Family Medicine/Primary Care

After my last pediatric blog post, I got a lot of requests for Family Medicine outpatient tips. I didn’t have a blog when I finished my past two rotations, so here I am making up for lost time. All of my family medicine rotations have been in rural and/or medically underserved sites. Primary care gets a bad reputation as one of the lowest paid specialties, but as student I’ve learned the most in family med. 

Why?....

Family medicine providers are essentially a jack of all trades (you must know a little about everything) and patients come in with different acuity levels, disease progression, and co-morbidities. Your communication skills improve as you often have to explain procedures, labs, and conditions in laymen’s terms. My preceptor use to say “if you cannot explain it to your patients, then you don’t really understand it!” Wiser words have never been spoken. 

As a primary care provider, you're responsible for managing the bulk of your patient's health concerns, both acute and chronic diseases. In a perfect world, you'd see a patient for one or the other. In reality, a lot of patients present with acute problems complicated by HTN, DM, CKD, CHF, the list goes on. As a student, perhaps the most difficult part of family medicine is chronic disease management, but know that this gets better with time and experience. I'm writing like I've been doing this my whole life (I haven't haha), but I'm becoming more comfortable in my clinical judgment little by little. I'm working my way through it all and I’ve been lucky to have incredible preceptors to guide me. 

Anyway, enough about me.... I pass along these tips in hopes they will help you! 
 
Tips: 

• Spend time listening to patients. A study showed that patients speak an average of 12 seconds before being interrupted by a provider. 12 seconds?! Yikes. Take the time to listen and you’ll learn a lot about what's important to them. 
• Address your patient’s concerns by beginning the encounter with, “What brings you in today?” or “What is your goal for this visit?” 
• Always recap your encounter. “I will be prescribing x, y, z…I will be making a referral to…I will be ordering labs for”…etc. This way the patient understands what the next steps will be.
• If someone presents for an acute reason (URI, UTI, etc) do not neglect their chronic conditions.
• ER precautions are always a MUST! Educate your patients about worsening sx and when to visit the ER or call 911. 
• Depending on the population, you will be dealing with lots of uncontrolled hyperlipidemia, diabetes, hypertension. Absolutely know these—pathology, screening, complications, management, labs, and when to refer.
• Know which preventative screenings tests and/or vaccines are recommended for certain age groups (colonoscopy, pap smears, mammograms, etc) and corresponding guidelines.
• Spend some time reviewing labs
  • Obviously know the basics of when you would want to order each test, but know when a value is concerning. In practice, you get various “abnormal” lab readings, but not everything is medically relevant or needs to be treated. The same goes for treating labs versus treating patients. Always treat the patient, this is why the phrase "correlate with clinical findings" is so important! (I'm starting to sound like my preceptor..not necessarily a bad thing haha). 

Books & Resources:
(links below)

• PANCE Prep Pearls
• PA Boards Review & Pharm Review Course
• Step-Up to Medicine
• Online MedEd videos & quick tables book
• SketchyMedical

White Coat Pockets: 

• Small notebook for tips/pearls/things to look up later
• Pen
• iPhone/smartphone

When I first started rotations, I would carry pocket resource books, handouts, and various notebooks. Quickly learned that I fumbled to get resources out or didn’t have much time to be flipping through a book. If you feel comfortable having a pocket reference, then by all means do it. I would suggest Pocket Primary Care, but I honestly had an easier time looking things up on my phone--check out my apps section. 

Apps:

• UptoDate 
• Family Practice Notebook
  • This is quite possibly my favorite new resource. Much more of a outline form, great for a quick read in between patients or quickly looking something up
• MedCalc (a must for calculating criteria scores, such as ASCVD risk, WELLS, etc.)
• AACE/ACE Comprehensive Type 2 DM Algorithm
• DxSaurus (~$5.00)
  • Great for differentials
• Pharm Related
  • Epocrates
    • If you have to choose only one of these pharm apps, choose this one. It'll give you the most information. It is also the most expensive, but there is a nice student discount!
  • Sanford Guide(~30)
  • ClassifyRx (~$10)
    • I often wanted to have an app that classifies the meds based on drug classes—this app has that all for you along MOAs, common side effects, etc. 

PodCasts:

• AFP: American Family Physician Podcast
• PA Boards Podcast: Exam Review, Medicine, PANCE

I LOVE listening to podcasts, I’ve learned so much from these two!
 
Language Translators: 

• Canopy Speak
• Google Translator

If I missed a great resource, please let me know in the comments! Hope these helped!

Namaste, 
Melody