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Everything posted by Rationalistlens

  1. You are right that bad outcomes of course happen in other specialties as well. But that was not even my argument. My argument was that as a FP, who only has superficial knowledge about everything due to the very nature of generalism involved, you are making decisions for things you do not have an expertise in. The gravity of it does not hit you when are you are a FM resident in hospital with supervisors to review your cases but only when you are MRP on your own with a waiting room full of patients you must see in less than 15 mins each and $33 each (being liberal here with 15 mins) and monthly expenses to pay to keep your clinic afloat. ER doctors see catastrophes daily, that is their training. An average family doctor probably only diagnosed PE once or twice (that is if you were lucky or spent half your 2 year training in ER or did that elective out of interest on hematology ward) in their training and is expected to make sure in 10 mins without access to stat Ct and stat d dimers that one walk-in pt with pleuritic chest pain is not having a PE before sending them home. Especially when you dont see chest pains daily in your practice and hence dont really rememeber WELLS criteria on the back of your hand so you have to excuse yourself from pt encounter to do the score on your cell phone before telling them “i think I am concerned about a PE, you should go to ER to get it checked out” and then it turns out they did not have a PE anyway. And must I remind you of the joy when that pt comes for follow up to you and reminds you, the lowly GP who probably never treated a PE in his life but was making decisions on suspecting/diagnosing it, “hey doc, i waited full 2 hrs in ER, they told me you are fine and sent me home, you were just worried for no reason.” And yes, all that “worry” for $33 for that encounter including the delays it caused on your schedule and other unhappy patients because you wanted to take time to properly reach the right decision for this patient’s discharge to home or ER. My message: Stay away from FM.
  2. I am a practicing family physician, so take my opinion for what its worth. I will recommend you to stay away from family medicine as it stands right now. Under a massive propaganda in cahoots with the provincial governments, med schools sell you family medicine as this great speciality. On every step you are shown how great and diverse FM is. But no one tells you the practical implications. No one tells you the medico-legal implications of being a FM physician. No one tells you the financial implications of being a FP. If you practice full family medicine, your income will depend on volume of patients you see, unless you are in a FHO (you cant create new FHOs anymore in big cities). So for all intents and purposes, the more patients you see, the more $ you will make and secure to keep your business running and your own family fed. You ask what is the problem with that? Well the more patients you see, the more chance of making errors in 5-10 min consultation for a patient who might need a full 30 min evaluation (including the time for your brain to process the diagnostic algorithms and ddx). And trust me, as a FD you CANNOT spend 30 mins, heck even 20 mins, with every patient that you see in one day or your business will go bankrupt, pts in waiting room will leave you extremely negative comments (they dont and wont give a damn how thorough and accurate and great care you were providing to the patient you were in exam room with...and they could also file complaint to your college, probably nothing will come of it but the headache and stress you will go through from getting a letter from your regulatortycollege) On any given day, a neonate might come to your clinic who is really sick but does not look sick enough to YOU (who is not an expert in pediatric care) to direct them to ER at that point in time. So you decide to send him home and he dies, guess who will be held responsible? You as a primary care FP (you are not a ped, keep in mind, and hence are not an expert in pediatric care). You will be held responsible for missing a critically ill child in a 5 -10 minute visit for which you were being paid only $33-40. The same patient when goes to ER, the ER physician will make at least $77 for the same presentation with the ADDED advantage of being able to do stat xrays/cbc to further hone his/her ddx.... Now you tell me, are you willing to take that risk of making critical decisions in light of the Limited time you can spend and limited $ you earn from making those hard and tough diagnostic decisions? yes this doesnt happen daily. Maybe it will happen 5 times in your life time that you see a critically ill neonate. But you just need one error to have your livelihood ruined and your face plastered on the news and your reputation destroyed. And that also makes it even more tricky. The less presentations you see, the rustier your clinical acumen and diagnosis. Hence even greater risk of not recognizing a catastrophe happening in front of you. i can go on and on. Dont ever do FM. find something you like and focus on that specialized care you can be and dream to be an expert in.
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