Experiencing Primary Care From Opposite Sides of the Spectrum: Clerkships Can Influence the Career Path of Medical Students

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Danial Jilani, MPH

The uncertainty surrounding primary care is arguably the highest it has ever been. Many medical students entering their third-year clerkships have preformed conclusions about primary care. At the face of a federal health care overhaul, declining reimbursements, and a workforce shortage estimated to reach 21,000 by 2015, for some medical students the future of primary care seems unpredictable. A third-year experience in family medicine and ambulatory medicine can be an imperative influence in the career path of a medical student.

Third-year students at Wright State University Boonshoft School of Medicine (WSU-BSOM) complete a 6-week family medicine rotation where they spend time with preceptors in a variety of settings, including private offices, indigent clinics, academic settings, and more. During my clerkship, I had the honor of working with Dr Joseph Allen, a recipient of the AAFP Foundation’s 2012 Pfizer Teacher Development award.

For the ambulatory component of my internal medicine rotation, I worked for 4 weeks at the Good Samaritan Hospital Homeless Clinic. The Homeless Clinic offers a variety of services, including dental, mental health, and many more. I had the pleasure to work with Dr Richard Surowiec, who works full time providing medical care to the homeless population of Dayton.

As I entered my first rotation of my third year, family medicine, I had almost no idea what to expect or what was expected of me. Fortunately, Dr Allen made the transition smooth and made me feel comfortable with his welcoming nature. As a graduate of WSU-BSOM and WSU Family Medicine Residency, Dr Allen epitomizes a family physician while incorporating so much more. From the start he created a very relaxed environment while simultaneously providing opportunities that were not afforded to many of my colleagues.

By the second day of my rotation, I was seeing 15 to 20 patients a day, presenting to him, and working with him to formulate assessments and plans. Dr Allen allowed me to give up to 60 injections a week, place PPDs, run hemoglobin A1cs, and use cryotherapy, all while perfecting my technique of obtaining a history and physical. He also permitted me to experience electronic medical records (EMR) first hand, specifically EPIC, the EMR predominantly used by our health care system and the one I’ve used in every rotation since. I saw patients who presented with a wide variety of conditions, including Bell’s Palsy and electric shock. I was able to experience the inner workings of a private office and the politics that surround it.

More importantly, I learned how to better myself as an aspiring physician by watching, observing, and absorbing all the information I could from Dr Allen. Perhaps the most intriguing aspect of his delivery of care was his desire, willingness, and ability to converse with his patients. I’ve never seen an individual so well versed on such an eclectic range of topics. He was able to talk to patients about almost anything: politics, health care, construction, farming, sports, classic automobiles, motorcycles, fitness, current events, etc. You name it, and he was able to hold a conversation about it, a remarkable trait that is truly unparalleled. His compassion for his patients was evident, and he pulled any strings within his reach to ease their burdens. Even with his heavy workload, he remains very active within the community, volunteers his time as the team physician for local football teams, and is a caring father for two young children.

I truly believe I could not have experienced a better 6 weeks in family medicine.

Ten weeks later, I began my second exposure to primary care, a 4-week ambulatory medicine rotation at the Homeless Clinic in the heart of Dayton, OH. According to the 2000 Census, 18.2% of families and 23.0% of the population were below the poverty line in Dayton. A nonprofit organization, the Homeless Clinic provides free medical exams, prescription medications, and basic lab work to thousands of Dayton’s homeless. They offer immunizations, STD testing, PAP smears, breast exams, nutrition education, pregnancy testing, HIV testing, and more. Dr Richard Surowiec, who attended St. Louis University School of Medicine and completed a combined residency in internal medicine and pediatrics from Wright State University, is the leader of the medical team who provides primary medical care, including new patient exams, prescriptions, chronic care management, and preventive care.

Initially, I did not realize the type of individual required for such a position, thinking it was just another job. Not only was Dr Surowiec patient, but his compassion for his patients really came across as genuine, a strength many doctors do not convey when dealing with this population. He demonstrated an exceptional bedside manner; he got to know patients on a personal basis, built strong relationships, and made it very apparent that his primary task was the care of his patients. He provided what seemed to be truly comprehensive care and unquestionable concern for patients’ well-being.

Many of the medical conditions treated at the Homeless Clinic were unique to this population, and much of what I was not able to see extensively during my family medicine rotation I was able to encounter here. On a daily basis at the Homeless Clinic I encountered poorly controlled diabetes and learned how to effectively therapeutically target uncontrolled DM. I feel as if I became an expert on the medical management of chronic issues such as diabetes, hypertension, high cholesterol, COPD, and much more. Additionally, I encountered my first patient with HIV, who presented with a diffuse maculopapular rash on his palms, and was ultimately diagnosed with a co-infection with secondary syphilis and HIV. Further, I experienced conditions very prevalent in the homeless population: substance abuse, hepatitis B and C, bed bugs infestation, wound/skin infections, malnutrition, and more.

On every patient, after my presentation Dr Surowiec would ask, “So what do you want to do?” Although at first my plans may have been sub-par, throughout the rotation I felt as if I improved exponentially, which Dr Suroweic had conveyed to me on the very first day was his primary goal. He facilitated an environment for academic growth and took the time to teach at every available opportunity. A truly humbling experience, I learned an immense amount in my 4 weeks at the Homeless Clinic.

Although Dr Allen and Dr Surowiec serve different populations, they possess many similarities. Their excellence in teaching, compassion for their patients, and ability to build meaningful relations with their patients is extraordinary.

More importantly, they both were able to dispel many of my misconceptions about primary care. A study done by the University of Pittsburg School of Medicine showed that “Involving students in a humanistic but rigorous approach to medicine and being a physician students wanted to emulate” ranked high when evaluating overall teaching effectiveness of preceptors. Additional studies have shown similar results.

The solution to the country’s primary care crisis may lie elsewhere, but I believe it begins with the experiences of third-year medical students in their first encounter with primary care clerkships. My exceptional rotations with these talented physicians are the reason why a career in primary care is on my short list of career choices.

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