After saying goodbye to surgery after 2 months, it was time for family medicine. Lucky me the day before orientation, I woke up feeling horrible. I went to orientation with a 102 fever and ended up needing to leave. Great way to start thanksgiving weekend. On the bright side, on the raffle for clinic locations, I got an office that was 5 minutes from my apartment.
Turns out I had the flu, but not A or B so no tamiflu for me. I spent the whole week at home. Second week I finally was able to go in and start seeing patients. I really liked my clinic, we were able to see patients on own and then discuss them with the attending. We had 2 different attendings during the week and it was great to see the different points of view and teaching methods.
I also ended up loving the clinic itself. The nurses were amazing and since the clinic had an urgent clinic too they taught me how to do EKG’s, venipuncture, IM injections, and run IV Fluids. I really enjoyed learning those little things that can definitely come in handy in the hospital and future clerkships and situations.
On a normal day we would start at around 9am seeing patients, mostly elderly patients and review their medications as well as acute complaints like asthma exacerbations, gastroenteritis, and colds. We also had a lot of opportunity to educate patients about their chronic conditions, diet and exercise, and proper medication use to avoid polypharmacy and negative interactions. What impacted me the most was how many patients we saw who were using medications wrong or who had medications that could exacerbate conditions like asthma and sleep apnea. This rotation went by really fast and it was fairly uneventful, especially since my hubby was away working back in the metro area.
In terms of resources used, I had the Family Medicine Case Files and UWorld questions. We had to use the Med-U fmCases, but at least for me those did not really work out. This shelf, for us is brutal. The lectures themselves are not good to prepare you for the shelf, and the exam is very focused on musculoskeletal. I did not really know how to prepare for this shelf and I tried my hardest to do as many questions as posible. For us they usually recommend the American Academy of Family Physicians Practice Questions but they are very oriented to Family Med Residents and preventive medicine which our shelf is not designed that way. They also recommended the app from the American Board of Family Medicine that is a very good question bank and is very similar to UWorld questions and you can easily access it through your phone app.
After Family Med it was time for christmas vacation and I got to go to my hometown, I could finally spend time with family and the hubs. We had a really nice time with everybody, we even went to a good friend’s wedding. We also took some days to go to Old San Juan and see the historic castles and just walk around the city. Christmas if definitely my favorite time of year and it will be hard when we move to the States because we’ll likely come home to see our loved ones and eat tons of Puertorrican christmas food!
The new year swung by and it was time for psychiatry. Oh psych, I was so nervous about this rotation. With my history of anxiety I was terrified that I would be triggered by a patient’s story or something and have a panic attack. I’ve only even had 2 and they were both triggered by situations, once was a sort of natural disaster about 9 years ago, and the other was a combination of things a few weeks before my wedding. I had never been worried about that, except when thinking about being in the clinic and a patient walking in with a panic attack. I know it sounds stupid. Thankfully, I was able to talk to the department head and my resident and they were able to help me out and reassure me that the situation was unlikely, but that if I felt the need to walk out of a case I could.
My resident was amazing, she taught me a lot about pathophysiology, compassion, and clinical practice of psychiatry. Our attending was also incredible at management of the conditions, and I loved how aware and how emphasis was put on having minimally necessary medications that allowed the patient to function and minimize dependance. In our society, where there is an increasing dependance of benzodiazepines and antidepressants, I found this particularly enriching. I ended up really enjoying this rotation and it was a very grounding experience on the mental health of teenagers and our society as a whole, especially here in Puerto Rico where there are so many cultural issues that predispose to anxiety and depression.
This rotation was very cool and easy to prep for the shelf. There were some good resources like the First Aid Clerkships: Psychiatry and the Case files, but I focused a lot more on First Aid and Uworld. I did pretty well on this shelf and I ended up liking this rotation.
Looking back I learned a few things during these clerkships that served to reassure me of my choice of specialty.
1. I really value being able to talk to the patients, empathize and relate to them on a ground level, and in psychiatry you need to be a figure of strength for the patient.
2. I really enjoy being in the hospital setting and being in more surgical/procedural situations.
So although I enjoyed my time in these 2 very different specialties, I cannot see myself practicing either one for most of my life. The knowledge and experience I got from both will forever be with me, like different methods of interviewing and documenting that I will forever continue to practice.
Thanks for stopping by!