For Internal Medicine, I'm currently on the TEACH service, which stands for Transforming Education and Community Health. They specifically serve patients with county insurance or who are uninsured. By default, the service attracts a certain patient population.

The patients come in 2 flavors (but most are a mixture of the 2 like chocolate-vanilla swirl): very appreciative for the free health care or demanding for pain meds. Of course I love working with the appreciative ones. They make me want to provide them care. On the other hand, I dread seeing the drug-seeking ones. I find myself having such a hard time connecting with them. As soon as they're labeled "drug-seeking," everyone's perception of them is colored by that label.

I still treat them with kindness and respect. But I might not be providing them the same quality of care as I would other patients. I spend less time with them, I don't ask about their pain thoroughly, I don't have deep conversations with them about their coping. This applies to the patients who are mainly only that flavor. If they're a mixture of the 2 flavors, then I can still connect with them...but I still don't address their drug-seeking.

I think it's because I haven't been trained well yet in addressing this topic and because attendings have had many more years of experience dealing with these types of patients. I've already imagined myself when I'm a practicing family physician prescribing opioids to a patient for their first time. I imagine myself having a very thorough conversation about the risks of starting these medications (e.g., addiction, overdose, tolerance, side effects), using a pain contract to make clear what doses I am willing to prescribe and how often, explaining to them that I want to treat their physical pain with these medications, but too often people use them to treat their emotional/mental pain. Pain is real, but I do believe in the mind's ability to at least decrease pain to a tolerable level.

It's kind of cool that I daydream about how I'll practice medicine. It took me awhile to believe that I will be a doctor.