Note to a Pre-med Student

Pre-med students occasionally shadow me for half-day experiences.

Below is a Q and A with my most recent student.



It was a pleasure having you. Thank you for being so respectful of our patients; that is number 1.

I will answer your questions below.

Q: Yesterday you stressed the importance of letting the patient tell their story, do you have any other strategies or tips for when engaging with patients? -- 

A: Good patient interviewing is a skill honed over years of practice, and I continue to work on improving my approach. Medical providers balance many demands during an encounter; time (usually 15 minutes for a visit), documentation (typing), and foremost, a patient's concerns. I need to make sure to rule out the most dangerous problems that could be underlying a patient's complaints, consider the most common, and make sure a treatment plan is going to be practical enough for a patient to actually believe in and try. 

For the most efficient and helpful visit, calmly and attentively listening to a patient is key. If a person feels rushed, they may leave out key details, hampering diagnosis. If I'm not attentive, same thing; I will miss key details. People love to feel listened to, seen, and considered. Listening in a professionally caring manner is part of the treatment.


Q: How frequently do you come across something you’re unfamiliar with? --

A: Like a new-for-me diagnosis or presentation? Probably daily. Family medicine means seeing every type and age of person in the community.

Did you know approximately 1 in 10 people live with a rare disease?  

This means I need to assume I will see a rare condition, that is, keep a 'high index of suspicion', seeing every patient. This way I am less likely to miss important pieces of the puzzle.


Q: On a typical day, what is your schedule like? How many patients do you see? --

A: The goal of my organization for me is to see 10 patients, on average, per shift. A shift is 4 hours. I usually miss that mark, my yearly review says I see about 8.5 patients per half day.

An example of a common 4 hour shift:

- 17 yo same day (like a cough); history of exposure to Covid-19
- 5 yo well-child visit; family wants evaluation for ADHD
- 3 day old newborn follow-up from the hospital; mom had gestational diabetes and baby is having a hard time latching for breastfeeding
- 50 yo pain follow-up (chronic back pain after 2 back surgeries); wonders about what other medications can be tried
- 60 yo follow-up on hypertension, diabetes; no insurance, figure out how to get medication for the patient in reasonably priced manner
- 28 yo follow-up on substance use disorder; injection of Sublocade, have discussion about partner getting treatment as well
- 35 yo evaluation for fatigue and rash; traveled abroad in past month, developing nausea and stool changes
- 55 yo new patient to establish care; has a list of 15 medications to refill, out of 4 of them for the past week 
- 70 yo hospital follow-up for heart failure; still very tired, wonders if should start exercising

Q: I’m personally really interested in family medicine, what special advice would you give to a person entering this specialty? --

A: I would say it is brave to go into family medicine. I recommend a willingness to learn an approach to every patient presentation. I recommend practicing exercising humility combined with confidence; there will be some things you don't understand; you will be learning every day. Cultural competence is key. 


Q: How do you continue to grow in your education and skills? --

A: I look things up on PubMed, UpToDate, and AAFP, and I talk to colleagues regularly. I read a lot. I read notes from the specialists I consult. I take students and residents so we can all learn. Physicians are required to have a certain number of hours of continuing medical education every year; approximately 50. 

New information arrives every day. Studies abound. I read journals as well. I receive  emails from my organization, MedScape, and Doximity.


Q: What are boards like? How often do they occur? --

A: Funny you should ask; I took my recertification examination in May, and last week, found out I passed! 

For DOs, recertification is every 8 years; for MDs, every 10. 

We are also required to complete learning modules and quality improvement projects.


Q: How does your profession affect other areas of your life? --

A: Medicine permeates my life. It is, I would say, a lifestyle. I finish patient notes on  weekends, I keep up with medical updates all the time. I am on call currently, which means I may receive calls about any medical issue(s) on any patient(s) in our practice overnight. 

Being in medicine affects how I take vacations, and how I interact with my spouse and the world. It changed my plans about having kids.

It also means I feel I am doing something meaningful in my every day work, so I feel slightly less pressure when not in the confines of the office, to be doing humanitarian work. But that pressure still looms appropriately, and I try my best to help in other ways, as well.


Q: Do you feel like you maintain a satisfactory balance of work, family responsibilities and personal interests? --

A: Yes, today. Ha. This is an ongoing process. The balance is an accurate metaphor;  I am on a balancing board all day, just like everyone in life. 

I work in the office Monday through Thursday which is the only sustainable way I can imagine keeping my head about me. I would not be able to work 5 days a week seeing 15-24 patients a day.


Q: In your book, you outlined tips to maintain a healthy relationship and work balance during residency. Have you learned any new tips since then? What tip do you think is the most important now that you’re a practicing physician? --

A: Remembering that I'm just as important as the patients I see is helpful. 

This work puts me second so I can take care of others. That is where my comfort lies; forgetting myself, and focusing on how to help others. Now - that is useful in many ways, but I must make a conscious effort to do basic things to care for myself.

Knowing myself and what I need and want, and working to maintain myself and get what I need and want ------ this is what is most challenging for me.

Asking oneself why one is drawn to medicine is absolutely key. The personal statement is a requirement because it must happen; one must have self-awareness of the motivation to go into medicine.

Must.