FM physicians truly are the "jack of all trades" in that they manage, to some extent, anything that walks into their clinic. From broken arms to delivering babies to depression to diabetes, family medicine physicians manage the whole gamut.
There's a huge breadth of knowledge, and each doctor I've worked with has had their own niche and interest that they branch off into. The FM doc I worked with for the month did a Fellowship in Addiction Medicine, so I worked a week of Suboxone clinic as well, and this was really unique. We would travel to different rural locations every day to manage treatment. It was an area of medicine where you could see patients do a complete 180 in their lives and I loved it so much that I hope to one day work in this field.
As a third year medical student rotating on outpatient family medicine, you will be expected to conduct a thorough history and physical on each patient and then succinctly present each patient to your attending with your assessment of their ongoing issues and your plan.
Here's a run-down of what my day-to-day schedule looked like on Family Medicine:
08:00 - 10:00: See new and returning patients and chart
10:00 - 12:00 : Addiction Medicine Patients
12:00 - 13:00: Lunch :)
13:00 - 18:00: Walk-in Clinic
What to bring:
Stethoscope
Reflex hammer
ID Badge
Business Casual Attire
iPad
Pens
General tips:
Practice a full PE on every patient
Practice charting a coming up with a broad differential diagnosis, no matter how straightforward a patient may seem
Participate in procedures
Resources used for boards & wards:
USPSTF website or the USPSTF App (download to your phone)
MD Calc App (download to your phone)
Favorite the following:
If you're interested in Addiction Medicine specifically, see more below:
Addiction is so heavily stigmatized and yet so extremely prevalent that I’m sure it has touched everyone’s lives in on way or another, either through ourselves, loved ones or, the patients we interact with. It’s a disease and an important one to learn so we can be a source of safety for our patients.
Currently, Fentanyl has been one of the biggest culprits of overdose in the US, especially amongst teenagers. The main treatment for opioid use disorder is Suboxone (Buprenorphine / Naloxone). It is a a partial Opioid agonist and blocks the Opiate receptors to reduce a person's urge/cravings. Suboxone is different from Methadone, which is more addictive/higher dependence rate, but both are used in treatment for opioid addiction.
An “X waiver” refers to the Drug Addiction Treatment Act (DATA 2000) “waiver” legislation that authorized the outpatient use of buprenorphine for the treatment of opioid use disorder. Any clinician can administer buprenorphine to a patient with opioid withdrawal symptoms in the hospital. However, in order to write prescriptions for buprenorphine, clinicians must have an X Waiver. The X waiver previously required an 8 hour (physician) or 24 hour (APP) training prior to applying for the waiver. This has changed and the training certificate is no longer required. However, clinicians still need to apply for their waiver.
If you're interested in learning more about Addiction, an excellent book an Addiction is called Unhooked, by Jason Coombs.
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