Family Medicine (or: Waking Up from a Bad Dream)
November 14, 1998
Saturday
Welcome to the Journal. Sorry about the lengthiness of last issue (4 parts). 10-weeks’ worth of experiences had to be written – catharsis?
Anyway, I’ve just finished a 2-week rotation in Family Medicine. People say that the Family Medicine rotation is just like waking up from a bad dream (Internal Med being that nightmare). Family Medicine is about integrating general practice and holistically looking at the patient as part of a bigger social institution, the family. Rather deep. For instance, you have a 44-year old male who suffers from chest pains. When does he get chest pains? During emotional or stressful situations such as fights with his wife. So now you need family counseling to heal the root cause of chest pains.
Actually, we never really got that involved in family medicine. Two weeks wouldn’t be enough! What we had was a “Family Case Analysis” where we picked a patient from the wards, interviewed him and his family, and analyzed their situation. This was only one of the requirements of this course, the others being reports and case presentations. Oh, and an oral exam too (thankfully much easier than the Internal Medicine orals).
A typical day either brings you to the outpatient department (OPD) where you sec new patients with such undifferentiated complaints like difficulty breathing or generalized weakness, or to the Ambu (Adult ambulatory unit). That is the challenge of Family Medicine – you have to draw on all the stuff you’ve read and/or experienced throughout your clinical years. I like this part of it, as it makes one feel so “doctor-ish”. It’s an anything-goes practice – much like a general practitioner (GP). This happens both in the Ambu and the OPD. The difference would be in terms of treatment, as you can be more laid-back in the OPD but more aggressive at the Ambu (Of course! It’s emergency care!).
The usual cases we see at the Ambu are abdominal pains (ulcers, appendicitis), urinary tract infections, diarrhea, breathing problems (e.g., asthma, pneumonia) and chest pain. If by initial diagnosis the Ambu patient does not need emergency care, he is referred to the OPD. There are occasional psychiatric cases that come in (yuck*) which we refer to the Psych intern and resident on duty. However, we still have to do an initial interview on these patients (yuck again*). But if the patient is violent and needs to be restrained, he’s referred to the AMMU (where I was 4 weeks ago as part of my Internal Med rotation – this is for patients needing “tertiary care” or hospitalization).
The Ambu also serves as a sort of triage center. To “triage” means to direct the patient to the appropriate department for management. For instance, a pregnant lady would sometimes walk into the Ambu and complain of contractions – we’d direct her to Ob-Gyne. Or a child would be brought in sick – go to room 5, Pediatrics. Post-Ambu duty (7 pm to 7 am the next day), the AMBU intern gets a day off. Hooray! This is probably the best part of the rotation 😀
I’m now 2 days into my rotation with the Department of Surgery, trying to gather enough material for the next journal issue. So far, I’ve confirmed a realization I made last year – A surgical field is not for me. I’ll be spending Christmas and New Year with the department, since it’s an 8-week rotation (from Nov. 13, 1998 to Jan. 6 or 7, 1999). Hopefully I can spend Christmas with my family. I don’t mind being on duty on New Year’s Eve (it’s firecracker time!) as I believe this is something I have to experience before I graduate. Plus TV exposure – the usual post-New Year’s Eve celebration documentaries on how firecrackers blow off fingers, etc. are usually filmed in hospital emergency rooms. Watch out for me!
5 1/2 months to go!!!
Notes:
* Apparently I really don’t like psychiatry. Which is still true. I prefer talking to people who make sense and are in their right minds. Within Rehabilitation Medicine, I dreaded the three-month rotation on the Traumatic Brain Injury unit during residency because patients there may be disoriented and confused.
JOINT is the Journal of INTernship, a series of email messages to family and friends (“journal subscribers”) written during my yearlong medical internship from May 1, 1998 to April 30, 1999. Internship is one of the requirements before taking the Philippine Physician Licensure Examination (also known as the Medical Boards). Journal entries were edited for clarity in January, 2020. Read more about it in the first blog post, Introducing JOINT.
