I started family practice three weeks ago and sadly haven't grown any fonder of it than I was on day 1. I enjoy the pediatric patients that come in but sadly they make up only about 15% of the practice. Most of the patients who come in throughout the day are there for "well visits". The term well visit is one huge oxymoron. When I did peds I enjoyed seeing the words "well visit" at the top of the encounter sheet because it meant there was nothing wrong, everyone was happy and I basically just got to play with kids for 30 minutes. In the adult world a well visit is anything but a good time (well mostly). The check-ups wouldn't be so bad if patients actually made an effort to make themselves well. They come in with new labs and want you to tell them that all of their numbers are picture perfect regardless of any efforts made to improve them on their part. Half of the time their results aren't improved and we have to increase their current medication dose or add new ones. Most of our patients have high blood pressure, diabetes, and high cholesterol. Those 3 diagnoses are guaranteed. There is sometimes another disorder like thyroid issues, cancer, or congestive heart failure. Those are the fun ones. I will say one thing, all of these disorders have really forced me to learn medications and how to interrpret lab results and why they are so important.
So as not to sound like a Debbie Downer, there are a few things I enjoy about family practice. I like that you have the luxury of taking time when with a patient. Most medical specialties schedule so tightly that you are only able to give 5 or 10 minutes per patient. It's normal for me to be with a patient for 30 minutes during a well visit. This leads me to my second like; talking to patients about things other than their problems. It's a nice change to be able to just talk to a patient. Some of the older patients have some really amazing stories! These stories sometimes give you an unexpected lift in the middle of a frustrating afternoon. This can back fire though. If I'm in a hurry to get out of the office that evening the last thing I want is to chit chat and look at pictures of someone's grandchildren or hear the latest neighborhood gossip. Nonetheless I am polite and give them the time because sadly I may be the only person they get to talk to that day. The last thing I will put on my list of likes is drug rep breakfasts and midday snacks. These are always a surprise. You never know when someone is going to drop by with a large box of assorted pastries from the local bakery. This too helps with those mid afternoon blues :)
It's no wonder there are fewer and fewer general medicine doctors anymore. It's a lot of medication juggling, helping those who won't help themselves, and fighting with insurance companies to get paid. Maybe I'm making one giant sweeping generalization here and it's not that way at every practice but that has been mine thus far and my friends' experiences have been similar. I sound like a heartless whiner. At least I know without a doubt that this is not the area of medicine that I want to practice in.
