Wayfaring MD

I am a family medicine resident who likes to highlight the hilarious in medicine as I write about patients, medical school, residency, medical missions, and whatever else strikes my fancy.



Disclaimer:
HIPAA is for reals, folks. All of my "patient stories" have been changed to protect patient privacy. I will change any or all identifiers, including age, location, race/ethnicity, sex, medical history, and quotes.
Wayfaring MD followers
Recent Tweets @WayfaringMD
Who I Follow
Posts tagged "family medicine"
How did you decide on your Family Medicine residency? I'm a third year med student and I want to do Family Medicine. I'm trying to figure out what I want in a residency program. Thanks!
wayfaringmd wayfaringmd Said:

Well first off, YAY family medicine! I hope your rotations during third and fourth year don’t turn you astray ;). Like you, I knew pretty early on what I wanted to do specialty wise, so here’s how I found my program.

1. Start with Geography. I knew I wanted to stay in the south unless I could find a program that really amazed me outside that area, so I went to the AAFP's website and pulled up all the programs in about 9 states. They have a pretty great Residency Directory you can search that will tell you most basic info about the programs.

2.  Considered my special interests. I want to do mission work, so I searched for programs that allowed international rotations and added those to my list.  

3. Narrow by program type. Think about whether you want an unopposed program (tip: you do) or an opposed program (ahem, you don’t.). Benefits of unopposed programs include higher acuity patients (because they’re not being passed on to other specialty residencies or fellows), more variety, better continuity of care experience, and more respect from colleagues of other specialties. I’ve been in both type of program, so I can explain more if needed.

4. Narrow by curriculum. Family medicine covers a lot, and many programs are skewed a bit towards one area of interest or another. If you love geriatrics, you should probably go to a geri-heavy program with a geriatrics or palliative care fellowship option. If you love OB or sports medicine, search for programs with tracks that offer more training in these areas. 

5. Narrow by extras. Check out the town. Figure out if you could actually enjoy your admittedly limited free time in residency. Check out their benefits options, schools, housing market, and job options for your significant other.

6. DO AWAY ROTATIONS. I scheduled aways at my top 3 programs on paper and ended up having to cancel one. My #1 program pre-rotation ended up being very low on my list because I didn’t like the location and didn’t think I fit well with the residents there. My #3 ended up becoming my #1. Away rotations are huge. Every program, like every Tumblr, has a certain feel or personality to it. Make sure your #1 actually fits you.

Are unopposed FM residency programs only at community hospitals?
wayfaringmd wayfaringmd Said:

Not necessarily. Most are, but you can find unopposed programs in big cities too. Usually they’re at smaller hospitals in those cities though. Just know that the most complex cases in the big cities are going to go to the place with all the specialists. 

Asker tsareia Asks:
Hi! I am starting DO school soon and am leaning toward family practice. How is it going for you so far? Is there anything you wish you had known earlier?
wayfaringmd wayfaringmd Said:

It’s going pretty well so far (with the exception of this week, but whatever). 

I had a pretty good idea of what family medicine was all about before I got into it. I did all my community medicine rotations in family medicine and did a few away rotations as well. I think the one thing I didn’t think about enough was that continuity of care—that thing I enjoyed so much and so looked forward to—can be quite burdensome. When you go on vacation, someone has to cover your patients for you, and then there’s tons of paperwork and crap waiting for you when you come back. And you’re pretty much always covering for someone else, too. That can get to be sort of tedious. 

But overall, family medicine is pretty great. There’s definitely no other specialty I’d rather be in. Let me know if you have any more specific questions about family med!

i saw in a previous ask you mentioned there's no obgyn residents at your hospital. when you were looking for residencies were you aware of what other programs they had there? i've heard of students wanting to go into fam-med finding 'unopposed' residencies, and i am having a hard time figuring out how to best research this. i'd love to do a fam-med residency where i get more privileges and get more experience, any advice on how to figure that out without visiting every residencies website? ty!
wayfaringmd wayfaringmd Said:

For those who don’t know, unopposed programs are residencies in which no other specialty training program exists in their hospital. It really only matters in family medicine, where you are often seen as “competing” with other programs like internal medicine, peds, OB, and ER. 

