A Day in the Life ScenariosOffice Practice InfoPersonal History


In several previous blogs I’ve written that I completed a two-year residency in Family Medicine. My residency was from August, 1972, to July, 1974. It was served at The University of Colorado School of Medicine in Denver, and I started it after a one-year internship (June, 1969, to June, 1970) and a two-year stint in the U.S. Air Force. In the early 1970’s, Family Medicine residencies were a new concept. Most doctors, if they didn’t choose a surgical specialty or internal medicine sub-specialty, merely went into private practice right after internship or their military obligation. My career path took a significant turn from orthopedic surgery to family medicine during the two years I spent in the Air Force, so I felt I needed additional training to better prepare myself for the vast array of problems I would see in practice. I never regretted that decision.

Family Medicine is such a limitless specialty that it becomes a constant learning experience. Not a day went by that I wasn’t challenged by something I had never seen before, or symptoms that didn’t fit into a clearly defined diagnosis. The feeling of inadequate preparation and the desire for a broader level of knowledge led me to spend two more years of my life in residency training.

For me, there were two major reasons for doing a Family Medicine residency. They were:

     1. To be exposed to learning opportunities I previously had been unable experience ie. see more patients with problems I had not previously seen to gain experience diagnosing and treating them.

     2. To acquire the knowledge and ability to reason so that when a set of symptoms is presented, I knew how to trend in the direction of making a correct diagnosis. Residency teaches a doctor how to come up with a list of possible diagnoses (differential diagnoses) and how to use reasoning to turn that information into a diagnosis.

While Family Medicine residencies were not the norm in my training era, they certainly are now, and have been for 30 years or more. Medical school learning is extensive, but is still limited by the length of time a student is assigned to each discipline. Residency expands that time 2 or 3-fold and gives the young doctor more learning time. One could say family doctors learn on the job because each patient is a learning opportunity. But in practice, there’s no experienced staff doctor overseeing your care to point out what you should to know, but don’t. Residency is the time to gain the knowledge missed in med school. 

Repetition and re-exposure are good teachers. You can’t do too many physical exams because every patient is different and the more you feel, or see, various differences, the more you develop a sense of knowing what’s normal and abnormal. You can’t look at too many chest X-rays or EKG’s because you’re looking for something different in each one, and again, it helps to be sure of what’s normal and what’s not. You can’t evaluate too many lab profiles because each is different and must be correlated with the symptoms the patient presents. These are all things the family doctor does many times every day, and the more you know, the easier it is, and the more accurate you become.

Family medicine involves just about everything included in a medical textbook (if they still exist), so there’s a lot to know. Residency adds an extra two years (it should be 3 or 4) of training that places the doctor in a far more comfortable position. The doctor knows he/she has the experience and reasoning ability to figure out the patient’s problem. That’s reassuring for the doctor and makes for happy, healthy patients. 

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