From the inpatient wards of the SF General hospital and the fourth floor operating rooms in SF, I have migrated to an entirely different world-- the outpatient world of family medicine.

Two weeks ago, I packed up my car and traveled 55 miles North to Santa Rosa, a city that prides itself for it's proximity to a diverse array of natural attractions, including vineyards, redwood forests, rivers and lakes, as well as a unique downtown that features a year round Farmer's Market. I left the fog behind and discovered a real summer filled with sunshine and heat.

In my two weeks of family medicine, I have learned about the broad scope encompassed by family medicine. So far, I have counseled several patients with metabolic syndrome (the triad of diabetes, hypertension and hyperlipidemia), examined pregnant women during their prenatal visits, listened to fetal hearts, performed well child visits for babies, evaluated numerous pediatric rashes, performed a PAP smear, participated in a wellness group therapy session, attended homeless clinic and learned about mental health issues in the homeless, interviewed patients in a community clinic as well as in a Kaiser clinic, burned warts off, counseled almost every other patient about lifestyle changes, and so much more.

I am lucky to be taking a hiatus from my beloved SF and learning about family medicine in a community-based program in a city that has few specialists and a large underserved patient population (mostly Spanish-speaking). I am starting to see how medicine is practiced outside an large academic institution (its pretty similar) that is equipped with specialists for every possible disease.I've had to draw on four-years of high school Spanish to communicate and in the process I have probably sounded absolute ridiculous. Oh well.

In such a community, patients rely heavily on their family medicine doctors for most every aspect of healthcare maintenance.

"One of the best things of family medicine is really the longitudinal care. For example, we take care of a pregnant woman, provide prenatal care, deliver her baby and take care of the baby and mom afterwards," said one of the family residents.

Family medicine is truly unique because of the focus on taking care of a patient through their entire life, requiring a comprehensive medical knowledge and solid patient-doctor relationships. At the same time, healthcare providers are limited by 15-minute appointment visits, healthcare cuts, a growing patient population and lingual barriers.

Despite the challenges, the process of interviewing patients, learning about their lives and developing meaningful relationships represents a incredible learning opportunity. We'll see what the remaining four weeks bring.

Venturing into Urology

"We help our patients pee and have sex," said the urologist, who was giving us a talk about erectile dysfunction.

Since completing my medicine rotation, I started my two week urology subspecialty rotation. With one week down, I can definitely say there is some truth to the statement (although urologists definitely do so much more for their patient). I've had the opportunity to observe a wide array of cases, everything from prostate cancer to vesicovaginal fistulas to circumcisions to labial reductions.

In addition to spending hours in the operating hour observing surgeries that utilize advanced technologies, including lasers and a robot, I have been learning about the preoperative and postoperative management of patients with common urological conditions. I have worked with patients, greeting them early in the morning (before 6 AM) and assessing their health (asking about passing gas, walking, eating and pain) before presenting their cases to my team to determine the best plan.

Coming from a medicine rotation, it's interesting to be involved in the operative management of patients. Surgical morning rounds are also so much shorter and so much earlier. Observing the operations has also been interesting; sometimes it's simply amazing to watch the urologists use laproscopic devices to remove the prostate or use basic surgical tools to reconstruct labial folds.

I have thoroughly enjoyed my first week. And the urologists I have worked with have been friendly and welcoming. I look forward to the next week and hope to continue learning about what urologists do...