Tips for a First Year | Family Medicine Resident

Tips For First Year Of Family Medicine Residency: Congratulations! You’ve graduated medical school and MATCHED into a Family Medicine Residency Program. You made it! You’ve worked hard, taken your exams, and broken your booty to get to where you are now.✓ Tips for a First Year Dr. Veronica Rodriguez Family Medicine Resident   You can now introduce yourself to patients as DOCTORS! That proud moment you’ve been waiting for. BUT then…your body begins to feel like it doesn’t belong. Your mind tricks you into thinking, “there is no way I’m a doctor”, “I don’t know what I’m doing”, “How can I possibly call myself a doctor”. This is all normal. Imposter Syndrome is a real thing. It comes hard and stays for a while. Cling to it… it will push you to read more, pay more attention, listen harder, and remember.✓  It will force you to become better. So why do we all feel this way? Because We’re Not Wrong. Let Me Explain.  When I think of the life cycle of a medical professional, I very much believe it is like that of a frog.???? Undergrad  = eggs. Medical student = embryo. Intern = tadpole. 2ndyear resident = tadpole with hind legs. 3rdyear resident = look like adult frogs but still have a small tail  Attending = frog.???? All Interns are tadpoles. No legs, still growing. Not ready but on their way. That’s right. I myself am a tadpole, but I’m about to sprout my hind legs soon! It’s just a few months away.???? So naturally, you don’t feel ready. Yet, you are.  Intern year is a combination of 3rdand 4thyear of medical school on steroids and then throw in a significant splash of responsibility.✓  Each patient is yours; their outcomes are yours. It becomes your responsibility to care for them.  Has the fear set in? Good. And now, let me reassure you. Although you are thrown in headfirst without the least idea of what to do, there is a massive safety net underneath you ready to catch you if you fall. Although you are making every medical decision, you have guidance if you don’t know what to do. The key is to recognize when you don’t see what you are doing.???? Believing you know more than you do, is more dangerous than admitting you don’t.  Your attendings will fill in the gaps in care, add things, take things off, increase or decrease meds, or doses and add diagnosis you missed or just alter it a bit. These patients are yours, but they are also your attending’s, but don’t let that make you lazy now. Family Medicine has the beauty of being all-encompassing, as you already know. “From the cradle to the grave,” we say. And although it’s beautiful that we have the opportunity to care for men and women, young and old, pregnant and just born, it means we need to know about everything. So it can be intimidating, especially when you start seeing patients in the clinic on your own. From day 1, you see your patients in the clinic. You start with two a day, and gradually increase the numbers you see. This will help you not only get the hang of clinic flow, but find your rhythm, learn time management skills, and realize how difficult it is to see a patient, examine, diagnose, treat and counsel in only 15-30 minutes. But you will get here, I promise! I am already seeing 5-6 patients, and honestly… took much longer when I only had 2 HA!’ Let’s not forget that although family medicine has all the above mentioned, we also focus on preventive services. This includes colonoscopies, mammograms, pap smears, AAA screening, Hep C screening, diabetes screening, depression screening, alcohol use screening, smoking, flu shot, pneumococcal vaccine, and beyond…and eventually maybe coronavirus vaccine too. It can be difficult to discuss every one of these items in one visit, and it’s not because of the time constraints. It’s because they should all occur in different age ranges, different demographics, earlier for special reasons or not at all because of age. And, you must access these things all AT THE SAME TIME to allow your clinic to flow. It takes PRACTICE! You will eventually get the hang of it. One tip I have learned from my attendings is, “don’t wait for tomorrow what can be done today”. This means, even if they are there for a sick visit, mention these screening tests and offer referrals so they can get up to date, schedule return to the clinic (RTC) visits for procedures, etc. Think ahead. Keep your patient’s health up to date.✓  It is not their job to know what they should be getting done, although it would help if they did. It is YOUR job to know and to offer it at every visit even if it declines every time. And don’t forget to DOCUMENT the offer and the fact that they declined it every single time. Also, learn your coding. Huh?  Each clinic visit needs a code. It is how patients are charged so that your clinic can bring in the $. New patients and established patients get different codes. Well-child visits get different codes. Procedures have different codes.  And then there are modifier codes that show you did something additional that is not covered in the first code. It can be daunting. But you will get it, I promise. Ask your upper levels for guidance or your attending’s. The last thing about the clinic is this: it feels as though you are out there on your own. It is scary to be responsible for a patient. What if you forget to mention something is important? Or if you forget to ask a pertinent question? What if you forget to talk about a screening test? Etc. Your mind will race. Luckily, every patient encounter you have must be discussed with an attending. So here are tips on what to do PRIOR to discussing the case with your attendings. Create an Assessment and Plan including differentials Read up on those ddx  Practice your case presentation  Remember to mention ONLY pertinent positives or negatives (this