The family medicine rotation was a challenging one for me. Thus far I have spent every single rotation in either a hospital or a high acuity setting. The pace and environment that I was used to were not present in the same way in this rotation. I rotated in a private practice with just a few employees and one provider on most days. I found this setting to be very tight knit, with everyone aiming to create a comfortable and pleasant environment both for patients and each other. It was a welcome change, as I really got to know every employee as well as my preceptor, differing from the welcoming but vastly changing environment of the hospital.

The most challenging aspect of this rotation was the focus on health maintenance and disease prevention. This was the first rotation where the aim was not solely to diagnose and treat a problem on the spot, but rather look at a patient in broader detail and figure out what needs to be done to ensure their health for the next month, year, and decade. I was really tested on knowing vaccine schedules as well as screenings and the appropriate candidates and times for them. While we have learned all of this information in didactic year, applying it to patients on both a broad and case-by-case basis was more difficult. I solidified my knowledge of cancer screenings through colonoscopy and mammography, as well as screening for sexually transmitted diseases and conditions like diabetes, thyroid problems, and anemias.

A pleasant aspect of working in family medicine is that you are quite literally working with families. During my time at this practice, I saw patients and their parents, children, uncles, cousins, and grandparents. In one day, I would examine and care for a toddler as well as a ninety-year-old, addressing concerns pertinent to each age group. It was humbling to see a provider quickly change focus from addressing vaccinations and concerns in a baby to then consider all the health-related aspects pertinent to a much older patient. Family medicine encompasses every disciple of medicine and being able to navigate this wide range of diagnoses, screenings, and treatments is a skill that I have begun to build but will surely improve with more time and experience.

Another aspect of this rotation that I enjoyed was the spectrum of complaints and presentations that could come through the office in just one day. I quickly saw that some days were filled with low-acuity patients, who did not have any worrisome complaints and were mostly presenting for annual exams, while other days a possible emergency unraveled out of the blue. While family medicine is generally a calmer environment with chronic conditions and check-ups, there were a few surprises where patients turned out to be in a state of hypertensive emergency or needing to be seen in the emergency room for worrisome complaints that could not be addressed outpatient. The broad spectrum of presentations kept me focused and prevented me from getting too comfortable, as you never know which patient will need more than the routine care they presented for. No visit is truly a routine visit, and each patient thought me to look deeper and make sure no detail was missed.

This rotation allowed me to work further on decision making and narrowing down a differential diagnosis. In a primary care outpatient office such as this family medicine one, there are limited tools available to guide diagnosis. This office only had an ECG machine. There was no x-ray or ultrasound, and lab results were not available within a couple hours like they are in a hospital. Utilizing the patient history and asking the right questions was imperative to diagnosis, as was a thorough physical exam. Deciding whether a complaint is truly an emergency or can be worked up on an outpatient basis was crucial. Homing in on my history taking and physical exam skills was important and allowed me to make an educated choice regarding patient’s disposition. Seeking advice and education from my preceptor regarding uncertain decisions allowed me to expand my knowledge and skills and grow in this regard.

The most enjoyable part of this rotation was witnessing the relationship between provider and patient. While shadowing my preceptor I found that visits did not consist of just ordering labs and performing a physical exam, but talking about each other’s families, plans, and day to day events. Many patients have been coming to that same family medicine office for a decade or two, so the preceptor and patient had built a true relationship. There were twenty-year-old patients who the provider administered some of their very first vaccines to after they were born and got to watch them grow up and assist in their development. There were also patients who the provider counseled on multiple occasions over the years regarding their health, the death of their loved ones, and diagnoses that changed their lives forever. The trust and confidence that these patients had in the provider was tremendous, and something that can only result from years of care, understanding, and commitment. I admired the provider-patient relationships I saw, and how invested the provider was in ensuring every single aspect of the patients’ health and well-being was addressed. I saw the provider stay after hours to help a patient and worry for days about another that wasn’t doing so well. The commitment and work ethic I witnessed was truly inspiring and made me respect and appreciate family medicine even more.

Family medicine was a rotation that has taught me much more than I expected. I learned vaccine schedules, screenings, chronic care of medical conditions, and general health promotion and disease prevention, but more importantly I exercised decision making, perfecting a differential diagnosis, and caring for patients in regard to not only their presenting complaint but their future and their long-term concerns. This was a rewarding experience that has shown me the value of a trusting relationship between provider and patient and the importance of caring for every aspect of a patient health.