Wednesday, February 11, 2009

So young, and so untender?

Cool, moist air greets my nose as I step out of the car. It feels light and sweet as it fills my lungs. Drink deeply of this - the vanguard of spring.

From my small-group seminar on endocrinology:

Girl: Question!

MD: Yes?

Girl: Are you an actual endocrinologist?

MD: [nervously] Yes... I am. Why, is there something wrong?

Girl: Oh, no... you just seem really... knowledgeable. I wanted to know if you were like a respirologist, because I don't think I would ever know as much as you do.

MD: [chuckles] Oh, you will by exam time. After you've gone through it a few times.

Boy: Thank God they didn't send us a family doc or something!

This conversation, while amusing, underscores that even at this very early level of education, there is already a bias against general practitioners. In response to this, Kushima commented: "If you decide to go into family, even if you work in the hospital, you'll have your own practice and won't really see those people and you'll have better hours, so who cares what they think?"

While this may be true once a person breaks through the activation energy of actually deciding to become a family physician, I do think that it discourages the brightest and most competitive students from considering family medicine due to its poor standing.

This, in my opinion, leads to many inexpert family docs (though there are excellent ones as well), which further damages the reputation of medicine. For instance, one patient who presented their story to us in lecture described how they were being treated for hypothyroidism but continued to lose weight. In hypothyroidism, weight gain is expected. Their family physician recommended they continue to take their medication for hypothyroidism, and that whatever symptoms they had were as a result of the meds not yet taking effect. It was not until many months later that they presented in hospital where they were diagnosed with Addision's disease in conjunction to their hypothyroidism. Misdiagnosis by family docs leads to a drop in their repute, which in turn leads more competitive students to avoid it. It is a vicious cycle of positive reinforcement which gradually whittles away the quality of primary health care.

[Read more about my views on family medicine: here]

The title of this post is from Shakespeare's King Lear: Act I, Scene I.

This entry was adopted by Brutus.