The other day I started drafting my blog post about my internal medicine core rotation and so my intentions were to complete that entry tonight, but I started to reflect on my day today and I decided to go another way. The internal medicine post will be on deck.
I started my family medicine core clerkship last week and after finishing my internal medicine rotation with four weeks of outpatient clinic, I was prepared for my family medicine core to be more of the same. In many ways it is but it is also different, however, in terms of management of new patients and established patients, they are one in the same. One of the things I find most intriguing about people (not just patients) is how we say we need one thing but many times that is only touching the surface of what we truly need. In the classroom during 1st and 2nd years, you learn to be prepared for these cases. You are taught to expect patients to come in with one complaint but then have a "secret complaint" that you must uncover because that is the real reason why they came in that day. I think the sheer amount detective work that goes medicine is undervalued. But its more then just detective work. It's building that rapport with your patients in the first 3-5 minutes of talking to them that they feel comfortable enough to open up to you about what is really going on. Although there is a certain art to it, it really is simply just being an empathetic and kind human. You know, the type of person that everyone feels comfortable talking to. So, once you are able to uncover that true reason for their visit then you can properly begin to assess, diagnose, treat and heal.
Today, I had a patient that came in for one thing but within a few minutes, my patient felt comfortable enough to open up to me about some other more pressing things that were going in their life. My line of questioning quickly adjusted and we proceeded to have a meaningful interview and conversation about their true concerns and issues. As I started reflecting back on this particular patient today, I was kind of taken back by myself because it was one of those tough cases that you prepare for in MS1 and MS2 but you've only really asked these questions on a standardized patient or via a standardized questionnaire in your outpatient office. It was in this moment of reflection that I realized how much I have grown as budding baby doc in just 1 years time. It's one thing being in an inpatient environment where everyone is super sick and they are not trying to hide it, but it's a different beast in outpatient where people are still sick but trying to fake it and pretend that they are well. But it was just crazy to me how effortless and easy my patient encounter and interview went even in the midst of a more challenging and sensitive case. It felt innate. It felt natural. It was not until tonight that I could really reflect on that "feeling". That feeling that you get as a budding baby doc when you uncover that secret chief complaint and concern and are able to address it in a sensitive and meaningful manner. That feeling when you actually think you are starting to honestly and truly "get the hang of" this medicine thing. That feeling when you know if you had not been truly listening to your patient, you would have missed what they were trying to tell you but you didn't. The feeling to know that even as the budding baby doc at the bottom of the totem pole you are still in the position to make a difference. The feeling to know that you are making a difference. The feeling that reassures you that you were meant to do this.
I felt it. I loved it. And I can't wait to feel it everyday for the rest of my life.