medicine. In order to combat this, there has been an effort in some circles to expose more medical students to family medicine, such as by requiring them to do a clinical clerkship in a family medicine office. I guess the logic is that if they see how great and fulfilling it is to be a family doctor, then more of them will want to go into it as a career.

As well-intentioned as this may seem, it has occurred to me that this may actually be counter-productive. There is no better way to turn off medical students from going into primary care than by having them see first-hand how frazzled, frustrated and overworked a primary care doctor's life really is. If you really want students to go into primary care, have them rotate through an office where there is enough time to talk with patients, where doctors are not overworked, and where both doctors and patients are happy. But you won't find many places like that in the current environment. That is why you won't see any signicant increase in primary care doctors until the lives of primary care doctors are improved. And that ultimately means: more money for primary care.

Returning to the present and vowing not to repeat the delays of my last two posts, I will now share what my latest medical student wrote just last week. Analisa just completed her 5 week family medicine clinical clerkship with me and was kind enough to share her thoughts about my practice model. Kudos to her for writing this during her trauma surgery rotation!

The first time I met Dr. S was not as a medical student. I first found his practice as a patient. I was new to the area and needed a vaccination booster. His practice was close by and gave vaccinations. So, I researched this new office discovery. I found his practice model intriguing and the level of care incredibly personal. Three years later, I was back in Dr. S’s office to learn more.

Initially, I knew Dr. S modeled a practice without the usual constraints of time and bureaucracy. Following the ideal medical practice model tenets of efficiency, quality, and care access, Dr. S offered a hope for something beyond the fast paced, quick in and out practice with which I had more experience. In Dr. S’s office, I was able to talk to patients. I was able to carry out a full conversation discussing the spectrum of life experiences that were either aiding or impeding wellness. We did not see many patients a day, and thus, when complications in patient care arose, we were able to be proactive and address concerns before they snowballed into something bigger.

Seeing patients with Dr. S was somewhat like the 1940s TV depiction of the town doctor whose neighbors came by with a cough, an ankle sprain, or anything really. Experiencing the paradigm of neighborhood doctor as confidant, consultant, and medical expert was rewarding.

Further, this personal care was enhanced with the aid of technology. I appreciated the efficiency of Dr. S’s near paperless office were patients could schedule their own appointments online and encrypted patient information was physician accessible, fully incorporated and well organized.

Some patients just needed a quick check up. Some patients needed more. Dr. S was there for his patients, whatever their concerns. I was impressed with the same day appointments, the evening appointments, the occasional weekend appointment, and the consistent email contact. I was impressed by the patient driven care.

As I move forward in my career, the principles of the ideal medical practice will stay with me. Dr. S’s insight into the importance of creating the medical practice for the kind of medicine you believe should be practiced is no doubt a lesson worth retaining.

Analisa Armstrong, MS3
Thank you, Analisa, for your enthusiasm, hard work and desire to learn. (Also your willingness to do administrative chores when things were slow.) You were able to handle anything I threw to you, so I am confident you will excel in whatever you end up choosing to pursue. Best wishes to you!