"What's a carb?"

The past week or so has been pretty busy, which is why I haven't written anything in a while! Actually, I guess I haven't written since the first day of this rotation....sorry! Even though I'm in family practice, the hours are fairly long and I just get tired by the time I get home and do everything I need to do for school. Most visits are pretty routine--three-month checkups for chronic conditions and medication refills. Something I have been enjoying is getting to talk to the patients. My preceptor always sends me in first to get a feel for how the patient is doing, and if they have any other issues besides their chronic conditions and needing more pills. All of the patients here have been really friendly, and seem to enjoy talking to me. I think a big part of this might be that I go in there without a computer in front of me, so I'm actually looking at the patient and really listening to them. My preceptor, and other providers at the clinic, are always staring at their computers and just going through the checklists. While this has its benefits, like standardizing documentation and making sure every pertinent question is asked, I can tell that it definitely makes patients feel alienated and ignored. So, I think they appreciate someone taking the time to sit at their level, without a computer, and finding out how they're feeling.

One thing I don't like so much is that practically every patient will look a little confused when I start talking, and eventually they ask me where I'm from. My lack of a Southern drawl is pretty obvious in this town, and people always ask where I'm from, what I'm doing here, and if I think they're a hillbilly. I've had people tell me I must be rich because of my accent and the fact that I'm from "up North", and that my accent sounds "proper" so I must think everyone in the town is an idiot. This is all, of course, about as far from the truth as you can get. The people in this town have hard lives, and I have an incredible amount of respect for them. I don't like that people assume that just because I talk differently, I've already judged them and think less of them. But! I still really like it here, but it's definitely interesting to experience life as a very obvious outsider.

Last Friday, there was a festival downtown to commemorate the anniversary of the founding of the town. We went down for the morning and set up a table to check people's hemoglobin A1C levels (basically an average blood sugar level over the past three months) for free, so they could know if their diabetes was controlled, or find out if they had diabetes in the first place. At least 80% of people that we see in the clinic are diabetic, and it's really sad because a lot of them don't control it and have pretty bad end-organ damage, meaning that they're going blind, entering kidney failure, or losing sensation in their feet. What I didn't know was that most people really just do not know what diabetes is, how to prevent it in the first place, and how to control it...and they really do want the information, but have never gotten it. When we were at this table, there were so many people who came up and wanted us to tell them all about diabetes, how to control it, what to eat, how to cook healthy meals, etc. It was kind of nice to see people who were actively interested in their health and be able to help them out! And yes, people really did ask us, "What's a carb?" I guess I just took it for granted that I know the basics of nutrition, and while I'm not an expert by any means, I know what's good and what's bad. I really think that some people in this part of the country just don't know why certain things are bad, and might not ever be told that certain foods are bad for them. It was nice to be able to give people information that will be helpful, and hopefully prevent them from having to be in the clinic here so often!

I haven't done many cool procedures in the past week, just a couple joint injections here and there. But, I did diagnose a heart murmur on just a basic visit! It's nothing serious for the patient, but it was really cool for me that I could hear it. I told my preceptor, and she listened and agreed with me! I'm also getting better at remembering everything from our Physical Diagnosis class and doing a really good physical exam...it's something I was worried about, since I never had to check anything beyond the pelvis/abdomen the entire time. But everything is coming back to me, and I'm really enjoying primary care. I know I've said this every time, but I really could see myself working in an area like this. As much as I love the OR, I think talking to patients, managing their chronic conditions, and hopefully preventing the development of those chronic conditions is much more rewarding. :)