Family Medicine in Big Sky Country

Hello again everyone!

I know you missed me, you don't have to admit it. I just know it.

(Hello? tap tap tap... Is this thing on?)

Family Medicine out here in Whitefish, MT is FREAKING AWESOME! No, I am not exaggerating. The doctors are marvelous, the patients are varied (some good, some bad, some easy, some confusing, some young, some old, some in between), the area is beautiful, and I am 15 minutes away from big city things like Best Buy, Target, Lowes, and Home Depot. I am finding, on my second day of the rotation, that my 6 weeks here might be a lot like my 4 weeks in Red Lodge, MT when I did the RUOP part of my training.

What happened in Red Lodge is that I found I could definitely LOVE Family Medicine, however, I would need to practice in a small town to do so. One of the reasons that I had eschewed (that is right, I said eschewed) Family Medicine before was because in the city, you don't get to do much. You really just have people that have sore throats and things like that, and then they don't always come and see you. Additionally, you don't get to practice in-patient medicine. However, out here, it is an entirely different story! You do everything for everyone (just about). The Family docs out here admit patients, deal with in-patient practice, have patients that range in age from teeny-weeny baby to great-great-great grandma Eloise.

Today, my patients ranged in age from 13 years to 70 years. The challenging part about that is that each age group has its own problems that are common to them. As a doctor, you have to understand that concept.

The problem, however, is that I never thought I would practice in a small town. It was never a plan of mine (or Mike's). The funny thing is that there is this female doctor here who visited this town as a medical student, came back for residency, and then stayed as a practicing physician. Interesting...

So, I am not saying that Mike and I are moving to Whitefish (or Kalispell) anytime soon, but it is weird that it seems like it could at least be a distant option for me. An even bigger surprise to me is that it would mean that Family Medicine is an option for me.

Argh, I hope that 3rd year isn't all like this... That would mean that I would like EVERYTHING and have a HORRIBLE time deciding which field to go into.

(Almost) done with Internal Medicine

I take my test tomorrow morning...

Then I have Friday afternoon and Saturday to pack.

Then I drive for 8 hours.

Then I start Family Medicine in Whitefish, MT on Monday.

LOTS of time of chill.

LOTS.

Well, I should go get some sleep. Hopefully the sounds of my neighbor blasting Rock Band won't keep me awake for too long.

Almost done with my first rotation

Wow! I am almost done with my first, and longest, rotation. I will be done with Internal Medicine on Wednesday and take the test for the rotation on Friday. I will then be in Whitefish, Montana next Monday.

(Yes, I will miss Mike)

Even though I have absolutely loved internal med, I will be very happy to be done with this rotation. I am so tired all of the time. I am also tired of changing attendings every two weeks and having to learn how they like presentations and rounds completed. I have learned an AMAZING amount of medicine, I can actually answer questions about healthcare with some authority and know that I am probably right. :) It is a nice feeling.

On this rotation, I have been "pinned" as the following types of doctors: surgeon, pediatric intensivist, and an internal medicine doctor. What do I think about those? I honestly don't know, the only one I have experience in is Internal Med. I think that I could do internal med, but I still have always pictured myself as specializing in something. I like that internal med docs need to know a lot about a lot of things (jack of all trades and a master of none) but I also like knowing a LOT about just a few things.

I am really not sure how I am supposed to "choose" my life-long specialty by March.

I am also not sure how I feel about practicing medicine in an academic setting. By academic, I mean having students on my health care team. I feel like I will never know enough to be able to teach other people about the subject. Also, academic medicine is very demanding (well, for certain specialties). The time spent in the hospital is massive and having a family can be challenging (yes, you have to think about those things at this point).

Minor heart attack... OMG, I am old enough to even THINK about when I would be having kids?!?!

However, practicing at a hospital like UW would put me into constant contact with so many new technologies and procedures, it would be great!

Well, I am going to go to bed now. I am sooo tired.

Ideas do not automatically translate into a blog post

I have all of these wonderful ideas for blog posts...

Talking about a recent night when Mike and I hung out with guys from Japan (yeah, not medical stuff but still pretty interesting)

Commenting on an article in the NYTimes (and then commenting about the people who made comments in that article)

Talking about my experiences in the hospital

Working through my thoughts about why people somehow think I am nervous when I am giving a talk but I myself do not FEEL nervous

Going over how much being on call every 4th night sucks

Talking about how people, in general, seem to think that as you "get older" your body fails... And so symptoms that are actually worrisome to doctors, people will not go to the doctor about those symptoms because they just assume that it is part of "getting older"

.....

So many ideas! So little time! I don't have the energy right now to really write a good (okay, at least adequate) quality post. I feel like I would just complain about "stuff" but not really get any point across.

This call thing needs to stop. Mike agrees as well. :) He is kind of tired of it himself.

An obstacle called "call"

So, if you may have noticed (again), I haven't been posting much.

Being on call is kicking my bootie.

Seriously!

No really, I am not that lame...

Being on call sucks.

Want to know what else sucks? Wanting to get honors in just about everything. It is bad because that means I get super worked up about things when I shouldn't. The result is that I look "stupider" in front of the people that I need to impress because I am trying way too hard.

Example: The first presentation that I gave in front of my current attending was pretty horrible. Partly because I was used to the previous attending who liked things VERY brief and partly because I was nervous. So, now that I am doing my normal level of presentations, I all of a sudden have achieved the "most improved" award for presentations.

Sigh.

What the heck does most improved mean? And really, the attending and the R2 have both said that I have "improved" a lot. In my mind, this means that I pretty much sucked at first. The next step in this interpretation is that did I just go from "horrible" to "okay" or did I go from "okay" to "pretty darn good damn it?"

Argh. I just want to do well! I want to have my choice basically of where I go for residency (which will probably be somewhere in Washington or Oregon). However, even though I know that I can do alright, I feel like I am coming across to my superiors as a "flighty" girlie-girl at first and I am pretty sure that is putting me at a disadvantage at first. I have to work harder to prove that I can handle the hard work.

Anywho...

I have seen some pretty cool things recently. Right now, one of my patients has a gangrenous toe that is going to be amputated tomorrow. My other patient just had a COPD exacerbation but he is still in the hospital because he uses cocaine and we have to rule out heart and other lung problems.

There is now another med school student on my team in addition to moi. I have known him for a while, but my competitiveness is kicking in. Also, a sense of loss. I have noticed that other medical school students are very good at playing smart when they really have no idea about what they are talking about. This skill works well when you have an attending that doesn't really question you all that deeply. I am realizing that I don't have this skill and I think that is working against me.

Some people might not see this as a skill. You would be amazed, however, to see how much this skill comes in handy when you only spend about 2 hours per day with your attending and you need to impress the hell out of her. I always wonder how much my attendings really pick up. Do they know that my classmate is faking it? Do they see that I might not know but I always look up the answer? I hope so.

I also think that I am a little too honest sometimes. If someone asks me how I am doing, or how well I am doing with the current attending, I want to answer the truth. But I am seeing (somewhat at a later stage) that most people around me just say that things are "fine." So that makes me look like I am whining. (Side note... The things that I bring up as "issues" I know are valid because EVERYONE else on my team complains about them in private.)

Well, hopefully I can adapt a little more quickly. I leave for Montana on the 27th or something like that so I only have a little bit more time. I am questioning why I feel like I am behind the ball game all of the time. I get feedback from people who say that I am doing well, but I still have this voice in the back of my mind that says, "They are just saying that so you don't feel horribly."