Shadowing a family medicine doctor

Today, I got to shadow a family medicine doctor at a small hospital in a rural community in Washington.  Every single patient we got to see had different family backgrounds and different reasons for coming in, and I was amazed by how the doctor could switch so quickly from one case to the next, all the while dictating his notes, prescribing medications, conversing with his patients, and explaining things to me.  He was a very gracious doctor and teacher, especially since I was very new to the whole doctor shadowing thing, and didn't know exactly how much I could be part of his work.

A few issues came up today that really struck me about rural medicine.  The first was about health insurance.  Most of the patients they see here are on Medicare or Medicaid or receive funds for treatment through the Indian Health Council.  The others get insurance through their jobs or don't have insurance at all.  This can be very sad in cases where a person doesn't have health insurance, doesn't qualify for Medicare or Medicaid, and cannot get a job due to an injury or preexisting health condition.

The second issue that came up frequently was drug abuse.  Methamphetamine abuse is common, and people have died of it.  There are also cases where one spouse abuses meth or marijuana, and the other spouse is left to try to make ends meet and care for the kids.

Teen pregnancy and single mothers are also common.  A single mom might come in and tell us that she thinks the father of her child wants to be involved, but isn't totally sure.

We had interesting conversations with another doctor and the chief operating officer here about administration.  There is a delicate balance between profitability and patient care.  Resources are limited, and the more patients you can see and successfully treat without high-cost treatments, the more sustainable a hospital is.  Promoting wellness in the community plays a huge role in this, because if the people who come are quite healthy and just need something simple to get better, the hospital is much more cost-effective.  There can also be problems when the administration tries to achieve maximum efficiency and then forgets that doctors need time to see patients and patients need to be happy about the care they receive.  Personal relationships and trust between physician and patient can be the key to successful treatment, and these relationships require time.  A hospital needs to be well-staffed so that it is not dependent on just a few doctors, but hiring staff can be expensive.  So, it really is about finding that balance so that doctors are able to care for their patients, the hospital can run even if one of the doctors needs time off from work, and the hospital can be profitable.

Overall, I was amazed at the diversity of patients and cases a family medicine and OB doctor sees in one day.  I also found that I really enjoyed seeing geriatric patients more than I expected.  Seniors can be so sweet and fun, and they almost always have a good story to tell.  I can't wait for tomorrow, when I get to see the operating room and then go to a smaller clinic nearby and observe the different dynamic.