Yesterday, the training wheels came off.
During my first 90 days with my clinic, I work with another provider. I chart under their name, they’re right outside waiting for me in case I have any questions. They’re there to pick up the slack of a patient or two if I get bogged down with a complicated problem.
On Monday though? I got my first taste of what it is to be a provider without all that support. I’m only about six weeks into my three month training period, but I picked up an extra day on Monday with the understanding that I wouldn’t have that same back up. In fact, for the first three hours I would be the only clinician in the office.
The feeling I had was at once unsettling, exciting, and mildly terrifying. I had a schedule to keep up with (for real this time), I needed to have the answers, I needed to be able to properly direct my (totally wonderful) support staff with my personal preferences for procedures.
Now, mind you, I still have support in case I have a question. In fact, my main preceptor was in the office doing admin work and gave me her extension in case I needed her. I know that support is always just a phone call away, even once I’m a fully fledged, independent provider.
Luckily, this day, where I was jammed into a full schedule (got to all 17 of my patients that showed and got out on time, thank you very much!) came after my first real day where I walked out saying to myself, “you know, you kinda got this.”
Last Friday I kept up with a full schedule. I put in 5 IUDs (I started joking that I was going to put an IUD in every woman in the county), two Nexplanons (tiny, plastic rods that release progesterone), triaged a woman with serious depression, and confidently talked a young woman through a new herpes diagnosis.
I spent so much of my time as a student agonizing about how I felt like a fraud, like I’d never learn it all (and it’s true, you can never learn it all), and terrified of independent practice. Most of the time, I still do feel like a fraud, and every time a patient asks me how old I am, or how long I’ve been doing this burns me more than it probably should. But I do sense a new authority resonating through my voice in the way I talk to patients. It still seems strange to me that they listen to what I have to say.
One of the things I am having difficulty with is the fast-paced schedule. Birth control starts, simple IUD insertions, routine well-woman exams, all of these things I can fit into my schedule in which my patients’ appointments are lined up in 10 minute segments. The thing that rips my midwifery soul up is that I don’t have time for the emotions.
On abortion days I am responsible for pre-medicating women with antibiotics and ibuprofen and get them set up with birth control for afterwards. My role is also to assess and review the degree to which a woman is sure about her decision to terminate her pregnancy. Sometimes, I get a two word response. “Yes.” “Very sure.” “I just want it done.” These responses allow me to keep up with my schedule. But for the women making a difficult choice, the women for whom they fear for their safety if their partner finds out they are pregnant, or that they are terminating this pregnancy, for those who fear they will hate themselves, who are traumatized by protesters, I would give anything to have more time. To not have to think, “I have four more patients I have to pre-med in the next 15 minutes.” I want to be able to be their witnesses, to offer support. To let them cry in my office for a minute before returning to the waiting room. This is the dilemma with community health. We’re continually understaffed, under-resourced, and have more patients than we can handle because our health care system is broken.
I think of the private practice midwives that have time for hour-long new OB appointments or well-woman exams. To fully assess emotional state. To treat underlying depression, anxiety, and address other primary care concerns. I am jealous of those who have time to get to know their patients, remember them, build relationships with them. But I realize that this is not the nature of the job that I can do. I work in a facility where I will see 21-24 patients a day. I try to forge relationships in our (literally) 5 minute visit for birth control starts, to shoe-horn as much teaching into the time I am allotted, but by the time I look back at my schedule at the end of the day, all the names blur together. I will likely never know the outcome of the herpes culture I ordered, or the pap result where I can visibly see HPV-related changes, because other providers in my system will see these patients when they come back on a different day and the follow-up nurse will make all the calls.
There’s something that is very difficult to get used to in this kind of system. I was working with a provider a few weeks ago who casually said, “It’s less than ideal. And it’s not what any of us want or how we thought we’d practice.”
I struggle with it sometimes, but know that my support of the mission of my clinic is worth the five minute visits. The removed follow-up system. Because without us, there would be no one to provide any care to my patients. So while it hurts my midwifery soul to not be able to have the warm-and-fuzzy visits I wish I could, I know that I’m being a warm-and-fuzzy midwife in a different way, even if it doesn’t come through in long visits, and deep relationships.