The goal for the year is to be able to operate as closely as possible to Intern status. I am set up with the Electronic Medical Record (EMR) with a username and password so I can log on as a provider. For each patient I see enter their chief complaint, take the history, perform a physical exam, and then quickly type up my assessment and plan before consulting with my attending physician. I am learning to ePrescribe and order lab tests. In Family Medicine, I get to see the patient before the real doctor does. Some patients are wary about seeing someone who looks like a teenager, but they are usually calmed by the fact that the real doctor will be there in just a minute.
Actually (and I know this certainly a biased view), I think most patients enjoy seeing both a student and the doctor. It's like having a "team" attending to their care (which is semi-true, although I certainly don't pull any weight). I've had very few patients hold back information or fail to divulge pertinent details to me when giving the history. When my preceptor and I see the patient together after my presentation, patients usually have moved from curious skeptics to excited participants in the patient-centered experience. Many are used to seeing students and are happy to help; of course a few others think I'm a waste of time.
Every week I get to the clinic at 8am (it is amazing to sleep in - no more 4:45am wake up for a while!). and we start with a brief oral quiz. At the end of each session, my preceptor identifies a "learning issue" to research and prepare for next Monday. These are traditionally bread and butter topics that all clinicians should be familiar with: diagnosis and treatment of hypertension, medications used in diabetes, goals for cholesterol and statin therapy, etc. Julia and I both work with the same preceptor, so we get to learn from each other in the process. Then it's off to our computers to get started on the day's patients. We usually "open" the notes the night before so we are extra ready to see our peeps, and then it's "knock knock" let's begin! After seeing the patient and presenting my plan, I return to the exam room with my doc. Sometimes my plan is right, often it's wrong. Fortunately, during the wrap up I can edit the details on the EMR, making sure everything's entered accurately. That way when we leave the patient's room, I am ready for round #2. Typically I see 3-4 patients each morning, but that will pick up as the year goes on.
The other thing I love about Family Med clinic is that many of my longitudinal patients are starting to return for follow up. When prescribed a new medication, patients often need to be seen again in 2 weeks or a month to check in. So, now I'm starting to see the same faces again, which is one of the big bonuses of this program. Keep learning, keep reinforcing. Recognize a name and face; it's what makes it all worth it (although, I guess it depends on the name or face). In between, I see plenty of acute and urgent issues as well.
When the clinic is over, I have the rest of the day off. I try to keep Monday afternoons open for work (gotta do it while the week is fresh). My other free half-days are Tuesday and Friday mornings, and that's the time I try to use to schedule other clinics, meetings, and continuity visits. Usually I frequent one of the local coffee shops, but I recently, in the evenings, I've taken to studying at the Grove Park Inn, reading Harrison's with a beer in hand. I watch the sunset through the clouds and over the city, with the mountains looming in the distance...
And, that's why I never have a case of the Mondays.
I thought you were going to say you never have a case of the Mondays because you work so many weekends!
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