Family Residency

So this is a post for those who I haven't told yet, but I've decided on Family Medicine for my profession.
There are many reasons that I've chosen it, but here is the short list
1 - I really like teaching people and helping them learn what they can do to live healthy
2 - I strongly believe that an ounce of prevention is better than a pound of cure.
3 - You can address the whole person and not have to pass them off to another specialist to deal with their problems (an Orthopedist doesn't do blood pressure, an Internal Medicine doesn't do much musculoskeletal, etc.)
4 - You can take care of a person, their mother, child, sister, grandmother, delivery babies, etc. all in the same practice
There are more, but like I said, this is the short list. I keep running into people who I haven't told about my decision, so I thought I'd better tell the 10 people who read this blog at least.

Making Good Choices

This Obesity Epidemic is getting way out of hand. I had a patient come in to the doctors office for a regular visit. She was about 5' 2" and was probably pushing close 300 lbs (that's just a little over what she should have been). I really wanted to help her because she didn't seem happy with her current health situation so I proceed to talk with her about her diet and exercise. Here is how our conversation went.

Me: Tell me a little bit about your diet and exercise?

Patient: Well, I know that I need to lose weight. I try to make good choices for what I eat, but it's really hard, ya know. I try to eat more vegetables so I went to a Chinese buffet for dinner because they have vegetables (!?!), but you need to be careful of those sauces, there are lots of calories in there.

Me: Uhhh (thinking: yeah, it's not the sauces that you need to worry about, it's the five helpings)

Patient: I had a really hard day last week and my daughters wanted to take me out to Carrabba's for dinner, but I said, 'No, I should be good.'

Me: Good for you

Patient: So we went to Golden Corral instead.

Me: Oh.

- I was dumbfounded. This lady is lugging around an extra 160 lbs (which is an entire extra person) everywhere she goes, and her "good choices" are going to a chinese buffet for vegetables and going to Golden Corral (another buffet) instead of Carrabba's Italian Restaurant!!

Me: Ummm...so...need any refills on your medications?

I do some push-ups.

Today a guy came in for his yearly check-up. Usually these are pretty uninteresting affairs with a series of questions about the person's health being answered with things like, "I feel fine", "No complaints". About half the time they answer my questions about exercise with, "yeah, I go running about 2-4 miles per day" and they look like it. Or they answer, "Yeah, I go walking sometimes" or "I'm pretty active."
Today I asked a guy if he exercises and he said, "I do some push-ups in the morning" "Me, too" I said. I thought this was code for I don't do much so I'll cover by saying that I do something menial. But when I scrolled down his chart a little more the nurse who checked him in had asked him how many, and he does 800 push-ups every morning. 800. Ridiculous? It gets better. When I asked him how long it takes him to do this punishing routine, as I think to my self I bet I'd be lucky to do 30 pushups, he told me that he pauses between each set of 100 for 30 seconds but could probably do the whole 800 in 8 minutes!! "Um, yeah. Me too." I replied.

Names

We had a patient today who was having her second child in as many years. After he was washed up and taken to the nursery, and the mother was cleaned up and getting ready to go to her room, we asked her what her first child's name was. She told us it was "Stephan" (the second syllable being stressed in her pronunciation). Then we asked her what she wanted to name her second son, and she replied "Steven" (the stress being on the first syllable this time but not sure of the spelling). This is what we said in response, "No. Absolutely not. You can't do that. That is too close to your first son's name. I'm sorry, but you are going to have to think of something else. He is a cute baby though. Congratulations!"

That is when it hit me, being a doctor is more than just providing medical care. It is also about helping people to just make better choices, whether they agree or not.

Another world

Have you ever had the feeling that there is another world just out of sight. I saw the preview for The Spiderwick Chronicles, and it reminds me of that. I'm on my OB/GYN rotation and we were in a C-section this morning. After they clean the patient's belly, they put a sheet up between their face and the rest of their body (I don't know too many people who really want to see or could handle seeing themselves with an 8 inch incision in their belly). They are numb from the waist down and are just waiting for the baby's cry. When the baby is born it cries, thy clean it off and give it to the pediatricians in the room who clean it off, the father is taking pictures, they bring the baby back to the mom to look at and...we're still down there trying to close up this gaping hole in her abdomen. Today this was all going on while the woman was losing lots of blood (like 1.5 liters worth of blood).
Them - Oh look how cute this baby is. He's got my chin
Us - clamp this down there, maybe it's coming from there
Them - Oh he is a fighter, look at him cry
Us - No, you're not sewing fast enough
Them - Can you believe that we have a baby. This is great
Us - There isn't time to make it look perfect, just sew here to stop all this blood.

