Emergency Clinical Guide Presents The Family Practice Clerkship

The Internal Medicine clerkship consists of one month of outpatient experience in a primary care office somewhere in Vermont, typically in Chittenden County. It is part of a four month block which includes three months of internal medicine.

The field of Family Practice (FP) is dedicated to the health of all patients. It differs from internal medicine in that FP not only includes the topics covered in internal medicine, but it also includes pediatric and obstetrical issues, as well as more extensive experience in gynecology. The practice of FP tends to have a stronger focus on health maintenance than some of the other specialties. During your months in FP, you'll be exposed to patients with an enormous variety of medical conditions, as well as basically healthy patients for regular exams, prevention, and health-maintenance issues.

With few exceptions, you will work directly with an attending physician, and although house staff may also be working in the office to which you are assigned, you generally don't work directly with them as you might in other rotations. If you are assigned to Milton FP, however, you will get the opportunity to work with a variety of the FP house staff as they see patients on their clinic days.

Family practitioners see every condition that happens to people, whether the condition is later determined to be surgical, psychiatric, medical, obstetric, gynecologic, or medical in nature. You will need to develop a keen sense of normal vs. abnormal, acute vs. chronic, and whether a situation is an emergency. You are expected to read daily, and to understand the basic principles of the pathophysiology, diagnosis, and treatment of common conditions. You should plan to read, from cover to cover, the textbook Essentials of Family Practice, although many students advocate starting your reading at page 200, and reading the beginning only if time permits. For quick reference, carry the pocket book by Ferry. Notes are written directly in the practice's chart for the patient, and should be direct and thorough. The details of what (and how) you're expected to write vary from attending to attending, so it pays to ask.

There is a strong emphasis placed in interpersonal skills. Always remember that you are a guest in the practice where you are working, and behave accordingly. The patients will often have a long history with your attending, and you will find that the information they present to you may be different from what they eventually tell their doctor.

There is generally no call, although you may be asked to accompany your attending during evening or weekend hours as they round on patients in the hospital or in the community (such as at a nursing home). In the office, different attendings have different routines, but a common approach is to ask the student to see every other patient on the attending's schedule. Generally, you will see the patient first, take a history and perform a focused exam, and present your findings to the attending - after this, the attending will join you and repeat the pertinent portions of the history and physical, pointing out their findings.

For many patients, family practitioners are their only (and often infrequent) contact with the medical community, and they may be uncomfortable discussing sensitive issues with people other than "their doctor," including students, so it's helpful to have something to read during downtimes.

Expect to see every medical condition you've ever heard of. For a list of topics to review, consult the internal medicine, ob/gyn, pediatrics, psychiatry, and surgery pages on this web site. Also, place a special emphasis on the material in the textbook, particularly in areas of prevention and health-maintenance.

Be sure you can perform a reliable and accurate exam - it may help to review the pages on pulses, reflexes, and particularly the lung exam, heart exam, and neurologic exam. Many offices will dip their own urine samples - review the section on urinalysis.