Yes, I was aware of what other programs were there. I wanted to go to an unopposed program, so that’s what I searched for.  (PS it’s absolutely the way to go). The AAFP has a handy residency directory search tool. I found that if you search for “community-based, non-affiliated” programs, you’re much more likely to find the unopposed ones. They also have the option to exclude hospitals that have other residency programs. It’s not perfect, but it’s a great start. 

**The first week of residency**

Uncle Oxy calls: Hey girl, how’s residency going so far? 

Me: Pretty good. Just finishing up orientation. I’m ready to actually start doing medicine. 

Uncle Oxy: So are you a real doctor now? Like you could treat me when I’m sick?

Me: Well, yeah, I’m a doctor, but I have to be supervised because I’m still learning. 

Uncle Oxy: But you can write prescriptions right? 

Me: Yeah, supervised. 

Uncle Oxy: Does that mean you are like a PA and can’t write narcotics and stuff without a doctors supervision?

Me: No, I can write that stuff too. 

Uncle Oxy: Oh… so you have a DEA number already? 

Me: oh, I see where this is headed… um, it hasn’t come in yet. Also I don’t have a license in your state. Also we aren’t allowed to treat family members, especially with controlled substances. That’s illegal. 

Uncle Oxy: Oh. Welp, uh, I gotta go. Have fun at work.

Me

**From the Archives of My Brain, An Adventure of Wayfaring Med Student**

Stepdad: Hey look at my leg. It really hurts and it’s kind of red and swollen. 

Wayfaring Med Student: Don’t ask me for medical advice. I’m not a doctor yet. Plus you never listen to me anyway. Go to your doctor.

image

Stepdad: You’re so selfish. You don’t care about people at all. You need to work on your compassion for other people. Just look at my leg!

Wayfaring Med Student: *takes a quick look and finds a red, warm, swollen lower leg that is very tender to the touch* Ok, now I’m going to say it again. You REALLY need to go see your doctor. Like right now.

Stepdad: Why? What is it?

Wayfaring Med Student: You either have cellulitis, which could get bad quick considering your diabetes, or you have a blood clot in your leg. Either way, you need to be seen immediately. 

Stepdad: Nah, it’s not that bad. I’ll wait till next week.

Wayfaring Med Student: Ok. I’m just saying that if it gets worse, I told you so. Enjoy your pulmonary embolism or your gangrene. image

Stepdad: You don’t know anyway. You’re not a doctor yet. 

*Several days pass. Wayfaring goes back to medical school.*

Mom on phone: So he finally went to the doctor. He had an ultrasound of his leg and he definitely has a blood clot. They started him on blood thinners. 

Wayfaring Med Student: I FREAKING TOLD HIM! That idiot. He better never ever ask me another medical question again. image

If Jesus had been a doctor, I think he would have been a family doctor.
FM resident at the Global Missions Health Conference, in her discussion of why family medicine is so well suited for the mission field. 

wayfaringmd:

I saw this lady in clinic recently who had neck pain. She said, “I feel like something’s wrong with my neck veins. There’s something pulling in my neck.” I was fairly certain she just had a muscle strain, but I listened to her carotids to assuage her worries about her neck vasculature. I mean, she was in her 60s, was a smoker with hypertension, and was obese. That warranted an exam, I thought. Sure enough, in addition to her muscle strain, she had bruits over both carotids, although it was much louder on the left. (Bruits are like heart murmurs over blood vessels…they are a shwooshing sound you hear when blood flow is turbulent from narrowing arteries). Her only symptom that could be attributed to the bruit in any way was frequent headaches. I told the resident that I found the bruit, and she listened and agreed. She noted that there was no record of it in her chart before. We sent her for a carotid ultrasound just to assess the degree of stenosis in her carotids.

For my non-medical friends, if your carotids become too narrow, you end up cutting off blood flow to the brain and get a stroke. A lot of times there are no symptoms beforehand; sometimes people present with transient blindness, speech problems, or facial weakness. 

Anyway, today I got the following text message from the resident I was working with last week:

"Remember the lady you saw in the office last week with the carotid bruit? I just got a stat page. She had her U/S today and it found 80% stenosis on the left and she is going to vascular surgery immediately today. You really may have saved her life! Good job! I’ll let you know how it goes."

So yay me. It’s amazing the good you can do just by doing a simple physical exam!

