I'm been meaning to write a post about my experience so far from my primary care preceptorship sessions, but I kept procrastinating. Tomorrow, I actually have an assignment due for ECM for which I'm asked to write a one page reflection about what I've seen and learned from my PCP sessions, so I figured, 'Hey! Good time to do the post I've been pushing back!"
Anyways, as I said earlier, I've had 3 sessions so far. It's basically a chance for us as students to get a glimpse of the daily interactions between a physician and his patients. Although as students we are distributed to many different offices of many different medical specialties, the point is not to expose us to specific areas of medicine, but to allow us to observe, and hopefully get a chance to practice, effective communication and interactions between the physician and the patient.
I've been assigned to a physician who specializes in infectious disease and currently practices at an HIV clinic. He sees patients in his office, many of which have been returning for many years, and checks up on them to see if they have been taking their medication and to gauge the effectiveness of each patient's regimen.
I can't say that I necessarily enjoy the sessions, especially since I've been assigned to an off-site clinic and these visits cut into study time, but I have definitely been able to see the value in them and appreciate them.
The physician that I shadow is a really nice. He's easy to talk to, open about sharing this thoughts in regards to medicine and his own practice, and is always willing to explain things. He's also very friendly with his patients and definitely makes them feel that he is there for them and is motivated to provide them with the best care that he can give them, meaning that he takes the time to help them based on their individual circumstances and cares to understand their social and medical background and history.
He explained to me about how in terms of HIV and the advancement of HIV drugs, patients now can be relatively well off as long as they are very compliant with taking their medications each day - viral load will be undetectable and T-cells will be within normal limits. The fact that compliance is the main issue makes it all the more important that he is able to effectively communicate with his patients about the importance of taking their medications. Building trust is also critical because with trust, the patients will take his word for it about how extremely important it is to be disciplined about taking the necessary pills each day.
[The reason compliance is so important with HIV drugs is that once a patient starts taking the medication, he must continue to take it to suppress the virus, otherwise, mutant forms which are resistant to the medications will slowly become predominant and the medications will no longer be effective. So now, not only does the patient have the HIV virus, he has HIV that is resistant to drugs, making it now even harder to control.]
It's not always easy to explain to patients about why it is important that they do certain things or make certain changes to their lifestyle for the benefit of their health. A common misconception is that if you don't feel well, you take your medication and your health improves, and if you don't take your medications, your health will degrade, but that's fine because you just need to take your medications again. This, however, isn't always true, and as physicians, we need to learn how to communicate to our patients about the necessity of complying with the treatment that we give them and dispel the myths they believe in as a result of their lack of scientific knowledge about how a lot of medications work and how their bodies respond to them.
From ECM lectures and smallgroup, we've been taught a lot about the proper ways to interview a patient, and it's great to have seen so many of these things applied in my preceptor's office! Although he sits behind his desk, he leans forward towards the patient and is constantly engaged. His responses and questions always integrate concerns and responses from the patient, which lets the patient know that he is being heard and personally cared for. Although it is an HIV clinic, my preceptor often asks the patient if they have other healthcare needs that they need tending to, such as for their eyesight and teeth and he will offer to refer them to the appropriate doctors. He also often asks the patients very direct questions or even makes bold claims such as straight out telling patients that they aren't taking their medications even without concrete proof of it, but always does so with either a smile on his face or a look of genuine concern, again, showing that his motivations are to help his patient and not to make mere empty accusations.
So, so far, it's been a valuable experience, going to these sessions every other week. It's good to stay exposed to the clinical environment in the midst of constantly studying just the sciences of the human body because it helps to keep the science material grounded in its ultimate purpose.
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