Saturday, February 23, 2008

Anything and Everything

Being a resort doctor is a lot harder than it sounds for someone who has already been in specialty training for the past 3 years.

It's been often said that when you become a specialist, you give up knowing a little bit about everything for the chance to know everything about a little thing. After being used to thinking a certain way, diagnosing and managing a certain subset of patients with certain problems, it is disconcerting to be confronted by patients and problems that no longer fit into that smaller, more specialized box of clinical skills you tote along with you.

I've been working as an internist with adult patients for the past 3 years. As a specialist-in-training in an institution with an excellent referral system, I no longer needed to dabble in the other aspects of medical care that didn't fall under the aegis of Internal Medicine. After all, that's what the other specialties were there for.

I haven't had pediatric patients since I was an intern. The last time I sutured a wound was well over three years ago.

But being the only doctor on the island demands that I must once more be that doctor who knows a little bit about everything. The one who can give initial management to a patient having a heart attack as well as the one who falls off his sailboat and dislocates his shoulder. The one who can recognize the signs of appendicitis in a four year old and make the decision to fly him off the island. The one who can stitch up a laceration and immunize the patient against tetanus during the same visit.

It's hard to be confident doing something that you haven't been doing for the past 3 years. The adult patients with medical problems don't faze me - I've seen the worst that can be seen in my years in the hospital. But I'm a lot slower and more tentative when I am confronted with kids and their frazzled parents. I am even more stressed out at the thought of having to sew anyone up for whatever reason. And heaven forbid that anyone suffers from a major extremity trauma or has a complicated birth on my watch.

Sure, I've been reading up on all these things, and, sure, I already went through all those specialty rotations as a medical student. Sure, I had to know all this stuff to pass my boards. But those days when I handled all those other cases seem so very far away, and I would be a fool not to be a bit anxious about meeting them again.

I'm learning, though, that practicing medicine is just like riding a bike - it may be slow-going at first, but you don't really forget how to do it. Of course it helps tremendously to have a lot of friends in different medical specialities whom I can call for advice and to discuss my diagnoses and treatment plans with. It is also vindicating when they confirm I am right.

I'm optimist enough to hope that I will get the hang of being an island doctor as the days go by. But while I am enjoying my work here despite the difficulties, I also know that this is not what I would like to do for the rest of my life. Maybe it's because I've gotten used to working in a hospital or maybe I've become too solidly entrenched in internal medicine to change my perspective. Whatever the reason, I know I will enjoy going back to the clinical work I've been trained to do for the last 3 years when my stint here is done.

It takes a certain degree of courage to make this your life's work. So I raise my hat to the noble doctors who choose to be the only doctor in the middle of nowhere. The world is a better place because you choose to know a little bit about everything in order to make a huge difference in the lives of people who need it most.


feefifoto said...

I like your South Park avatar. i made one for myself -- it looks so benign when you consider the source.

Manggy said...

Gosh, I feel for you.. Complicated birth, hahaha :)

Despite being less isolated in the community, I felt even more helpless... I needed an x-ray for most every consult! Parang napakadaming TB. May isa pa na may pleural effusion in the end (pinakiusap namin yung local radio tech)... And then there was a kid with developmental issues... I mean, omg, really.

MegaMom said...

Ahhh, Claire is finally getting her medical education. ;)

Em Dy said...

I know how you feel. An ER aide once remarked that I could handle cardiac arrests anytime but the only time he saw me frazzled was when a taxi driver brought a pregnant woman to the ER with one baby's leg already out. Hay naku!

dr_clairebear said...

@ feefifoto: glad you liked it!

@ manggy: the day after i wrote that, i had a consult for menorrhagia!!! OMG. I had to call an OB friend...

hope the next days are more quiet!

@ megamom: this is more effective than a board review

@ em dy: OB patients are the worst, hands down. pedia patients are still sort of medical... but OB?! *lol*

Bone MD said...

oddly, my "memories" of treating pneumonia or even HPN would suddenly come handy despite being relegated to my brain's dustbin because of "specialization"!

Perks of being the only MD in a place where there is more of the "other" field than what you were trained for?Maybe. Ganyan sa probinsya. Kaya magastos sa cellphone calls to other subspecialty friends somewhere else!LOL

ian said...

maligayang bati, claire_bear! a GP's life is never easy; and it seems to get tougher when you're The Only One in your Area =0 i really hope the telemedicine program of the UP-National Telehealth Center will go fullblast soon. it aims to provide real-time consultation with online experts ranging from derma to trauma for us non-specialists targeting those practicing in far-flung villages (or resorts haha) it's being tried already for Doctors to the Barrios MDs... hopefully more lives will be saved and less doctors will undergo the stress you just did (or continue to do so...) Happy Island Duty!

dr_clairebear said...

@ boneMD: i know! i think mauubos ang makukuha ko here sa mga phone call. :)) i used to think my advantage in taking IM was the breadth of the subject matter, but i guess i took fo granted i would ever be treating pedia patients again.

@ ian - that is a brilliant idea. i also think that all Docs to the Barrios should be given a fully-loaded PDA (asa!). I miss mine... I really have to get one soon. thanks for the good wishes! ;)

PePPeR_MD said...

hey claire! goodluck over there. i learned so much from working in boracay and moonlighting in manila, that i'm now so much more confident with any case that presents to me in the ER. especially when we were in boracay, when you go on housecalls and you're the lone doctor as well, there's not even an ECG, an XRAY or a pulse ox around to help.

enjoy the sights! the amanpulo stint was offered to our batch when we just graduated, and no one really tried it out coz we heard it was lonely after a while. :P