And so on. It was a very surreal experience. It was like to different worlds right next to each other and (because I wasn't really doing anything important) I was able to see both of them in this weird juxtaposition.

Family Medicine

I have 2 weeks 3 days and 18 hours until I'm officially done with my 3rd year of medical school. For those of you who don't know what exactly takes place third year here's a brief explanation. You do a series of rotations in the major areas of medicine (Internal Medicine, Family Medicine, Psychiatry, General Surgery, Pediatrics, and OB/GYN) with the idea that you will use this time to learn a lot about medicine and ultimately choose what you want to do for the rest of your life. I have picked Family Medicine for my career and I am very happy with it. It has been interesting, however, to note other peoples' responses to me when I tell them this decision. "Oh, that's...nice" or "Really?!? Why?" or my personal favorite, "Don't do that!!"
Some of the reasons people disparage the General Practicioner are
1) It is a very non-competetive field to get into which unfortunately means that some people go into it because they can't get into anything else.
2) As with most primary care fields (fields where most families have this type of doctor - family doctor, pediatrician, etc.) get paid much less than other fields
3) Some people view Family Medicine doctors as knowing a little bit of everything, but not master of any.
There may be some validity to these arguments, but here are some of the reasons that I want to go into it.
1) As a family medicine doctor you can go almost anywhere in the world and be of use to people. I would love to test this theory and travel to some of these places and/or live in a small town.
2) You can have a fantastic affect on people's health over the course of their lives. I know many people won't change their ways, but I believe that there are many out there who will given the right opportunity
3) There is a lot of face-to-face time with patients and I really like spending time with people.
There are others, of course, but they are harder to define. The best way I can describe it is that it fits my personality and lifestyle.
(Though I curse my luck that I'm not interested in radiology. Man, great lifestyle)

"Spoon People"

Now I am not a "crafty" person, meaning I have never been good at or particularly enjoyed making crafts. At Girls' Camp I hated the craft we always had to do, mine always turned out ugly. I never attend Super Saturdays, and I rarely enter stores like Michael's or JoAnn's Fabrics. Just not my kind of stores, you know? However, for the last couple of days my two girls have been sick, so we have been prevented from spending time with friends, or from going to the YMCA, because we don't want to make everyone else sick. The weather has been cold so we haven't been able to get out by ourselves either and just go for walks or head to the zoo. The result is that my two year-old is going stir crazy. So, in an attempt to add some variety to her life, I pulled out The Preschooler's Busy Book, which was a gift we received from Brock's sister and her husband for Christmas. I looked up a couple of things I thought we could do and headed to Walmart for a few supplies. One "craft" I tried was called "Spoon People." Here is a picture of my attempt at a "Spoon Person."


I was fairly satisfied with the result, and I thought my two year-old daughter, who was helping me glue on the hair, eyes, clothes, etc., would be thrilled with it. When we finished and I handed it to her to play with, she gave me this look that expressed some hesitancy, like she was embarrassed. I guess the toy her mother had made for her was not really up to par. "Come on," I said, "look how fun this is." She finally accepted the toy with a resigned air, as if she was humoring her mother. If this is how she is going to act at two, I wonder what she is going to be like at thirteen.

Maybe we will just stick to gluing macaroni to construction paper next time and letting her paint it. At least that doesn't embarass her.

