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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*

Why It Sucks To Be A Primary Care Physician

DrRich entered medical school 40 years ago with every intention of becoming a general medical practitioner, and indeed he became one. But after only a year in practice as a generalist, he found himself so frustrated with the frivolous limitations and the superfluous obligations that even then were being externally imposed on these supposedly revered professionals, that DrRich altered course and spent several years retraining to become a cardiac electrophysiologist.

(Electrophysiology is a field of endeavor so arcane as to be mystifying even to other cardiologists. DrRich hoped that the officious regulators and stone-witted insurance clerks would be so confused –- and possibly intimidated –- by the mysterious doings of electrophysiologists that they would leave him alone. Happily, this ploy worked for almost 15 years.)

Still, DrRich has always held general practitioners (now called primary care physicians or PCPs) in the highest regard, if for no other reason than these brave souls –- unlike DrRich himself, who cut and ran at his earliest opportunity –- have stuck it out. Read more »

*This blog post was originally published at The Covert Rationing Blog*

8 Things You Shouldn’t Keep From Your Doctor

It’s important to have an open relationship with your primary care physician because the more he or she knows about your health and lifestyle, the better able he or she is to diagnose illnesses as they come up.

You wouldn’t take your car to a mechanic and not tell him that the brake is sticking, and a human organism is thousands of times more complicated than a car. But patients are shy. They’re embarrassed. They don’t want you to think badly about them, so they often leave out important information that’s critical for the physician to know. Read more »

*This blog post was originally published at EverythingHealth*

Why You Should Still See Your Doctor When You’re Not Sick

Patient Power logoExperts say over 100,000 lives a year could be saved in the United States if patients focused more on preventive medicine. What is preventive medicine? What can you do in your everyday life that may make a long-term difference?

On this Patient Power program, you will hear from two board certified internists from the UW Medicine Neighborhood Clinics in Western Washington. They will discuss how having an ongoing relationship with a primary care physician who you check in with regularly –- even when you’re well –- gives you the best chance at staying healthy.

Read more »

9 Tips To Improve Patient Satisfaction

Some interesting points were raised at a recent Society of Hospital Medicine (SHM) session by Winthrop Whitcomb and Nancy Mihevc on patient satisfaction. To improve satisfaction scores:

1. Review the patient’s chart before you go in the room. It makes a big difference if the patient perceives you know what’s going on without having to bury your face in a chart.

2. Patients are often confused about who they are supposed to see after discharge. This, of course, is a safety issue as well as one that affects patient satisfaction.

3. Sit down when you are visiting a patient. Patients are happiest when they perceive you’ve spent enough time with them, and they are more likely to perceive this if you are sitting than standing with your hand on the doorknob. Read more »

*This blog post was originally published at ACP Hospitalist*

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