UPDATE: After the resident mentioned above graduated, this patient was assigned to me (because of this very encounter as a medical student). On my first visit with her as her PCP, we discussed her carotid disease. As it turned out, she had refused surgery in 2011 because she believed that her carotid stenosis was not a problem (and actually, we don’t recommend surgery for asymptomatic carotid stenosis). The resident who was her PCP at the time continually tried to push her to have surgery, but with no success, so she maximized her medication therapy, hoping it would be enough to slow the progression of her stenosis. 

During our visit, I asked her about several specific stroke symptoms. After inquiring about episodes of blindness, she said, “yeah, actually I get this brown sheet that comes down over my eye and stays there for about an hour and then it goes away. That’s my cataracts, right?”  

I explained to her that cataracts cause slow progression of blindness with haziness of the vision, not a “curtain pull” effect, and that these episodes were indeed caused by her carotid stenosis. I emphasized the fact that since these episodes were becoming more frequent, she would most likely become permanently blind or would have a larger, more debilitating stoke in the very near future. 

She finally agreed to see a vascular surgeon, and now, just over 2 years after our initial encounter, she has had her endarterectomy! When I got the report from the surgeon, I had a little celebration at my desk. This is why persistence, continuity of care, and good follow up with a PCP matter. 

7:00am

  • po-po shows up at my house because my alarm went off because I broke a glass in my kitchen and the glass break detector detected it and then I couldn’t remember my verbal passcode to tell the alarm company it was a false alarm so they hung up on me and called the po-po and I answered the door in my pjs with no bra.

7:48

  • 8:00 patient checks in at the office. I have not left my house yet. 

8:09

  • roll into work late, now with a headache, because 1) the po-po 2) ironing 3) people forget how to drive on Friday. Pop ibuprofen. 

8:15

  • 8:00 patient finally put in a room for me to see (I have nurse EasilyFlustered today, so I keep my mouth shut about the late start). Of course they are not my patient, and they’re here for pre-op risk assessment, and they have uncontrolled diabetes and hypertension and are a smoker and have renal disease and anemia and oh yeah they use street drugs.

8:55 

  • finally finish with 8:00 patient— who oh-by-the-way wants to talk about urinary incontinence and smoking cessation and venous stasis but ain’t nobody got time for that— now 3 patients behind. I suggest bringing those issues up with her PCP soon. 8:00 patient wants to switch to me as their PCP because “you get me, Dr. Wayfaring.” The front desk nurse, who has Dr. Wayfaring’s back, notifies the patient that Dr. Wayfaring is not accepting new patients at this time, but your PCP has an opening early next week. 

Read More

I’m currently a medical student applying to family medicine programs this year and reading your stories, I know you’ll be a great family doc and I hope to be like that some day. But, right now I’ve been writing and re-writing and editing my personal statement for residency programs and it isn’t that great. Do you have any suggestions or tips on what would help make it a good personal statement for family programs? -anon

Family med programs are looking for applicants who:

  • are fully committed to family medicine (a lot of people apply FM as a back up to their “first love” and FM programs would rather attract applicants who truly want to be there)
  • enjoy (and are good at) patient interactions
  • able to communicate easily with patients 
  • are flexible and enjoy treating a wide variety of conditions and patient demographics
  • advocate for primary care and for availability of primary care for all patients

image

So it helps to show that you have these qualities in your personal statement without listing them out like on your CV. You need to show how family medicine (and not some other specialty) fits your personality. 

Remember that your reader is probably a residency director who is tired of reading personal statements, so don’t write a research paper.

image

Weave stories and examples throughout your writing. Many people will also somewhat tailor their personal statement to the programs they apply to. For example, if you apply to a program that is geriatrics-heavy, you might want to mention your interest in geriatrics more in the PS you send to them. The same would go for OB or sports medicine or global health or any other side interest within family medicine. 

Ultimately, your goal in a personal statement is to make the reader want to know more about you—and therefore invite you for an interview. Leave some mystery in it, but give them a taste of how awesome you are ;). 

image

With solidarity, 

WMD

Not every patient can be saved, but his illness may be eased by the way the doctor responds to him—and in responding to him, the doctor may save himself. But first he must become a student again; he has to dissect the cadaver of his professional persona; he must see that his silence and neutrality are unnatural. It may be necessary to give up some of his authority in exchange for his humanity, but as the old family doctors knew, this is not a bad bargain. In learning to talk to his patients, the doctor may talk himself back into loving his work.
Anatole Broyard, from “Doctor, Talk to Me”. 

