Doctor as a townsperson.

I saw a truly remarkable thing this week. Something rare in the world of medicine. The most intimate relationship between a doctor and his patients. The good doc has over 2500 patients, more people than the town itself...people come from miles around to see him and figure out their illnesses, whatever is ailing them. Mostly pain management, diabetes, hypertension, but some other cases of rashes and blisters and sore throats. Fifteen minute mini-sessions of patient counseling in what hopefully results in compliance with medications and advice. What I loved most about observing the doctor in action was his relationships with them. He was one of them. He wasn't just acting the part of the doctor. He was a resident, a neighbor, a caretaker, a family man, an adviser, all rolled into one person that people pay to talk to. And most of the visits involved him sitting there, listening intently, and maybe providing some options for treatment, and usually explaining the physiology of disease in order to engage his patients, and more often than not, letting the patient decide on the next stage of her health management. He provided guidance during a person's most vulnerable state of being, without being too pushy.

I am grateful that so many of his patients allowed me to observe during their visits. I had the opportunity to interview a few patients before the doc entered the room - simple cases of sinus infections or strept throat. I probably should have asked more questions than I did, obtained a more thorough patient history, but I had no clue what I was doing and the patients were very...well...patient.

Most patients main concern, besides their medical problems, involved how they were going to pay for their treatments. In every case, the doctor had to cater his diagnosis and plans according to the patients' insurance, or lack thereof ("Do you want this antibiotic, which is cheap, but might not help you in your case? Or we can run this semi-expensive test, and once we get the results, we can decide which antibiotic to use?"). And on the flip side of the whole encounter was the doc's own medical bills - the high cost and overhead involved in running a private practice. You bill the insurance company for a routine check-up, the insurance company might pay you 50% of what you billed, or they can try to deny the case in the hopes that the office will drop the charges. It's a constant uphill battle for the doc to get reimbursed for treatment. And subsequently, the manner of primary health care has changed significantly, resulting in hustled appointments and rushed diagnosis.

This week has not helped me decide which type of medicine I might go into. The family physician that I stayed with recommended that I choose a specialty that has at least one "procedure" - a high cost but quick fix for the patient, financially rewarding and not time restrictive for the doctor. See, dermatology. Surgery has always interested me, but it's a lifestyle that no one should have to endure, and it is certainly not conducive to having children (something else that I am unsure about). Family medicine is appealing because of the slightly better schedule, and the ability to build lasting relationships with people-patients. And it's all dependent on where one chooses to practice, from the boonies to the big cities. However, changing locations is much easier than changing specialties.

I guess for now, when all my classmates and all my professors and preceptors ask me what type of medicine I want to study, I'll continue to give the vague, uncertain reply, "Not quite sure, I guess I'll figure it out when I start my rotations". I'm sure it won't be an easy decision. But nothing in life really is.


And with that, I have to enjoy my last day before the rest of my life! Er, the last day before medical school starts.

Family Practice in a Rural Oregon Community

Upon arriving to Cave Junction, I was slightly nervous but mostly excited. It's been quite a while since I've spent time in a small town - Santa Barbara, San Francisco, Oakland, and Portland are certainly large urban areas. Downingtown, Pennsylvania, where I went to middle and high school, is populated with 8,000 people....I thought that was a small town (my backyard was a corn feed farm!!) Whereas San Francisco is close to 800,000 people, Cave Junction is a mere 1,600.

When I first talked to the doc, he told me he and his 4 children live in a 2 bedroom house, and they weren't sure where I was going to sleep. I was a little concerned....it seemed impossible to me to raise that many kids in such a confined space! The house is actually pretty huge, lots of open spaces, lots of deck space and crafts spaces and a game room - the kids have it pretty good! My doc and his family live on a 60 acre plot of land a few miles from the "downtown" area. They've put a lot of effort into a beautiful garden, plush with grapes, blueberries, squash, strawberries, basil, garlic, peas, peppers, and probably a whole bunch of other veggies I couldn't identify. A few apple, pear, plum, and cherry trees spot the land close to their small house. The rest of the land is mostly light forest, and the kids fall oak and madrone trees during the end of summer to sell as firewood to the townspeople. The good doc dabbles in wood etching, silversmith-ing, pottery, rock collection and jewelry making, woodwork, and probably a whole slew of things he forgot to mention. Hobbies do not go unheard of in this household. His kids are so well-behaved, they do well in school, and they care not for the material possessions that sometimes us city-folk get carried away with.

