When I learned that our first rotation is Family Medicine, I don’t know how will I react. I don’t have the slightest idea of what Family Medicine really is. I only have that idea I usually hear from other students: that Fam Med is basically general medicine practice that is more of a specialty. And so I rotated in Fam Med with two identities: as a liaison officer and as a student.
With this rotation, surprise! (yes, with an exclamation point included) is the key word. You are not aware of whatever the patient’s chief complaint will be as long as it is an outpatient complaint. The secret to success therefore is that you remember at least the general medicine. For us students who hardly traversed LU IV, not all information can be retained. Thus we have to review our history taking and physical examination (which are not yet refined even if we have been doing it for so long already) and the diseases’ signs, symptoms and differentials. Fortunately, the consultant/resident is there to guide us especially in prescribing and explaining to the patient the diagnostic and therapeutic plans as well as in performing particular maneuvers. Needless to say, this experience forced us to read books again for the sake of our patients who subject themselves into our care.
As a student I can see my loopholes with the help of my classmates and residents/consultants. There was an instance when my partner and I were already reporting the PE of a possible Hepa B patient when the resident noticed ear piercings which we have not noticed (hence not reported) earlier. During that particular moment, I want to ask myself, “How the heck did you examine the patient’s ears?” It is also my first time to hear BPS model in action, when the same resident asked another patient of her feeling, idea, functionality and expectation. I also had my first female patient, and from her I learned (or probably, re-learned) two things. First, some patients do not really want to talk about the labs/diagnosis with their parent who accompanied them to the clinic; and second, it is legally safer to let a nurse rather than the relative/informant of the patient accompany you in examining the patient.
This rotation also introduced me to what is known as Tondo. I think everybody knows that Tondo is a breeding place of all sorts of bad guys. With a limited period of stay at Canossa, I was able to be with some people of Tondo. Thus being there to experience the social context (or maybe, burden) of medicine in the country risks the future doctors’ lives or limbs. Putting prejudice aside, I rationalized that being in Tondo is like being in a war. If you are a medic and you are wearing white, your mission is to save lives and heal the wounded even if he or she is your enemy. However, the reality is, you don’t know the thoughts lurking in the mind of another person, in this case, a Tondo dweller. The way going to Canossa Health Center has good concrete houses, which made me think that Tondo is not a depressed area at all. Later when we crossed a busy highway, I realized the real poverty. The smell welcomed me badly. One significant thing I have learned from the shanties of Tondo: in order to get to Canossa Health Center, one must cross that life-and-limb-accident risky highway or go to the nearest footbridge, which is actually too far. One needs to surpass a lot of risk just to get a check up of his or her health.
The two weeks have passed and I can say I am thankful with Fam Med as our first rotation. It is a holistic way of introducing the students to the clinics. In fact, I believe, Fam Med should be the first rotation of every medical student so as not he or she does not fall initially into the more specific. If I may, I would also recommend it as a final rotation as it seems to be an integration of the whole year’s learning. That means, Fam Med at the start and at the end.
One disadvantage I see in Fam Med is that it probes families and relationships too much. If I were a patient being asked of these family-oriented questions with my simple chief complaint, I would be annoyed too. Nonetheless, this is where the art of family medicine comes in.