Welcome to the revolution. It starts with me and you taking care of ourselves. Woo. I’m feeling pretty good. I just got done a long clinic day and then I went to the Y and walked. I was cracking up coming up with good ideas. I plan to go on a medical/musical tour. I’m going to do the bit onstage about “I don’t have any merch, but I am a primary care doctor and I’m seeing patients tomorrow. $25. Bring your backaches, your earaches, your non-psychotic mood disorders, let solve some problems! I’ll have my tourmates do the typing on our medical typewriter. I don’t have to fill out of bunch of extra paperwork for any insurance companies. I just need to have some record if I get sued!

I was also thinking about how I am down most of the time, but people seem to think I’m doing a good job because that’s what I show outwardly. A lot of us are doing this. It’s nice that we are able to keep it up in some cases. And it’s okay that some people never are. We are all at different stages and that’s okay.

And I was thinking about my program. There were clear times as an intern where I felt that situations were unsafe for our patients. It is so inter-related to the culture of the program. It’s very hard to know if the problems that affect my program are really worse than they would be at another program. It can seem like it, but hardly anyone really has good perspective on that question. At one point when I was an intern I called an old friend from medical school who was a G3 at the time 2 states a way and was asking about some of the problem areas of my program. She sounded pretty surprised to hear I didn’t think I had enough supervision. I remember at the time wondering if I should think about switching programs in hopes of getting better training for my future career. I was worried that the foundations of my medical career had bad roots. That still may be true. But I don’t worry about it as much as I used to. There definitely is an effect of adjusting to your circumstances. And in the case of residency, we can normalize some pretty shitty conditions.

I know the new interns are going through some of the growing pains. I was talking with one about the difficulty of being an expert in such a broad array of fields, and how that is really counter-cultural in medicine. The mainstream gears towards specialization. Every medical problem has specific, sometimes technical answers. And if you are caring for the problem, the expectation is that you should be giving the best care. You can’t give the wrong antibiotic for a kid’s sore throat because you don’t see them very often. You shouldn’t undertreat a senior’s COPD because you aren’t up to date on the latest GOLD criteria guidelines. If your laboring mom meets pre-eclampsia criteria, you need to recognize it and induce her for delivery. If you know enough to get the consult, that’s all fine and good, but the danger zone is when you don’t recognize that you don’t know what you are doing. Anyways, primary care is a hard job. Even if some of our visits are easy. And the end of that conversation, she was pretty sure she needs to do a fellowship to narrow her scope so she can do a good job with it. That is a common sentiment in medical culture.

And so with our program’s culture, there are obvious problems. Some of them are BIG, some of them we are working on, and some of them WE ARE NOT. I recognized that I would be able to get through the training. I recognized that doing so would qualify me as a board certified family medicine doctor. I recognized that that doesn’t mean as much as I thought it did from the outset. The standard is sometimes lower than you might think (hope). People get through by sticking with it. That’s pretty much it. If you adapt to the system and keep going, you get there. I had had different expectations. The previous graduates of our program don’t meet those expectations. I don’t think I will meet those expectations when I graduate. I’m not getting the training I want.

Our program doesn’t do a lot of hand holding. I felt like there wasn’t a lot of hand holding in medical school. I have always wanted more explicit teaching. I have this golden image of what ideal teaching looks like. It involves expertise and attentiveness and patience, and creating the right level challenge for the learner so they are in their growth zone. Nu-uh. Not here. Here there are sick patients that you get to take care of. It’s high responsibility, low teaching. People should know that coming in. It’s not what I would have wanted. I don’t think it suits me. The intern process still intimidates me. Being a resident continues to be much the same. But actually, it does change. It’s weird, but I do get a sense of pride about it. It’s that odious “good old boy” thing. It’s this hard thing that feels good when you are done. I don’t know why it’s not considered hazing. Maybe it is. But it kind of feels good for me. From right here, right now when I’m close to done with it. I’m through the worst part for sure. And gosh darnit, I learned how to do it. I’m not completely done. But I’m through the hardest stage. And I’m going on to other hard stages. But it’s okay.

So after graduation, for a period I may go on a road trip. If I can charge 25$ a person to provide general medical care, that sounds like a dream. I’ll accept tips. And if I see 10 people, that’ll be a heck of a day. If I see 2, I can afford my meals and gas. It’s a hobo life. That what I want. I want to be a traveling doc. I don’t know how long it will last. I don’t know how long I’ll sit on my loans, with the interest festering. But fuck, this sounds fun.

And if I take a few urgent care gigs, that would be a real good skill set to get good at. That is close to what I will be doing. Urgent care, event medicine, travel medicine, lifestyle medicine. I can wear a lot of hats. I don’t want to do hospital work I don’t think. I can cover low acuity gaps. I can cover nights or something. I mean, I don’t want to run codes. But I could run codes. ??? I don’t know for sure. I can run a code. It’s a big deal, but I could do it.

I don’t want to be in an ER. But maybe I am fucking wrong? How do I know so little about myself? What the heck? Well… I have developed coping mechanisms that shut parts of myself down. One of those was a real stiffening in the ER. I was in survival mode and I was not thriving.

I have a lot to learn as a doctor. Residency is a phase. It sucks most of the time. It sucks more than most anyone can relate to or believe. But it is the route to a medical career. I have wondered along the way if I should just quit. It wasn’t wonder sometimes. It was just frank truth that I did not belong in medicine. I wasn’t interested in medicine. I didn’t care. But I kept going.

Holy shit. I went to this cookoff the other day and I cooked a pot of beans over an open fire. It took a long time. I gave up hope in the middle cause I didn’t think I had enough heat. The water wasn’t even boiling for the first 45 min. But eventually they were cooked. And at one point I had given up hope. But the beans didn’t care. It didn’t make one bit of difference to them what my attitude was. They were still on the fire, so they cooked. And they turned out. I missed the competition. They announced the awards while my beans were still cooking. I’m the beans!