Outpatient clinic feels like med school, for better or worse. The pace is slow, the stress is low, and it's a lot more about learning than doing.
There's four of us interns, two more senior residents, and an attending, so it's a lot of one-on-one with the residents talking about the patients, a lot of consultation with the attending, and there's a lot of emphasis on taking our time to get to know the patients, take a careful history, be thorough, don't rush through-- which is all so radically different from life in the hospital, and especially from life in the ICU or in the middle of a code.
These aren't particularly sick patients-- I diagnosed an ear infection yesterday, we had a woman with some standard follow-up, a guy who's basically just depressed, and a woman with a cold.
In a lot of ways, it's great-- everything I was reacting negatively to over the past three months isn't an issue here. The hours are fine, there are people to talk to, I can get to know my patients, I can feel like I'm helping them (sort of).
It's what I've said I want to be doing all along-- treating patients in an outpatient setting, getting to deal with people who aren't inches from death, who we can actually make better.
And yet-- I hate to admit it-- I'm bored.
This is what I've said I want to be doing-- but it's boring. Especially after two months of high drama, of adrenaline, of feeling at the edge of sanity and deprived of sleep and thrown into situations I have no business handling.
This is slow medicine. This is "take a Tylenol and come back in six weeks." Anyone can do this.
Look, I think it doesn't help that these patients, for the most part, don't speak any English and so I can't really talk to them and feel like I'm getting to know them. It doesn't help that the appointments are so spread out that we have hours of downtime throughout the day. It doesn't help that one of my co-interns keeps stealing my lunch. But, gosh, forty years of this? This is what I went to medical school for? To prescribe Zithromax and take blood pressure? I may not be capable enough to run the ICU, but surely I'm more capable than this.
But what's the middle ground, if there is one? Either you're shepherding people to their death in the cancer ward of the hospital, or you're spending your day listening to healthy people cough.
I've never doubted my choice to do internal medicine. I've always pictured this perfect suburban life, a wife and kids, heading into the office every day, seeing some patients, getting to know their families, feeling like I'm a part of the community, and having time to enjoy my life and my family, time and the means to take vacations, to have friends over for dinner, to walk the dog.
But the family piece isn't there and I don't see how I'm going to get it. I'm not meeting anyone, I'm not doing anything outside of work-- and without that piece, I'm worried this life couldn't possibly be enough. Head into the office every day... and then what? Go home and eat a microwave dinner and fall asleep in front of the TV only to start it over again the next morning? Be the pathetic single doctor who doesn't have a life outside the office? I had all weekend free, but I was bored. I slept, I read a book, I went to the movies by myself... I called a couple of friends, but when you've spent the past two months never having a free minute, you can't expect people to drop everything and work their schedule around your newfound freedom.
I know why people go into surgery, I know why people become ER docs and moonlight and take extra shifts-- it's something to do. There's excitement and purpose that you don't get sitting on the couch watching ESPN. I don't want that life-- where work is everything-- but if it's a choice between having nothing and at least having the work, I don't know if it's so terrible.
I write this and it makes me realize-- the problem isn't work, at least not on the outpatient side. Maybe the problem has been work for the past two months. But the problem now is me. I need to meet people, I need to do things, I need to not sit here and feel sorry for myself. If I want someone to feel sorry for, I have sick patients I can transfer those feelings to. Being a doctor-- sadly-- isn't going to be my magic bullet. It can't take care of the rest of my life.
It's just frustrating to realize that and then hard to fix it.