Externship

Dear Administrator,

I am a former Associate Clinical Professor at the Stanford Medical School affiliated San Jose Family Medicine Residency program. I am a Fellow of the American Academy of Family Physicians and the former Department Chairman of the Good Samaritan Hospital in San Jose, California. For more than 30 years, I have practiced family medicine in San Jose California. During that time, I have served as a preceptor for the learning experience for Stanford medical students, physician assistant students, family practice residents, and international medical graduates.

… the doctor completed a four-week Observership-type clinical experience designed to provide an international medical graduate with a comprehensive introduction to US Healthcare. In addition to observing my clinical encounters which consisted of the typical array of medical problems that would be expected of a primary care physician in an urban setting, they received didactic presentations that gave particular attention to ensuring exposure to the infrastructure of US Healthcare and to many of the ways it is unique.

During the four weeks, we discussed and gave participants insight to:

the daily responsibilities and various roles of the primary care physician including the role of gatekeeper for referral to specialists, administrator for paperwork such as state disability, work and jury duty excuses, and adjudication for the DMV,

a patient-centered, integrated, holistic approach to patient care,

the utility of interview techniques such as active listening and I-statements,

the utility of setting an agenda for the patient encounter,

the utility of obtaining and documenting the salient history and observations in the SOAP note format using an EMR and techniques for doing so,

a thorough orientation to the EMR Office Ally, the maintenance of the progress notes as a legal document,

the concept of the local medical community standard of care,

instructions for the disposition of patients including writing prescriptions for medication, requisitions for routine and special testing such as blood work, imaging, polysomnograms, CPAP administration, and authorizing treatment such as physical therapy and hospice care

the concepts of professional liability insurance, defensive medicine- both positive and negative types,

the administration of the routine annual exam and early detection and intervention techniques,

the various means whereby healthcare is financed including health insurance,  disability insurance, Medicare and Medicaid, and the various formats such as managed-care, PPOs, HMOs,

important aspects of managed care that impact the primary care physician such as tiered medication formularies and prior authorizations,

and an introduction to alternative approaches to making lifestyle changes including cognitive behavioral therapy, reframing, and hypnotic suggestion.

…etc., etc.,