My most recent rotation was family medicine. Admittedly not a particular area of interest for me, but one that I recognize an important foundation for all medical practice. I now know after 7 rotations that I am someone who enjoys the procedural aspect of medicine. None-the-less I was determined to make the most of this rotation as I have for my past 6 rotations. What I encountered at Dr. Streete-Smalls office was an experience that taught me so many things both medically and from the standpoint of practitioner-patient relationships. Dr. Smalls patients love her and it shows. Many of them wait for hours to see her and while they may be a little annoyed at the outset of the patient interview, they always warm up once she enters the room. 

The areas that I improved upon most during my rotation were physical exam and pharmaceuticals. After shadowing Dr. Smalls for the first day I was able to modify my own exam to include all relevant areas in the most efficient manner possible. Most of the patients I saw during my rotation were follow ups for chronic conditions as such, most exams were full, head-to-toe exams (and I ALWAYS checked the feet). I had the opportunity to listen to a variety of different murmurs and cardiac rhythms, to offer patients lifestyle and dietary counselling, to work on my pediatric exam and immunization schedule, and to perform many gyn exams as well. After my first day I was given a lot of autonomy to see patients on my own, but Dr. Smalls would always see the patient with me after I presented to her and decided on a plan. I could tell that she genuinely respected my input and listened to what I had to say which was greatly appreciated. I found it very helpful that she followed up the patients after I saw them and had me present in the room as it allowed me to see areas that she focused on either with her physical exam or patient questioning. It also allowed me to listen to her tactic for counselling patients and recommendations for medication changes or compliance. 

Everyday there was a different catered lunch from a pharma rep. I learned to make the most of these opportunities. I understand that the ultimate goal in these lunches is to increase prescription writing for the drug(s) they sell, but as a non-prescriber I was able to learn a lot from the different reps. For example, I learned that there is a new indication for xarelto with aspirin in CAD which was recently published in The Lancet. Most of the reps were selling diabetes medications which was great for me because that is an area that I have always found to be overwhelming. Even after my 5 weeks in family medicine and the countless lunches I still feel overwhelmed by the sheer number of options, but I do feel more confident with the MOA of all of the categories and am familiar with 1-2 medications in each. 

What I learned most from this rotation is simply how to talk to patients. Dr. Smalls spent a minimum of 30 minutes with every patient – something I have not seen with a single rotation to date. That being said, most of her patients waited to see here for a minimum of 45 minutes. Something that made an impression on me was that the first thing she said to every patient when she walked into the room was to apologize for the wait and thank them for their patience, this always made the world of a difference to all of her patients. This was a great foundational rotation, and something that I look forward to building on throughout my clinical practice.  

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