Family medicine is a specialty of breadth of knowledge and depth of relationships. This is especially true here in my rural clerkship, where my preceptor has seen multiple generations of many families and where a visit for one member of the family also usually results in tiny other check-ins on the rest of the clan.
My preceptor is amazing in many ways. First, his patients clearly adore him, which is for the obvious and simple reason that he truly listens to them, knows them, and cares for them. He manages to convey all of this without resorting to paternalism or self-righteousness. Even on my first day, he mentioned "entering humbly into the exam room" and the "humility of medicine." This is definitely a stark contrast from the RPM clerkship: few specialties require hubris of the magnitude demanded by anesthesia and surgery.
Second, my preceptor is just simply a badass. He was in the air force, lived in Alaska and worked there to establish many of the native village health clinics, ran the Iditarod several times, and now is a family physician who works in his clinic, is the medical director of the local nursing homes, and gives health presentations to the community on wellness and holistic health.
I am constantly surprised by his sincere pursuit of the lifestyle changes that can make long-term improvements in his patients' lives. He approaches these topics with sensitivity but also honesty and humility (there it is again!), and while it may be hard to quantify whether or not his efforts are successful I find myself benefiting from the constant exposure to his exhortations to treat oneself well, to value one's relationships with others, to revive the spirit with music and poetry, and to embrace one's inner beauty as a pure expression of self. His approach is so positive-minded that I feel pretty constantly uplifted.
That being said...
Family medicine is exhausting. I really enjoy talking to people and hearing what's going on in their lives; when I'm in the exam room, I feel fully present and I like the experience of connecting to them. However, something about the constant onslaught of patients makes me feel smothered. Maybe this is just the early pains of adjusting to a new rotation, but so far I have been mentally spent by the end of the day, far more than on internal medicine or any of my other rotations (it seems. Maybe this is just because I'm two months out from surgery and the mind suppresses what it cannot forget).
Today we did nursing home rounds. Some of the patients are just heartbreaking: they have no other place to stay, or they're just too unsteady to live on their own anymore, or they have become debilitated by illness and need the constant cares that a nursing home can provide. One woman was recently diagnosed with lung cancer (on top of other ailments) and today she was tearful and worried. She wanted to know how chemo would go: would she be sick? how sick? how long would it last? would radiation hurt? what side effects would happen? was she going to die? My preceptor tried to comfort her as best as he could.
Another woman had written down her memoirs, including all her travels from when she was younger, and had them bound in a hardcover book (complete with dozens of pictures). My preceptor left me with her to chat and she let me flip through the pages. I would ask her a question and it would spark her memory for a story or two. She had been a bit crabby and frustrated when we first came in to talk to her, but a half an hour or so later when I left, her spirits seemed lifted. So many of those patients just want someone to listen and visit with them.
I have Friday off, so I'm going back to Milwaukee for the weekend. I like it up here but the weekend can't come fast enough!