"I’d blow my brains out if I had your job. Your job sucks. When someone refers a patient to me, it’s a compliment. When they refer to you, it’s an insult." -sentiment from a surgeon

I was a bit offended by this doc’s comment to me. I like my job, and for the most part, I like my patients. He didn’t mean it as an insult to me, though. It was meant to be more of an observation about the state of the medical system in this country.

He has a point. When a local primary care physician refers a patient to a surgeon or specialist, it’s because that specialist has a skill or expertise that the PCP doesn’t have. 

Read More

  1. captainmudphud said: Gracias. I appreciate the info. I’m probably missing something, but why do y’all do a surgical rotation?

We do a surgery rotation to get more experience doing small procedures and to learn more of the care of the pre- and post- surgical patient. It also helps you get a better grasp of which patients need a surgery referral. Honestly, that’s why we do subspecialty rotations. You learn a little for your everyday practice, and then you learn how much you don’t know and what you should refer out. 

How is a family medicine residency different from an internal medicine residency in terms of what services you rotate through? -captainmudphud

The main difference is that Family medicine is going to be more outpatient-focused and is going to probably have more variety in rotations. FM residencies are required to have continuity clinics where residents see the same patients over the course of their 3 years (adding more each year). I’m not sure if IM has this requirement.

For a breakdown of intern year schedules,

Sample Family Med intern year:

  • 4 months Inpatient Internal Med wards (some programs do a separate critical care rotation, whereas others do longitudinal care where residents care for ICU and general floor patients on the same rotation)
  • 2 months OB/GYN (inpatient and outpatient clinic)
  • 2 months inpatient peds
  • 1 month outpatient peds
  • 1 month surgery
  • 1 month ER
  • 1 month elective
  • 1 month community /ambulatory med
  • minimum of 1 half-day a week in continuity clinic (but usually at least 1 whole day, sometimes up to 5)
  • nursing home visits at least monthly

**I am aware that this adds up to 13 months. A rotation is 4 weeks, so it makes room for a 13th month.

As the years progress, you have less of the “core rotations” in family med (the first 3) and more elective time. Over the 3 years we are also required to do a month of surgical subspecialty, 2 months of medical subspecialties, almost 3 total months of sports med and ortho; 1 month of geriatrics, psych, and practice management; an extra month of ER and outpatient peds; and 2 months of “ambulatory med” which encompasses our general clinic and subspecialty clinics.

Sample Internal Med intern year (from 2 friends in different Medicine residencies)

  • 6 months general wards
  • 4 months medical subspecialties like Pulm, ID, Nephro
  • 1 month ICU (separate from gen wards, but again, some programs combine them)
  • 1 month ER
  • 1 month elective
  • 2-4 half-days a month in clinic

My friend says her program requires them to do Pulm, ID, Nephro, Rheum, Geriatrics, Heme/Onc, Neuro, and Cards rotations, and the rest is up to them.

Friend #2 says she has 4 months general wards, 3 mo med subspecialties, 1 mo ICU, 1 mo ICU stepdown, 1 mo ER, 2 clinic months (1 residency clinic, 1 VA), 1 mo geriatrics. Her program offers a “primary care track” that requires more outpatient blocks.

Asker Anonymous Asks:
As a family physician, what are the top three most common ailments you have patients come in for? Also, what is the age group that you see most often in family medicine?
wayfaringmd wayfaringmd Said:

If we’re talking general adult medicine, then the most common things I see are:

  • Metabolic Syndrome (combo of diabetes, high blood pressure…a sneaky way to put 3 conditions into 1)
  • Joint pain - mostly back and knee
  • respiratory issues - colds, allergies, COPD, asthma
But if you want to add in women’s health, then vaginal discharge and pap smears are pretty high up there too. I’d say the majority of my patients are between 40 and 80, but I do see a pretty big range when you add in OB-GYN patients (teens-30s) and kids. For example, on my last clinic day I saw 12 patients with a pretty good “family medicine spread” of 3 OB, 2 kids, 1 well woman exam, and 6 adult patients with the typical metabolic syndrome / joint pain /respiratory issues constellation of symptoms.