Sunday, August 29, 2010

Practice of Medicine

My two month stint of Family Medicine has come to an end. Observing both the corporate and private practice side of things has offered a new perspective into this particular specialty and medicine in general.

Family Medicine


Family Medicine encompasses a little bit of everything. As a result, this leaves me a little uncertain how to best prepare for my upcoming shelf exam. There are the usual chronic diseases with a some acute illnesses, occasional small surgical procedures and the rare emergency. The clinical preferences of doctors are not always the preferred methods of diagnosis and treatment, and yet we are expected to know both. At least in the classroom setting, we knew what we were going to see on the exam. The clinical shelf exams, on the other hand, seem a bit more ambiguous.

It is easy to see a patient, ask them to explain their history, and perform a physical exam. The tough part is narrowing the differential diagnosis down to a select few pathologies, choosing the optimal tests to identify the real problem, and providing a treatment that will ultimately help the patient. On paper there is only one right answer, but in the real world the rules tend to have a little more freedom. The "practice of medicine," as students know it, is comprised of physician observation, trial, and error.

Every day I am learning more what it means to be "practicing" medicine. There isn't always a perfect solution and we may not have the answer to every patient inquiry. Nonetheless, we put our best educated guess on the table to be tested like any good experimenter would. We celebrate when we are correct in our assumptions and scratch our heads if wrong. Medicine is always evolving and we are simply trying to keep up. It is OK to "not know." Accepting that as a physician is hard, knowing that as a student relieves a lot of undue stress. After all, we are expected to make mistakes and learn from them.

Question of the Week
A 36 year old patient is brought in complaining of palpitations. Upon physical exam, you notice an irregular rate. He says he feels hot, anxious, and is tremulous. Thyroid studies yield elevated thyroid hormones. TBG is below normal. Examination of the neck is unremarkable. Which of the following is likely to be found in the patient?

A. A 20 year history of alcohol abuse
B. Exposure of the neck to radiation 20 years ago
C. A family history of heart disease
D. A personal history of Parkinson disease
E. None of the above

Answer & Explanation 

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