So after three years of waiting and wondering I finally get to glimpse into what that contract that I signed in blood will bring me after med school. Up to this point I have done officers training, and a short course last summer in aerospace medicine. This will be my first time seeing patients in the military and learning how their system works, and hopefully not having too many regrets about it.
My experience with Family medicine at Eglin Air Force base has been completely different than my first couple of weeks at Tulane. The weirdest part so far is that nobody wears a white coat and we all where our fatigues with the combat boots. But even more strange is that most of the patients are also wearing the same thing, and really the only way to tell a doctor apart from a patient is the stethoscope around the neck. Besides being ready at a moments notice to go wade through a boggy marsh the other big difference is that this is a true residency program, unlike Tulane that was just an average clinic staffed by attendings. My schedule has me doing different things with different people every day. Some days I am in clinic all day, and some days I get to do more diverse things like sports medicine, procedure clinic, and sometimes I get to go to the nursing home and smell the old people.
My experience so far has mostly been in the clinic. What I’ve learned is that once you cut all the things in the periphery out of the equation, like the uniforms and computer systems, your left with one timeless constant. The patient, their doctor, and the disease bringing them together. Unfortunately for my learning the disease is the thing that seems to be lacking in this setting. If you think about a military patient population it makes total sense. Just about everyone is active duty is fairly healthy, and the only somewhat good stuff comes from old veterans, or family members. Now it’s really not fair comparing the pathology of a military base to that of the city of New Orleans where people simply don’t take care of themselves, not to mention that syphilis is still a real problem. But I will say that in the first week I did see a lot of healthy kids, some ear aches, and a couple of runny noses. The most “interesting and complicated” patient I saw all week (according to the resident) was an overweight, diabetic, dyslipidemic, hypertensive woman that wasn’t taking her meds. Now to be all fair, yes this is a complicated patient. However in the city of diabetic overweight gumbo lovers this condition is the baseline, and I expect everyone in New Orleans to be on metformin, lisinopril, and HCTZ. Throw in some Prozac and they should put it all in the water.
This patient taught me the best lesson I have learned about going to Med school in New Orleans so far. No matter how bad the system is, no matter how broke down and rotting the health care infrastructure has become, the single greatest and most important aspect to any medical education is the disease you see. I think in the end, once you cut all the fat away that’s all that really matters. I had a patient once on Medicine at Tulane that had HIV, disseminated tuberculosis, disseminated herpes simplex, Hepatitis B and C, Neurosyphilis, toxoplasmosis, and Gram negative sepsis. You weren't going to see that in an active duty military population