I spent my family medicine month in Troy, Alabama and feel like I learned more than most of my other rotations combined. A medium-sized clinic with the same preceptor each day allowed for longer time spent with each patient, for me to ask questions as we went, and to actually get to know the patients’ medical histories. My preceptor grew up in Troy, attended UAB for medical school, returned to serve the community, and is a hometown hero to his patients. He takes care of entire families from grandparents to great-grand children, manages his former elementary school teachers, and gives patients his cell phone number to call in times of hardship. Southern Health Associates really puts the family in family medicine. I could often see a 3 month old baby and a 97 year old man in the same day. I gained an entire new respect for the world of primary care and the complexities of managing patients throughout their lifespan, particularly with chronic diseases. I remember distinctly one time in simulation lab, my classmates and I stared at each other when we saw our mock patient and were then asked, “so what do you want to do?” My favorite professor said, “You feel like you could never figure out what to do right now but one day, probably in a year or so, it’ll all just click and you’ll know.” That feeling did not happen to me until this month, where my preceptor took my knowledge seriously and would actually let me make my own plans for the patients in terms of which antibiotic to use, whether to refer to specialty care, interpret my own images, etc.

I now understand why many people encourage primary care as a first job on which to build a strong foundation as a clinician before going into speciality care.

How To Prepare

Back to Basics – It seemed like this month I saw everything I had learned about in my first semester of PA school, in pathology and in clinical medicine 1. I was asked about the types of hypersensitivity reactions, differentiating diastolic and systolic heart failure, the most likely bacteria causing every type of upper respiratory condition imaginable, almost every single one of the musculoskeletal classic findings (Ober, Hawkins, Neers, Apley, Patellar Grind, Clunk test, and so on). Interestingly, my preceptor had once served as a team physician for the Alabama football team and also practiced sports medicine. Basically this month was a review of all the things I’d read about but hadn’t seen in real life yet. Keep a little notebook to write down all those little things you’ve forgotten so you can brush up later.

One word: Diabetes – If you’re like me and are a month away from graduating but still confused about dosing insulin and managing diabetes, you gone learn today. (At least if you’re practicing family medicine in the Deep South in an area that the CDC has nicknamed, “The Diabetes Belt.”) Like really, google it. I’m including some incredible handouts on diabetes management and options for glucose control gifted to me by a very enthusiastic, Lilly rep that I referred to often. GET THEM HERE! I wish someone had just given me these charts during the endocrinology block. I learned to manage Type 1, Type 2, and how to program and interpret data from insulin pumps. I didn’t know this, but insurance companies actually monitor how successful primary care providers in this area are at normalizing A1C levels. Good thing all the patients are so compliant to these complex medication regimens, right!? Ha…

Binge the Game Show Network – If you’re nearing graduation and can’t force yourself to prepare for your last rotation, binge Family Feud for hours and it’ll halfway prepare you to see patients. More people asked about medicines they’d seen on pharmaceutical (or lawyer!) ads on TV than I ever guessed would. I constantly had to read up on the latest and greatest drugs being advertised including Trulicity, Aimovig, Xeljanz, and more. All the hours spent on my guilty pleasure (game shows) paid off when I knew a little about what they were and their indications.

Review Plain Films – Our clinic had an in-house xray so we often obtained plain films ( the ubiquitous chest xray, KUB, hand, feet, knees, you name it). Review the systematic way to read CXRs (ABCDE), look at the normal amount of joint space when assessing for osteoarthritis, brush up on the Salter-Harris classification of pediatric fractures, remember what the scotty dog on a T spine xray is, and so forth. (I actually truly saw the scotty dog for the first time on this rotation, I swear. You have to tilt your head a certain way…)

What To Expect

Minor Procedures – One thing I liked about primary care was the opportunity for different procedures throughout the day. I&Ds, wart and skin tag removal, punch biopsies, casting and splinting, excising cysts and ingrown toenails, and all sorts of joint injections were daily occurrences. This kept things interesting and allowed me to practice technical skills and get more comfortable with infiltration of lido, nerve blocks, and joint injections.

New Considerations – So, in primary care, not only is it your job to manage people’s acute and chronic illnesses throughout their life, but make sure that they have the resources to be compliant to their regimen whether that is diet, prescriptions, physical therapy, you name it. My preceptor spent as much time as necessary to help his patients with medicare denials, unexpected charges, finding the best coupon cards for prescriptions, obtaining samples for extremely expensive inhalers, etc. Don’t forget that Medicare is evaluating these patients outcomes but do not take into consideration compliance issues or the socioeconomic status of the community. When I voiced that I thought this was unfair to providers my preceptor said, “Well that’s part of the ART of medicine.” Ok, mic drop! Learn about programs like GoodRx,  and assistance programs from the specific drug companies.

Importance of Networking – When a patient is coming to you for a problem that is outside your scope of practice, it becomes your job to connect them to a provider that you trust will meet the patient’s expectations. Having a good network of specialty providers in ortho, physical therapy, ENT, neurology, etc. will serve both you and your patients well. Start building relationships with other soon-to-be providers now!

A note about the EOR.. it actually worked out well for primary care to be my very last rotation (AGHH!!!). The topic list for the EOR is very, very long and broad, much like the PANCE, which I will be taking in February (AGHH x 2!!!). I was more motivated to study for this one because it seemed like also studying for the PANCE. As always, I used PANCE Prep Pearls.

This will be the LAST of my rotation recaps, which is UNBELIEVABLE! Check out the months of my life over the past year categorized by medical specialty including: Emergency Medicine, Inpatient Medicine, Pediatrics, General Surgery, Psyche, Trauma ICU, Cardiothoracic Surgery, Plastic Surgery, and OBGYN! Thank you so much for reading! I hope you find something helpful, interesting, or at least entertaining in my blog!

Love and Light,

Asia