So, way back last spring the department of family medicine asked us to write a wish list of sorts of things we would like to get out of our family medicine rotation. Many folks probably left the section blank or had a particular location in mind (ie, they could go home for the month). But if you know anything about the breadth of family medicine, from rural family docs to hospitalists to Emergency Room doctors to docs who deliver babies to your run of the mill suburban family practitioner to your urban underserved practice....the list goes on and on! Family doctors can do a variety of procedures too, like simple surgeries on the skin (for a large or deep biopsy, for example), joint injections, cryotherapy, delivering babies...there are probably many more, but you get the picture. Family docs do it all!
I knew that I was interested in family medicine back then, so I figured in order to experience a broad scope of family medicine I would have to land a rural rotation. When not too many doctors and large hospitals are around, doctors (hopefully) tend to do more for their patients to avoid having to send them out for many referrals and fancy diagnostic tests. Not to say that they are bad doctors, they just have to be more creative and use their diagnostic skills to save their patients time and money (shouldn't all doctors practice that way, really?).
I marked up my "wish list" with various procedures and rural practices and a few months later I was matched with the Crewe Medical Center! Crewe is only an hour and a half from Richmond, but it is definitely rural. The population for the entire county is only 15,000 and the nearest hospital was 30 minutes away in Farmville. Perfect, I thought!
As I said in my last post, there is a division of labor at CMC. The 2 nurse practitioners see all the well child visits, medication refills, and gynecological visits (basically, all the routine visits). That frees up the 3 doctors to see acute cases and uncontrolled chronic disease. Since I only worked with the doctors, that narrowed the scope for me quite a bit (I mostly only saw adults with acute and chronic disease), but it worked out for the best I think. I learned a lot of medicine in those 4 weeks! Dr. Hall (who I worked with most days) liked to joke that I was X patient's endocrinologist or Y patient's cardiologist. Perhaps a bit of a stretch, but fun nonetheless.
I could go on and on singing the praises of my month in Crewe, but I think I'll stop here. In short, I learned a ton, I loved the practitioners and patients, and I even narrowed down my list of specialties to one. See, I loved family medicine, but it wasn't really family medicine in my eyes. I saw acute and chronic adult medicine (internal medicine...right?). It will take more soul searching to be sure, but I don't see why the extra training in pediatrics would be of benefit to me if I really just want to see adults. Family medicine opens many doors since you can practice in so many settings, but I think Internal Medicine has many, if not more doors. It just narrows the patient population a bit.
