Primary care doctors: masters of flexibility

by Lorien E. Menhennett

One week into my primary care clerkship, and I have developed an incredible new respect and appreciation for this group of doctors.

First, a little about the clerkship itself. At many schools, this would be a family medicine clerkship. (Family physicians being doctors who treat the whole family, from babies to kids to teens to adults, including pregnant women.) But Cornell does not have a family medicine department, so for this clerkship we spend time at various ambulatory care sites. Being at five different clinical locations throughout the week was disorienting at first, but I do think it will give me a good sense of various ambulatory settings. I’m in Brooklyn with an internist on Monday, and on the Upper East Side the rest of the week for dermatology, ob/gyn clinic, more internal medicine, and the emergency department.

So what’s so incredible about primary care doctors? Plenty, but what I want to focus on right now is how adaptable they are. In primary care, when a patient comes in for an appointment, you might know what her ongoing medical problems are — diabetes, hypertension, etc. — but you don’t know why she’s here today. You need to be prepared for anything, quite literally. You manage acute and chronic complaints in all systems: heart, lungs, stomach, liver, brain, muscles, bones, and so on. And when you do a physical exam, you don’t just listen to her heart, lungs, and belly. If indicated, you might do a focused musculoskeletal exam for back pain, or a neurologic exam if she has trouble with balance.

I’ve seen this flexibility as a patient, of course, when visiting my own primary care doctor. It seems so natural. But it’s different being on the other side of that doctor-patient relationship. There’s so much information to filter through during the patient interview, so many potential physical exam maneuvers, so many diagnostic possibilities to consider. In some ways, this is intimidating for me as a medical student. It’s all so new, and I have so much yet to learn. But it’s also incredibly rewarding to help solve these clinical puzzles — and to help these patients.