Family Medicine

The nature of my specialty right now is that I don't have glorious stories of pulling tumors out of abdomens or waking up at 4 AM every day (wait, did I say glorious?? I think I meant seriously sadistic). My people-- yes, I feel like I OWN them after a mere 3.5 weeks together-- deal with the seriously mundane business of taking care of what, to the untrained eye, are the most superficial aspects of medical care.

But if you actually agreed with what I just said, you would be horribly, horribly wrong. It is estimated that for every 1000 people in the community in a typical month, 800 feel medical symptoms. Only 327 of those even CONSIDER medical care. 217 of them visit a physician's office (113 visit a primary care office), 65 visit an alternative/complementary medicine provider, 21 visit a hospital outpatient clinic, 13 go to the ER, 8 are hospitalized, and FEWER THAN ONE are hospitalized in an academic medical center.

What does this all mean? For one, it tells us what we can and cannot believe about clinical trials, which are mostly done in the academic medical centers visited by the fewer than 1/800 symptomatic patients in every month: they are not necessarily representative of the total patient population. Secondly, it tells us something about the attitudes towards medicine, and the (in)accessibility of medical care out there in our communities (about 500/1000 don't even consider it). Most importantly, it illustrates the importance of primary care: providers in outpatient settings and family practice clinics are on the front lines of almost every medical battle.

I used to brag that I hate people. I am shocked to find that I actually like them very much. I like how each one comes with a wholly different set of challenges, and how many of them are eager to form an alliance with their medical caregivers (and that now includes me, I'm part of the team, too!) to surmout these challenges. I like the stories I hear, and the stories I get to tell. I even like the patients that don't really get it, or try really hard and are just too weak to do it, whether it's quitting smoking, eating healthier, getting more exercise, getting out of an abusive relationship, or checking blood sugar levels every day-- those are the most challenging ones (and anyone who knows me at all knows I like a challenge).

I got my first taste of continuity last week. I have been seeing patients in one situation or another for longer than many of my classmates, since I worked as an EMT for 2 years before I started medical school. But it was always "Hi, nice to meet you!" and never "It's great to see you again!" Of all the things that have happened to me in the last couple of weeks, I have to say that the first time "It's great to see you again!" happened to me was the most transcendant: continuity of care is really all that it's cracked up to be. I think back to all the stories I've heard about doctors who delivered a baby and remained its care provider for 20 years... what an honor to be a part of an individual's life in that way.

The first 2 minutes of any patient encounter belong entirely to the patient. I have a whole cheat sheet of tips and tricks to make someone talk without the use of torture devices (apart from my presence in the room, that is). My first "It's great to see you again!" patient rewarded me by opening up to the incredibly vague, general question of "So, what's going on your life?" with "well, it's been pretty bad since my wife died five years ago." By the time I left the room ten minutes later I felt like I had died. I thought I was ready to "be there" for people, but that was the arrogance of youth speaking. How could I, without mourning for five years, match the magnitude of sadness this gentle old man felt? In ten minutes, I had drained every ounce of sadness out of my being to share with him in empathy (in school they love to teach us this in abstraction, they call it "humanism"), but it I knew couldn't possibly be enough.

The "don't get burned out" answer is NEVER to let a patient GET to you. I'm still letting them do that. Being in the room with one particular patient, who had a sinus infection and obvious depression, felt like meeting a group of dementors (YES! A Harry Potter reference!) in a dark alleyway-- it was cold, you felt like all the happiness had gone out of the world, despair took over. Why is interviewing her like pulling teeth? Why do I feel so angry at the patient I'm trying to help? There is no hope left. I am helpless... She made me so angry I could barely get my presentation out to my attending afterwards. Her passive agressivism frustrated me: why was she here, in our place of healing, if she didn't want to be healed?

I'm still green, so my frustrations and joys soar and crash with the tide of human drama that is all around me constantly. Eventually, I will become the rock that others depend on for shelter in that stormy sea.