I love being a rural family doc! I take out splinters all the time, deliver babies, biopsy skin cancers, provide practical solutions for almost any complaint, and orchestrate most of my patients complicated surgical and cancer treatment. Most know they can always come to me or go through me to get what they need or where they need to go. Can't imagine doing it any different. Family medicine in many place seems to have lost their role as "advocate".
Zack Bechtol
I realized today how far we have to go as advocates of performing procedures and solving problems in family medicine. A woman from a metro area out of state was in town for her class reunion. She told me her left 3rd finger was quite sore. 2 weeks prior while cleaning a cabinet she stated a piece of wood slivered off and went into her finger. She went to her primary care provider. They told her it would likely "work out" and gave her a tetanus booster and placed her on cephalexin. The finger got worse so she went back. She was referred to a hand surgeon who told her, "I do not deal with slivers". I anesthetized the finger, probed the wound track, and removed a hardwood splinter that measured 12 mm long. The rule of "first do no harm" has been so overstated that it has paralyzed the majority of primary care. Not an endoscopy issue today - but part of the same problem. The woman asked for the splinter, she wanted to take it back to her clinic, to show them the opportunity they missed. My guess is - they won't care.
Brian W. Meeker, D.O. FAAFP
Vinton, Iowa
The failure to remove an infected splinter is the visible tip of a larger iceberg. Below you find the comments regarding the tiered revisions for family medicine training. The issues are related to the notion of the limited generalist. See my blog at the bottom.
WMR
Index--Surgical FM is a minority as the residencies fail to enforce teaching of the specialty.
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