Family Medicine: Part 1

I'm back from the boonies for the weekend and I wanted to report on life in Crewe! I usually wait until the end of a rotation, but I'm just too excited to wait!

First, I'm staying at a lovely Bed & Breakfast called the Grey Swan Inn in Blackstone, VA just down the road from Crewe. It's cozy with a fireplace and endless bookshelves and floral sheets like my Grandma's. Every morning I eat breakfast with the other guests (they have been from near and far--Washington state even!). I have sat with an astronomer, two gents who are working on remote controlled helicopters for the military, and travelling substance abuse counselors to name a few. The Innkeepers make fresh breakfasts every morning with bottomless coffee, thick slices of bacon, creamy eggs, rhubarb crisps, homemade pumpkin butter...you get the idea. Heaven.

After filling up, I hop in the Mini and drive about 20 minutes through the countryside and down tree-lined highways bursting with fall colors to Crewe Medical Center. Patients are always lined up well before I arrive, since the clinic allows walk-ins. Dr. Hall and I review lab results that came in from previous days before seeing our first patients. We typically see patients non-stop until 2pm when Dr. Hall decides it's time for a lunch break (see, that big breakfast is key!). Then we power through until 5-6pm.

Since CMC is a little isolated (the nearest hospital is almost 20 miles away), we double as an emergency room too, it seems. The doctors joke as we sometimes "admit" patients to CMC to give IV fluids if someone is orthostatic or to suture lacerations. We also see the full spectrum of patients (young to old, well to quite ill), though many also make the trip to Richmond to see specialists. There is some division of labor within the practice though, as there are 3 docs and 2 Nurse Practitioners. One of the docs sees most of the kids, while the NP's see most of the OB/Gyn.

I mostly see chronic and acute adult medicine. I have helped diagnose and treat diabetes, heart failure, osteoarthritis, nephrolithiasis (a fancy word for kidney stones), a diverticular abscess, and a host of other problems! I have also gotten to do steroid injections of the knee and sacroiliac joints and my first fecal occult blood test.

In next week's edition I will talk more about my progress as a baby doc. This is my first real medicine rotation (on surgery and neurology most patients came in the door with a diagnosis), so I am finally getting to work on my differential diagnosis and reaching way back into the dusty cobwebs of my brain-space to remember how to test and treat for these diagnoses. It was a steep learning curve this first week, but I know I am making good progress!

Family Medicine

Tomorrow I am moving to Crewe, VA to start my family medicine rotation. I requested a rural location for this month, and apparently my school obliged!!

Neurology

Another rotation down!

Let me first explain the breakdown of the neurology rotation. We spend a month on the service but it is divided into thirds: wards, consults and clinics. The reason for this being that each service sees very different kinds of neurological cases. On wards, one is likely to see a lot of patients with strokes or epilepsy. Consults is more of the same with some oddballs added to the mix. A patient on, say, the cardiology service might suddenly develop leg weakness and the Neuro consult service would be called on to evaluate the patient's new problem, though their primary reason for being in the hospital is not a neurological issue. On the clinic service, anything is fair game. Headaches, Parkinson's, Alzheimer's, Epilepsy, Stroke follow-ups, Multiple Sclerosis and a variety of movement disorders.

Disclaimer: This blog has become my primary place to record my impressions on a given field to help guide my future career decisions. These are only my personal opinions based on a very limited exposure and are therefore not meant to dissuade anyone from entering a given field, or to detract from any department at this institution.

The pros and cons of Neurology as I see it:

Pros:

• The neurology residents were top notch. Nerdy-cool, well-adjusted, friendly and they seem to love to teach!
• Procedures: I helped perform 2 lumbar punctures (you may know them as spinal taps) and learned to place nerve blocks for people suffering from certain types of headaches
• The physical exam in neurology is extremely detailed and it's pretty fun to try and localize the lesion (be it a stroke, tumor, abscess or a peripheral nerve problem) within the nervous system based on your exam findings.

Cons:

• Lengthy and expensive work-ups (especially for strokes) with seemingly little knowledge gained or benefit to the patient
• Very few diseases in Neurology have cures; treatments are symptomatic or merely intended to slow disease progression
• Neurological diseases are devastating. It's heartbreaking to see patients with disabling movement or speech disorders, especially when they are entirely cognizant of their deficits.

One thing I am starting to learn about myself is that I love instant gratification! I like to see a patient, diagnose the problem, provide some sort of intervention, and see some immediate improvement in the patient's condition. I guess I am just simple minded like that. It's just funny because I used to think I would enjoy spending a lot of time educating patients and trying to help them modify risk factors for disease. Perhaps my ideal career will combine an intervention with some long-term/preventative care.