What I Learned on my Primary Care Rotation

The astute readers among you will have noticed a little change to the header of this blog a few months back. As many of you know I indeed recently finished my PhD, and have returned to medical school, where I have been thrown in with a group of people, some of them 10 years my junior, who have not taken a five-year hiatus from their clinical studies. This afternoon I finished my first of the third-year rotations, the clinical courses in which we are sent out to clinics and hospitals around the state to learn from practicing doctors and try not to get in anyone’s way. I was lucky to be assigned to begin with primary care. Lucky because it is a broad overview which I sorely needed, and lucky because it’s the part of med school I had been waiting for, ever since I started back when Bush II was in office. I got to split my time this summer between a rural family practice clinic, a pediatric clinic here in Madison, and a super-cool nonprofit, and frankly, I loved the whole thing. I started my third year wanting to go into primary care, and nothing that has happened in the past eight weeks has changed my mind. In fact I have quaffed deeply of the primary care kool-aid.

Now, mind you, none of this means I expect a good grade in the course. My performance on my first practical exam of the year can’t really be summarized by one gif alone, but perhaps in combination you’ll get some of the feel of it:




Whereas the national board exam was more like:


But in the clinic I was really content. I’m not saying I put my best foot forward with every patient or enjoyed every interaction, cause it’s med school and not The Nexus. Like any other time of my life, the rotation had its highs–like watching a patient and their parent go from “I don’t want to see a med student” to “thank you, that was really helpful.” And it had its lows, like when the earpiece of my stethoscope caught on the hem of my skirt and I accidentally flashed my (male) preceptor–a situation mitigated only by my loyalty to the world’s comfiest and most conservative undies, albeit in flamingo pink.

What I am saying is that I feel more strongly than ever that this is the work I want to do. And I’ve been lucky enough to spend the summer learning from people I really respect, who seem to think I could be good at it some day. I’ve learned a lot in a short time.

So here, in summary, is a list (not exhaustive, thank you very much) of lessons I have learned, and in many cases re-learned, this summer. Some I learned right away, and some I had to mess up repeatedly. Some I didn’t really put together until the rotation was over, and my poor beleaguered preceptors were probably thinking, “How is she not getting this yet?”  Anyway…

  • At this point in my career, my job is to learn how to form an assessment. Even though I’ll pretty much always be wrong.
  • A lot of the job is communication. As much as certain representatives of the medical school have treated my humanities background as an unfortunate handicap, it’s what’s taught me to listen analytically, write, teach, and make an argument. Which is kind of what I do all day now.
  • Before you talk to the patient about anything else, establish the identities of the people they brought with them.
  • My teenage hijinks, though bad decisions at the time, are coming in handy in peds clinic. Apparently, as med students go, I’m hard to shock.
  • I really suck, however, at using tongue depressors. I’ve seen so few oropharynxes that for or all I know 50% of children are born without them.
  • I like working with seniors. The demographic with which I have had the best luck establishing rapport is women over fifty, especially if they are “non-compliant,” and/or believe they are psychic.
  • It is possible for a moth to get stuck inside a human ear canal.
  • Rural medicine is for badasses.
  • With respect to rural populations, my cultural competence has a long way to go. I literally do not understand one sentence on this magazine cover.OutdoorLife
  • It’s on me to recognize the limits of my Spanish. I’m most likely to get in trouble when I’m feeling awkward about making someone repeat themselves.
  • That being said, a lot of patients are pretty stoked to find someone who speaks Spanish at all.
  • People who see the world very differently can be very much in sync when it comes to what they value in medicine
  • A lot of medical students are really excellent people. I have always held my colleagues to a pretty high standard, and sometimes my disappointments have dominated my feelings to the point where I almost forgot just how many fantastic people I had the privilege of knowing in med school. I’ve now met about 20 members of my new class, and I’ve liked all of them. When was the last time you met 20 people in a row in any context and liked them all? I’ve met young people with a lot of wisdom, men who care about women, people who respect their patients not because of some higher calling but just because they basically like people. They’re going to be great doctors.
  • Some doctors are really excellent people, too. My colleagues and myself are in danger of having the compassion ground out of us by a tough and often irrational medical education system, before we ever get out and to practice independently. But I’m beginning to believe most of us will be ok.