My second clinical rotation during my third year of medical school was an underserved medicine rotation. I worked at a family medicine clinic in a rural county. In a related First Line episode, I speak about the rotation and the importance of the social determinants of health.
I remember when I started my first clinical rotation (psychiatry) and how novel it was to see patients after finishing two years of pre-clinical coursework. By the end of the clerkship, I did not by any means become an expert but became more comfortable in both outpatient and inpatient psychiatric care settings.
As I started a clinical rotation in underserved medicine, the first lesson I learned was that most patients come in with a significant amount of medical issues. It is in no way like the mock patient encounters from the first two years of medical school, and it certainly is not like a question stem I would see on my board exams. Real people are complex, with complicated backgrounds and needs. Asking the right questions is the first hurdle. Then, there is the challenge of deciding what to focus on during the physical exam and what labs to order, if needed. The next huge hurdle is figuring out what is happening and how the healthcare team can address it. This challenge was the most significant gap in my knowledge, but I was excited to gain insight through experience.
I find that patients are very willing to talk with you if you ask them open-ended questions and that you do not need to think too hard about what pointed questions to ask. The patient will likely reveal to you what you forgot to ask.
Even after just one day of the rotation, the patients I see have fully reminded me why I started this podcast and blog in the first place. I am passionate about education, whether it involves sharing my experience with current and future medical students or teaching vital health issues, especially preventive care. Unfortunately, most patients I saw during this rotation relied on their medications to treat chronic diseases while sharing that they take too many prescriptions or do not want to be on any more pills. However, the problem is that their concerns are challenging to manage during a doctor’s visit scheduled for 15 minutes. I always ask patients about diet and exercise, at least getting them thinking about it. However, there is not enough time for me to thoroughly review the details of their day. Personal responsibility is essential, and everyone controls their lifestyle choices. No one else is. A doctor can prescribe a medication, and you can take it. However, it is a struggle to treat by prescribing a better diet, especially since that looks very different from person to person. What about exercise? The same problem exists. Individuals must find something they enjoy, or they will not do it. These conversations take time to get good at, but I hoped that by the end of the rotation, I would be able to holistically address the patient’s body, mind, and spirit.
I developed these skills throughout the rotation, but the month also brought new problems. I started thinking more about the rural underserved population and how prevalent chronic diseases like hypertension and diabetes were. I saw healthcare delivery through the lens of the social determinants of health and thought more about how socioeconomic status and childhood upbringing can affect long-term health. These are topics I hope to continue to explore in future rotations and my residency training.
In a related First Line episode, I speak more about the rotation and the importance of the social determinants of health.