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A Letter To Medical Students Considering Primary Care

Dear Student:

Thank you for your consideration of my profession for your career. I am a primary care physician (PCP) and have practiced for the past 16 years in a privately-owned practice. (At some point I intend to stop practicing and start doing the real thing. It amazes me at how many patients let me practice on them.)

Anyhow, I thought I’d give you some advice as you go through what is perhaps your biggest decision regarding your career. Like me, you probably once thought that choosing to become a doctor was the biggest decision, but within medicine there are many options, giving a very wide range of career choices. It is the final choice that is, well, final. What are you going to do with your life? ”Being a doctor” covers so much range, that it really has little meaning. Dr. Oz is a doctor, and he has a very different life from mine (for one, he’s not the target of Oprah’s contempt like I am -– but that’s a whole other story).

Here are the things to consider when thinking about primary care:

1. Do you like talking to people who are not like you?

Primary care doctors spend time with humans -– normal humans. This is both good and bad, as you see all sides of people, the good, bad , crazy, annoying, funny, and vulnerable sides. If you see mental challenge as the main reason to do something, and would simply put up with the human interaction in primary care, don’t do it. The single most important thing I have with my patients that most non-PCPs don’t have is relationship. I see people over their lifetime, and that gives me a unique perspective.

2. Do you prefer variety over predictability?

Every room I walk into is different –- often vastly different -– from the last. I could be walking in on a crisis or a stable recheck. The person could be elated or crying. They could be 90 years old or two days old. They could have something wrong with any system, and it could range from mild to life-threatening. I’d go nuts doing the same thing every day, be it looking just at skin or just dealing with the kidney. But some folks do better with routine and a lack of surprise, they don’t want their days to be unpredictable. Read more »

*This blog post was originally published at Musings of a Distractible Mind*

Video: One Primary Care Doctor’s Journey

Doug Farrago is a family physician in Maine and the editor of the entertaining Placebo Journal. He uses his Placebo Journal media platform to show his audience what primary care is all about. In this video, “Doug Unplugged,” Dr. Farrago gives us a little taste of that journey. Hollywood, take notice.

*This blog post was originally published at KevinMD.com*

Practicing Primary Care: A Lesson In Treading Water

As a primary care physician, I am becoming painfully aware of how hard it is to be good –- I mean really good — at what we do today. I would prefer to believe that it has always been so, yet I do not believe that our predecessors in the medical profession found it nearly as difficult to excel in their time as we do now.

With all of the technological and medical advances, you might ask how I could believe this to be true. Too, you might consider it pessimistic or even crazy to suggest that physicians 20, 30, or 100 years ago found it easier to practice medicine well in their time.

You could counter with numerous or obvious examples such as antibiotics, pharmaceuticals, robotic surgical procedures, or even our wondrous ability to peer inside the human body without cutting it open. You also would be correct to point out that the technological advancements of the 20th century opened the way for the medical profession to become a real science thus giving me and my colleagues the chance and knowledge to make a real difference in our patients’ lives today. Read more »

Doctor-Patient Communication: Much Room For Improvement

In a surprising report from the Archives of Internal Medicine, we learn that most hospitalized patients (82 percent) could not accurately name the physician responsible for their care and almost half of the patients did not even know their diagnosis or why they were admitted.

If that isn’t enough, when the researchers queried the physicians, 67 percent thought the patients knew their name and 77 percent of doctors thought the patients “understood their diagnoses at least somewhat well.” I would call that a pretty significant communication gap.

Ninety percent of the patients said they received a new medication and didn’t know the side effects. Although 98 percent of physicians thought they discussed their patients’ fears and anxieties with them, only 54 percent of patients thought they did. Read more »

*This blog post was originally published at ACP Internist*

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