The world of medicine is like a bubble. A lot of people THINK they know what goes on there, but unless you're down in the trenches it's unlikely you do. So here is my semi-anonymous blog, here to tell you what really goes on in the life of a medical resident.

Sunday, February 05, 2006

Paging Dr. Hypocrite...

As a family doctor (or in my case, a reasonable facimile) a big part of my job is preventive medicine. The idea behind this is that by taking care of the 'big picture' of our patient's health, we'll prevent larger problems down the road. The fee schedule that my preceptor works under actually encourages this... in place of a fee-for-service model that encourages assembly-line medicine and rewards procedures over counselling, under this new model a family physician is paid a monthly fee for every patient enrolled under his care. Regardless of how many times or for what reason each patient actually comes into the office. This isn't quite as wacky as it sounds. The monthly fee for an elderly woman, for instance, is substantially higher than a young adult. Young adult males, who traditionally are the lowest users of the medical system, are worth the lowest monthly fee... unless they have a serious mental illness, which makes the fee higher. Get the idea?

So anyway, this alternative funding system lets us spend time doing things like helping patients stop smoking, improve their diet, cope with their stress and other things often deemed 'touchy-feely' but that pay off in the long run. The problem is, the medical system makes it pretty damn hard to practice what you preach.

Before medical school, had a pretty healthy lifestyle. I ate well, I managed stress in a constructive manner, and I was pretty active. I hit the gym 4-5 times a week, and picked up a new sport every year-- most recently I had learned to row, play touch football and golf. And I maintained a weight, which although I was always unhappy with, translated to a healthy BMI. All in all, I was doing okay. Then came clerkship.

The hours got longer and the gym visits got fewer and further between. Healthy meals gave way to take-out on more evenings than I care to admit. Sleep became a valuable commodity, and I wasn't getting nearly enough of it. And the stress grew. Some people coped... some didn't cope so well. I did okay, mostly thanks to a kick-ass support system in the form of two close friends and an amazing significant other. But many of my healthy habits went right out the window.

So here I am, 25 lbs heavier than I was before I started medical school. Before this week, I haven't seen the inside of my gym more than once in the past month. I'm relying less on take-out thanks to the joint efforts of myself, my fiance and our slow-cooker, but diet alone isn't enough to undo the damage. And that makes me a hypocrite. What are people thinking as this overweight, overtired doctor advises them on improving their diet and finding time to exercise? How can they take me seriously when I can't take me seriously?

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Anonymous Sandra said...

I bit too hard on yourself. This is a moment in time not a forever way of being. Soon enough you will find a schedule that works for you or someone in your field will give you a suggestion of what they do.

Fine tuning. Don't stress yourself, you will always be a cuty.

11:56 AM

Blogger drmimers said...

Year two gets better -- trust me! There will be less call and more time for yourself. Hang in there.


5:36 PM

Anonymous Anonymous said...

I just discovered your blog and I'm so glad! I'm a new family physician in the USA and I just added you to my favorites. Maybe we can learn to find the balance together!

10:25 AM

Blogger HanktheDog said...

Considering the stresses of the ER, sounds like you're doing pretty well.

11:04 AM

Anonymous Anonymous said...

Im in year three psychiatry, and I was just asking myself this the other day!!!
Eden from WB

11:55 PM


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