Ask questions about family medicine here

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On 6/5/2020 at 3:08 AM, gogogo said:

I asked this in a separate post, but maybe it'll get more traction here: 

 

I'm still early in med school, but it seems that the bread and butter of family medicine is chronic diseases with little tangible evidence of benefit (e.g., HTN meds, diabetes management) or tenuous symptom management  (e.g., autoimmune conditions). Combining this with patients who may not always be grateful or questioning/not listening to your recommendations (e.g., lifestyle modification), I am wondering where you derive satisfaction? I don't mean to ask this in a critical way, and I also recognize that I'm probably painting a caricatured picture of the specialty. In fact, I am strongly considering family medicine and want to expand my awareness on what makes other family doctors excited and satisfied with their work.

 

Thanks!

I think it is all about having a positive attitude.

You can use a similar reasoning for any specialty in medicine and make it look boring.

Family medicine is about building a relationship with your patients. They come to you for help. They are looking up to you for guidance. I think that is very rewarding experience.

Let's take diabetes for an example. If you pick up a new diagnosis of diabetes through screening, you have the potential to significantly change a patient's life.

Let's say no one picked up that this patient had diabetes. It is possible that he/she could present one day to hospital in severe hyperglycemia state with sepsis that could potentially be life threatening. Or he/she can lose vision one day all of a sudden due to diabetic retinopathy. Or he/she can develop chronic kidney disease requiring life long dialysis.

As a family doctor, you are in a position to screen for morbid diseases like diabetes and then connect patients with the right resources (e.g., optometrist for diabetic eye check up).

Will you be successful 100% of time? NO. But just because you will fail sometimes that does not mean that it is not worth a try.

[magneto 46]

On 6/6/2020 at 1:19 AM, gogogo said:

Thanks for answering. I completely understand that satisfaction may emerge from the relationship building (trust, connection, respect, etc.), but what about the care? I suppose you could argue that developing a relationship is in itself therapeutic. But besides that, do family doctors find satisfaction in making incremental decreases to HbA1c or BP? Do patients appreciate that? I guess I'm trying to understand whether any of the satisfaction in family medicine comes from the medicine/disease side, or if it is exclusively on the communication/relationship/patient side of things. 

It is not only incremental decreases in HbA1c. It is about looking out of your patient.

A 50 year old male can come to your clinic because he has blood in his stool. You can refer him for colonoscopy and potentially pick up an early cancer.

Many people don't feel comfortable sharing their embarrassing problems to new people such as a physician at walk-in-clinic or emergency doctor unless they are anxious or super unwell. However, they trust their family doctor because they believe that their family doctor is their quarterback.

Let's take another example. A patient has a small mole on his skin. He/she is worried that she has cancer. You can do a skin biopsy or small resection under local anesthetic and send it to pathologist for diagnosis. Within a week, you have the ability to potentially diagnose (and even treat) a skin cancer OR give good news that the mole is benign and nothing to worry about. You can possibly pick up an early melanoma and save a patient's life.

There are not that many things in life where you can play such a crucial role in another person's life.

[magneto 46]

On 6/29/2020 at 12:59 AM, medigeek said:

What's wrong with an FM applicant wanting to be a hospitalist? Society of hospital med in USA is co-sponsored by the internal med and family med boards. 

If anything, we should be encouraging more inpatient practice.

Nothing wrong with an FM applicant wanting to be a hospitalist. But I would advice to not make that the highlight of the interview. They are interviewing applicants for family medicine program (and not hospitalist program). The goal of family medicine program is to pick up applicants to train to become family medicine doctors. If you want to be a hospitalist, once you get into family medicine program then you can start advertising. Hope that helps.

[magneto 46]

On 6/29/2020 at 5:44 AM, chateau22 said:

What about if you said palliative care? Does it get treated the same as saying you want to do a +1 in EM?

If asked about subspecialty interest during the interview, you can say palliative care. But overall your message should be that you want to become a family doctor first. And you will explore special interests once you are in the residency.

[magneto 46]

Thank you to all the forum members who have contributed to this thread and answered questions and advocated for family medicine. I am looking for your help going forward. 

I did not log in for several weeks and couldn't answer the questions right away as I was busy finishing my residency and then finding a job. I am hopeful that I will be able to check more often from now on.

[Meds2022 0]

Do family physicians who do pain clinics get remunerated the same as an anesthetist would doing a pain clinic? Ie are the billing codes the same? 

[CaRMS2021 1]

1 hour ago, Meds2022 said:

Do family physicians who do pain clinics get remunerated the same as an anesthetist would doing a pain clinic? Ie are the billing codes the same? 

Seeing how a decent % of the Ontario over $1million billers are family physicians doing pain clinic, I would assume so? I personally know someone on the list who is family medicine trained doing pain clinic

[bearded frog 449]

3 hours ago, Meds2022 said:

Do family physicians who do pain clinics get remunerated the same as an anesthetist would doing a pain clinic? Ie are the billing codes the same? 

Depends, like if its a standard H&P visit with prescriptions then probably, but there may be some procedural stuff that on anaesthetists may bill for.

[unmatch 22]

6 hours ago, Meds2022 said:

Do family physicians who do pain clinics get remunerated the same as an anesthetist would doing a pain clinic? Ie are the billing codes the same? 

FM doctors doing pain clinic vs anesthesiologists doing pain clinic are two very different things. FM pain=joint injections. Anesthesia pain=nerve blocks, stimulators, etc. 

[JohnGrisham 1,693]

Not to mention "pain clinics" are very province specific in connotation. Ontario for some reason or other has an abundance of them compared to other provinces, where it is really not as prevalent.