Students in the Field: Family Medicine in Milton, Vt.

Kinjal Thakor '20
uvmmedicine blogger Kinjal Thakor ’20

Primary care physicians equipped to practice in rural locations are in dire need across the country. According to the Centers for Disease Control, there’s a “striking gap” in health between rural and urban Americans. The causes are complex, but socioeconomic conditions and access to healthcare play a role.   Rural Americans have higher rates of cigarette smoking, high blood pressure, and obesity, according to the CDC. They also have higher rates of poverty, and are less likely to have health insurance. All of this translates into patients who are more at risk for death from preventable causes as compared to their urban counterparts. In this series on the UVM Larner College of Medicine blog, we explore what students experience during rotations in more rural areas, and how it shapes their thinking about their own career paths and the practice of medicine overall.

In this first post in the series, Kinjal Thakor ’20 talks about her family medicine clerkship at Milton Family Practice in Milton, Vt., a town of about 1,900 residents 20 miles north of Burlington.

What was a typical day like?
The night before, I prep by reading up on the patients I’ll be seeing the following day. I arrive to clinic at 8 a.m. and end at about 6:30 p.m. every day. Before seeing patients, I “huddle” with my preceptor and the nurse, discussing relevant history, labs, and preventative care needs for each patient. With the patient, I get a thorough history and perform the physical exam before stepping out of the room and presenting to my preceptor before going back in together. My preceptors have many teaching points for me to learn from and improve my skills. Before I leave, I finish any notes I have left.

What kinds of patient complaints/conditions/procedures did you generally see? What skills did you develop?
I generally see a lot of follow-ups for hypertension, type 2 diabetes, hyperlipidemia, anxiety, and depression. Now that its’s summertime, I see more tick bites, allergies, and contact dermatitis as well. I’ve performed pap smears, wound packing of a diabetic abscess, used ultrasound, done a Wood’s lamp exam to check for corneal abrasion, and skin tag removals.

Seems like you spend a lot of time with several preceptors in the practice – what was that like? What did you learn from them?
I work with a new preceptor almost every half-day, but I more frequently work with my primary preceptor, Dr. Gibson. Everyone has a unique style and rapport with each of their patients that they’ve built over the years. It’s been a privilege and honor to have had patients entrust details of their lives in us and let out their thoughts and emotions, sometimes at their most vulnerable of moments. The learning curve has been steep, and the room for improvement is infinite. The more I learn, the more I realize how much I have yet to learn. In the last few weeks I’ve learned about cancer screening guidelines, medication indications, management of chronic conditions, and have improved my presentation, note-writing skills, and general flow of how I converse with patients. This is only the beginning of the rest of my life in medicine!

Do you have any interest in practicing in a rural location? How has this experience helped to shape your thinking about practicing in rural areas versus larger cities or suburban areas?
I’m more interested in practicing in a suburban location, but have found my time at Milton in a rural setting to be invaluable. I do think patients in rural locations face unique barriers that urban dwellers do not. We referred many patients out to Burlington for their tertiary care needs, which posed a challenge for some in terms of finding transportation and getting time off work.

What surprised you about working in a rural location like Milton? What were some things you learned or took away that you didn’t expect?
I was most surprised by the high number of mental health follow ups on anxiety and depression here at Milton. I have found my time with these patients to be an incredible learning experience on the power of open and non-judgmental listening and on the ways in which physicians can guide patients in the right directions. Even though this is family medicine after all, I was surprised to see patients on several separate visits over the course of a few weeks as the spouse, parent, or child of other patients at the practice. I even got to see a woman on her antepartum visit and then her child after the delivery on his five and 14 day-old visits. It was delightful to see families together. I think this is why family medicine is so rewarding – you care for not only the whole spectrum, from pregnancy to newborn babies to older adults, but the whole family tree together!

What are your thoughts about this topic?