Shadowing Family Medicine was something I was looking forward to for a while. I was interested in seeing why an elderly would schedule with family medicine rather than internal medicine or why a child would choose to schedule with family medicine rather than pediatrics. What I learned about family medicine that makes it special is how the elderly can be the parent while the younger patient can be the son or daughter. I believe that this concept of having the family be seen by the same physician makes sense since most diseases are passed on inherently.
My main purpose of shadowing Family Medicine today was as an attempt to open my mind to departments other than pediatrics. However, it didn’t work out in my favor because the first patient we saw was the cutest 2 year old. So, I left the family medicine clinic loving pediatrics even more. This first patient was brought in by her mother because she was concerned the child had pinworms. Pinworms are a common thing amongst children especially. Although the patient was showing too much concern, symptoms wise, Dr. Miller thought it would still be helpful to treat it. The anthelmintic medication was a one chewable tablet that would be refilled in two weeks. Although I enjoyed seeing the child patient I also really enjoyed seeing how Dr. Miller and Dr. Walker, the attending, were able to conclude that it was pinworms.
The second patient was dealing with hypertension and diabetes. The patient was advised to be more consistent with testing the blood sugar at home since she is hypoglycemic. She was also recommended to continue testing for her blood pressure at home. I was able to see the diabetes foot test for the first time and learned that it tests for sensation in the foot. This is because diabetes can cause neurological loss in areas like the foot. When this happens, there can be bleeding or scars on the foot that the patient might not feel.
The third patient came in to get referred to dermatology. I will admit that I don’t understand why patients need to get referrals to be seen by their desired speciality. I get that it is supposed to decrease unnecessary visits especially in clinics that are in high demand. However, is there such a thing as unnecessary visits? Isn’t it good to be proactive when it comes to your health? Doesn't it make it harder for patients to find the care they need through referrals? I will definitely be looking farther into this through research.
The fourth patient just needed to get a physical. I also found out about Cologuard which is an alternative for colonoscopy. Cologuard is when you send your feces to a lab that looks for cancerous cells. If the test comes back positive, a colposcopy would still be needed. The last patient we saw was one that solidified how much I care about the patient-physician relationship. As a family doctor, it is important to know a little bit about everything in order to provide the best care for the patients. In this case, this patient clearly needed Dr. Miller to be her therapist. She simply gave her life updates and was very emotional during it but all she was looking for was someone to listen. As soon as Dr. Miller said “that is really hard”, the patient was relieved knowing that her feelings are valid. The patient also trusted Dr. Miller with advice. She was afraid that she would not be able to pick herself back up and when Dr. Miller advised that it is okay to give yourself a grieving period, the patient was at ease. This was amazing to watch and I can not wait to use my individualization Clifton Strength in a role like this one day.
The three Core Competencies that stood out to me the most from today’s observation were Oral Communication, Reliability and Dependability, and Critical thinking. I was able to clearly see how oral communication needs to be very clear in family medicine. Because the patient-physician relationship is a huge part of this role, it is important to set boundaries. The third patient was very persistent with the extensive labs he wanted. However, some of the results he was looking for were ones that Dr. Miller wouldn’t use oreven know how to interrupt. Being able to communicate that to the patient was something I foresee as challenging but essential. A way I saw communication was made easier at this distinct clinic was through the Blue Card. The Blue Card is when it is a mutual agreement between the patient and physician and the insurance company that this visit is only pertaining to a physical. This sets that boundary ahead of time not only for monetary reasons but more importantly for time reasons. When scheduling a patient for a physical, it is important that everyone stays within this time limit so the next patient is not getting pushed too far behind.
Not only does communicating things make the time the physicians have with their patient more efficient, but it also makes them have Reliability and Dependability. Being efficient through charting was another way that Dr. Miller exhibited this Core Competency. Dr. Miller found the perfect balance between charting as she goes but not extensively to where her patients are waiting. I noticed that Dr. Miller took it upon herself to make sure that once a patient was seen by the nurse, that she would go in almost immediately after. As a patient myself, I know I can appreciate when physicians do that.
Lastly, Dr. Miller conveyed so much Critical Thinking on her own as well as with her team. It wasn’t obvious that the first patient we saw had pinworms, but after a lot of thinking combined with Oral Communication, Dr. Miller was able to confidently prescribe her patients the medication they needed. With pinworms, it is common to have marks around the anus due to irritation from itching. Although Dr. Miller didn’t notice that symptoms, she was still able to conclude that it was a helminth based on the description the mother gave.
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