Ordinary and Exceptional

Fight For Your Life by *darkcalypso on deviantART

On my flight to Chicago to take my USMLE Step 2 CS exam, I sat next to a pre-med.  She saw me open my review book and asked, "Are you a doctor?"  To which my reply is, "I hope to be soon!"

At one point during our conversation while waiting for the plane to take off, she told me a story about how her mom had received a liver transplant.  She had been fine seeing other patients hooked up to lines and machines, but when it was her mom, it was far more difficult to see.  She remarked, "I think one of the hardest things for me when I get to med school is to not be too emotionally attached to certain situations."

To this I replied, "No, it's a good thing to hold on to your emotions."  Emotions are what make us human and is what draws some (hopefully many/most) of us to medicine.  It's surprisingly easy to detach oneself from a situation, that seeing exceptional situations over and over again make them ordinary - but it'll always remain exceptional for someone.  I believe the moment we lose that attachment, the moment we become cold and treat the patient as "just another patient" or a "bag of symptoms," that is the moment we lose our raison d'etre - if you will - for medicine.  It's not called "the art of medicine" for nothing, as the art represents the human side of care.

Once I arrived in Chicago, I was at a McDonald's getting coffee with my uncle when I eavesdropped on a nearby conversation.  A man sat down across from some friends by coincidence.  They asked him how his wife (I think) was doing.  He replied that she's probably alright, she probably didn't have a heart attack and was just released from the hospital, and that they did a big work-up involving an MRI.  The friends gave their sympathies.

A small part of me ran through that in a purely clinical and almost mechanical way.  But most of me stopped to consider how frightening it must've been for this person, their friends, and the patient herself.  This was an exceptional event.  But we in medicine see this kind of stuff often enough that it becomes normalized and even ordinary.  We sometimes become unphased by the gravity of the situation.  Is this necessarily bad?  No, as it helps us stay calm and collected under stressful situations.  But I don't think we should shrug off our emotions entirely, rather we need to acknowledge them openly.

In a moment of reflection and Zen, I think we in medicine should ask ourselves: are we more healer or are we more diagnostician (doubtless we should strive to be equal parts of both)?  Do we let exceptional events become ordinary?  Or do we, despite the ordinary-ness that exceptional events become for us, openly acknowledge that they are exceptional - perhaps the most exceptional - event for someone?

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Family Medicine: A Holistic Balance

Balance by *BlackJack0919 on deviantART

Family medicine is often thought of as a "jack of all trades, master of none" branch of medicine.  And this isn't false.  Family medicine generally can't manage multiple co-morbidities in an acute setting, nor can they do much more than simple in-office procedures, nor are they as aggressive about pediatric issues or being as detailed/complete as a pediatrician.  But family medicine offers something else: a holistic balance.  During my time with my family medicine preceptor I've seen many things - things that are a natural continuity of what began in outpatient pediatrics.

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Whole Family Care

It was common for my preceptor to see all family members, from the newborn to the child to the parents and even grandparents.  The family physician observes and understands the intimate family dynamics between each member and, at one time or another, hears all sides of the story.  He is then able to practice medicine within the context of the family, utilizing other members where possible if needed.

There is a back-edge to this sword.  Sometimes numerous family members are squeezed into the same exam room to be seen in rapid succession - the child for a cold, the father for back pain, the mother for headaches, the grandma for knee arthritis.  It can be chaotic and frustrating, but one learns to flow through these moments with a smile and an efficient plan.  And through it all, the family gains a deeper trust and respect for the family physician.

Holistic Medicine

Now, when I say "holistic medicine" I don't mean alternative/homeopathic medicine, that which is outside the realm of the mainstream evidence-based medicine.  When I say "holistic medicine," I mean medicine that takes care of multiple aspects of a person's health.  My family medicine preceptor has a saying, "I don't want to give you my medicines if I don't have to.  Let's work on this together and see what you can do first.  Sometimes medicine is necessary, but let's not go there right away."  With every new patient, he'd spend an hour talking to him/her about their life, their concerns, what they want out of my preceptor's care, and lifestyle modifications that can stave off my preceptor prescribing medications.

With many physical complaints, my family medicine preceptor worked with patients to identify the problem and find some home remedies - often in conjunction with medication - to help solve the issue.  He was particularly astute in asking about herbal supplements.  He never dismissed what the patients were taking, but did often caution them as to how some supplements may interact with the medications he prescribed them or how another brand of the same supplement may be more trustworthy.  At times, he even referred patients to complimentary medicine practices such as an acupuncturist.

Work-Life Balance

More so than most other physician I had met, my family medicine preceptor actively stressed the importance of work-life balance.  He often reminded me between clinic visits to take a drink of water or eat a snack or take a moment to sit and just breathe.  He was proud that the flexibility in his hectic schedule still offered him plenty of time at home with his family.  He emphasized the need for us, as health care providers, to maintain a healthy lifestyle and to be an example for our patients.

He had a saying that he often repeated to me, his nurses, and his patients: "Have a good day.  Or not.  The choice is yours."  For many patients he utilized that as a means of motivation to help them get back on their feet and move forward in taking care of their own health - that we have a choice in how we begin each day, that our attitude about health matters.  Whereas in outpatient pediatrics reassurance and education are paramount, in family medicine it would seem motivation and helping patients reach a kind of self-determination is key.

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I understand that there are about as many different family medicine practices as there are family medicine physicians.  And for that reason I count myself very lucky to have been paired with a preceptor whose life values and medical philosophy match so closely with my own - nay, are steps above and beyond what I have come to on my own thus far.

As I move forward with my career, I must continue to take his words to heart and remind myself to slow down once in a while and take care of myself, so that I may take better care of those who need me.

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