Every rotation (except, I guess, psychiatry) has a free clinic, where the residents see Medicare and Medicaid patients. The med students tag along and there’s also an attending present, of course, but really the residents are the ones running the show.
What we get to do as med students really depends on the resident. Most of my neuro residents were cool about letting me do my own history and physical then presenting to them. My ortho resident today was more of the “Med student, you stand over here and watch” type. They are quite protective of their patients, these orthopods.
More than anything, I’m aware of the difference in care that you get in the free clinic versus the attending’s office hours. In office hours, you see the same physician every time. There is continuity. In clinic, it’s just whoever is available; the residents always check the electronic record for previous clinic notes, and it’s certainly adequate care, but it’s not consistent. Then the residents and attendings sit around afterwards and gripe about how Paul Bunyan* is non-compliant with his follow-up appointments because he’s too busy chopping down a forest to come to a clinic and repeat the story about Babe the Blue Ox stepping on his forearm.
Would better continuity improve compliance? My guess is yes; seeing the same physician every month would set up an expectation of personal care. But when it’s as random as your supermarket cashier, why should you bother showing up? Maybe I’m being naive, but it does seem bizarre that we worry so much about continuity in an inpatient setting (e.g. resident work hour restriction) but totally ignore it for ambulatory care.
*I would love to have a patient named Paul Bunyan. But I guess then I couldn’t use it as a pseudonym anymore….