I probably got a slightly biased view of their seemingly relaxed, weekend lifestyle. He's on call every 7th week, which means he might get paged a dozen times a day, for which he calls back and either briefly counsels his patients or tells them to go to the Urgent Care or the Emergency Department of the nearest hospital (which is in Grants Pass, about 30 miles away). He doesn't make house calls, he doesn't have to answer to any hospital - he's his own boss for a private family practice that he built from the ground up after working at a group clinic bogged down with bureaucracy. He has Wednesdays off, and he told me that he would really like to share the practice with someone else so that he can work less and take more vacations, a real family man! He jokes with me, "If you're interested, when you finish your residency, come on back!"

It's tempting. And this is only my impression from Saturday and Sunday with his family. We went on some neat excursions, tempting poison oak while on a hike through his property, mountain biking down the hill to pick 5 gallons of blackberries for pie, swimming, playing cards and Snooker (sp?). I have been instructed to pick a project to complete before leaving - I think maybe a pair of earrings would be fun. He's got some fancy Jade that he'll cut up if I desire. This week should be a great experience.

The move to Portland

Lake Tahoe, California....2 days before I moved to Portland.

I made it to Portland! Jen drove her car and I drove my car - we left on Monday last week. The drive took a while but it went pretty well. My car was full, packed to the brim, exploding with possessions I have accumulated over the past years. Jen's car was full, too, and I'm so grateful to her for helping me move.
We arrived at night and met my new roommates, who are also my classmates. Anuj and Mark. Really nice guys. The cars were unpacked before long and we had a few beers before retiring for the night.
The following day I had my orientation for the summer observership I signed up for. I had been assigned to a doctor in Cave Junction, Oregon, which is halfway back to California. I deemed it a bit unfair that I would have to drive so far while the some of the other Portland-resident classmates were "stationed" closer, but I tried to be happy for the opportunity to stay with a family practice physician and his family. During the orientation, we did some mock patient interviews and learned a few basic skills for the physical examination. Family docs spoke to us with inspiration and love for their practice.

The next few days were a whirlwind of unpacking, exploring, running errands, and visiting friends and family. My brother and his fiance are on a road trip to Idaho for a wedding and they stopped by on Wednesday to visit Portland. Heather made some new feather earrings (smoobage.etsy.com); she gave pairs to Jen and I. We walked around Portland, went to a happy hour on the 30th floor of a building (cheap apps but expensive drinks!), watched an American-Brazilian samba group, and then hung out at home playing Wii, eating stuffed shells, and drinking. The next day, my best friend from high school came up from Corvallis, and we went over to Hawthorne and later to the Pearl District to try to catch the tail end of "First Thursday". We had a drunken dance party late at night and we all woke up with a bit of a hangover - we had to scratch our plans to go to the Rogue Brewery and the Tillamook cheese factory along the Oregon Coast.

Jen eating a doughnut on the wall at Voodoo Doughnuts in Portland!

Eeek - I found out that my loans didn't quite go through as planned - one big chunk of them was denied due to a delinquency in my credit report (don't worry, I got that part straightened out). I'm going through the appeal process right now....and all I can do is sit back and hope they have enough information to change their mind.....or else I'll be scrambling to pay my rent come September!

After I spent an hour trying to fix my credit, Andrea, Mark, Jen and I bussed downtown (Anuj wasn't feeling too good) to go to "Mother's Bistro", a tasty joint with tasteful new-age colonial decor. Andrea and I shared some banana pancakes and a potato and bacon fritatta - yummmmm.

A few more errands, a movie, some more Mariokart, and packing....and a Friday night of no sleep....but Saturday morning (at 5am) I awoke to prepare for the big drive back down to Cave Junction, OR. I carpooled with 2 of my classmates, Sharen and Dawn. Music and good conversation filled the 5 hour ride down to Talent, the first stop on our journey. Dropped Sharen off, drove back up the I-5 to Merlin, where Dawn's doc resided, and then back down along the 199 to Cave Junction.
Took me about 30 minutes to find my doc's driveway! This was definitely the most rural of all the rural observerships, and I was super excited!