Cookbook suggestions

I've always been a fan of eating healthy. Unfortunately I'm also a fan of delicious food and it can sometimes feel like those are mutually exclusive. We also feel a lot better when we eat more fruits and vegetables but have found it difficult to incorporate those into our daily fare. Enter Moosewood. My older sister gave us The New Moosewood Cookbook for Christmas and it's been really fun so far. Before you read too far I should give you my review of the books and then see if you want to read further. These two books are for people who want to incorporate more vegetables into their diet and aren't afraid of a little work in the kitchen. They don't take that long to make relative to other made from scratch dishes (usually anywhere from 40-60 minutes) to prepare. Some of the soups take special ingredients, but most are fairly simple. Another feature that I particulary like about one of the books (Daily Special) is at the bottom of each page are suggestions of what to pair it with. With that out of the way, back to Moosewood.

The Moosewood Restaurant (http://en.wikipedia.org/wiki/Moosewood_Restaurant) is a restaurant in Ithica New York that started in 1973. They found that their vegetarian dishes were selling best so they became a vegetarian restaurant. They have about 10 cookbooks our right now and the two we have are winners. Enjoy

Orthopedics

Orthopedics is back on my short list. For the first two years of medical school I was all about the orthopedics surgery option for residency. However, I really came to enjoy family medicine. I continued to like it the more I did and it became the top thing I was interested in. Part of this reason was because of the horror stories I heard about surgery from my classmates.
This attitude was only encouraged when I started my Surgery rotation. The surgical residents and some of the full-fledged physicians are demeaning to the medical students, they can be verbally abusive, and seem like very bitter people. The hours are also really long (you get up at 4:20 or earlier, get to the hospital by 5AM, and don’t leave until 7PM, you also have to be on call at the hospital every 3rd night and you don’t get much sleep) and the residency is 5 years long of this. Unfortunately, most of the general surgeons I have talked to LOVED their surgery rotation. I really hate my general surgery rotation and I thought this was a death knell for any plans for surgery that were still floating around in my head.
Thankfully my father was persistent in encouraging me to not dismiss surgery too quickly. He sat next to his cousin who is an orthopedic surgeon on a recent trip and when he got back he told me give him a call and chat with him. One of the most encouraging conversations I’ve had recently. He HATED his general surgery rotation. When he went into orthopedic residency he had to do a year of general surgery before he got going on his orthopedics training and he said that that year was probably the worst year of his life.
Although that may sound less than stellar, it’s actually the best news I’ve heard in a long time. I have hated my surgical rotation and the thought of doing it for 5 years is intolerable, but if I only have to put up with it for 1 year before getting into a cool residency with cool surgeries and nicer people…well it’s back on the list. The hours are still going to be very very long as an orthopod resident, but I think it’s something that I can like as much as my family medicine dreams.

Why surgeons are the way they are

I’m finding out on my surgery rotation that surgeons and family medicine (FM) doctors are worlds apart (as are many different types of doctors, but let’s compare these two). Surgeons don’t really spend a lot of time talking with their patients. They don’t really connect with them as readily as FM doctors. With this in mind, here are some thoughts on surgery and surgeons.
Surgery is a very interesting process. One minute I’m introducing myself to a 30-something year old lady who is worried about her upcoming surgery, answering her questions, and reassuring her I will have absolutely no part in the actual surgery, and the next she’s under anesthesia. We take off her flimsy hospital gown, put a Foley catheter in her so she doesn’t pee on herself during the surgery, start marking on her body where we’re going to cut, cover everything that we’re not operating on and suddenly…viola…she’s just a torso of meat that we’re going to cut on.
For the next 8 hours I’m fascinated with what the surgeons are doing, identifying which parts of her insides I can from anatomy, managing the laparoscopic camera and things like that. I totally forgot who she was as a person.
In a similar story, there was a lady who needed a really big catheter inserted into her femoral vein (big vein in the thigh). She was very nervous, jumpy, and the process took over an hour for what should have taken 15 minutes because she kept yelling that it was painful and jumping making the needle come out. She quickly became an annoying leg that needed a catheter inserted.
Overall, I think it’s good that surgeons view patients as warm living pieces of meat. They are going to do very uncomfortable and frankly extremely painful things to them. They are doing this to help the patient but things are going to get a lot worse before they get better.
Some surgeons are better than others at connecting with their patients, but surgeons don’t have a lot of time to talk because they are in surgery all day in addition to following up with patients after and before the surgery. If I were to break this article down, I would say that I respect surgeons for what they do and I don’t know where we would be without them, but I really like talking with people too much to be a surgeon.