Met a fammed case in ortho opd. I hate that these "surgeon" residencies often ignore the other problems of the patients. We are often told that we should always look at the patient as a whole and address the most pressing problem in the patient. This may or may not be within the area of specialization. This may or may not be related to the chief complaint. We are all trained to become general practitioners first and we should always act like one if the patient has problems outside of the specialty. Often times it means referring to another physician and at the very least, educating the patient and giving preliminary management.

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Today, I met a breast cancer patient who is deferring chemotherapy. It sucks that she got sent to Ortho. Surgical OPD clinics are not known for their use of the biopsychosocial approach. They don't even use the complete clinical approach. It was clear to me that her problem is not the shoulder pain but lies in her family. Something is terribly disturbing if a patient who just underwent MRM continues to view her cancer as death sentence. Maybe I should have sneaked in a referral to Fammed or Hospice on her chart.