Confirming my Commitment to Family Medicine

My final rotation of fourth year was a two week elective in OB/GYN. I’d chosen it in late January, with only a few days to cement my schedule I assumed by May I’d want to brush up on my women’s health skills before beginning residency. The hours were not typical for OB/GYN, I wasn’t on call very much, nor did I even get a single call the nights I was on. Despite the “ease” of the rotation, there were several moments that cemented my commitment to family medicine, and it had nothing to do with the labor and delivery floor.

One of Several Moments

An experience in OB confirmed my commitment to family medicineThe most definitive moment was when a patient came in with a concern that technically wasn’t OB/GYN related. The patient knew the cause was another condition, already treated by an IM specialist, but the area of her concern was her vulva. Why does that matter? Because anywhere else on her body, the IM doc would have handled it. But when the word “vulva” was uttered, that particular doctor quickly recommended she talk with her OB about it. This is a cliche, but it became one for a reason. Many people who go into internal medicine want nothing to do with reproductive medicine or the “lady business” side of things, and their gut response is to refer when scary words like vagina or vulva are uttered.

Unfortunately, the typical doc who goes into OB feels the same way about everything that isn’t related to breasts or below the waist. In the case of this patient, my attending was definitely cut from that cloth. When I presented the patient’s concern and suggested Dermaplast as a way to help her the OB boldly went into the room… and told the patient to talk to her IM specialist. We shared a look, both of us acknowledging the frustration and ridiculousness of the counter-referral, that the OB never saw.

Why It Has to be Family Medicine

That was one of those key moments, confirming my commitment to Family Medicine. FM docs embraces all ages, all issues from head to toe and refer to specialists to improve patient health. Neither the OB or the IM specialist are bad doctors – they want to stay in their wheelhouse, where they’re comfortable. Yet, if this this woman had a good family doctor she could have had the opportunity to discuss her issue with someone who, aware of the specialist’s tunnel vision, would offer something, rather than punting her down the line.

I want to be that kind of doctor, who helps patients be treated as something more than ‘the next pap’ or ‘another referral.’

By Pixie

 

 

 

Additional Reading

  • UC Davis’s unique FM plus OB program, and results on the first six years of the residency
  • AAFP’s Family Medicine Facts
  • The List – a compilation of criteria for ‘strong OB’ followed by a 2012 list of programs that made the cut. A starting point, but not your end! One criteria is ability to do C-sections, which I feel strongly limits the applicable residencies. Some of us enjoy the low risk options, and many rural FM docs do full spectrum OB, sans C/S, with a local OB on call to do them as needed.
  • A Tumblr blog discussing full spectrum OB.