1st place winner in the resident/fellow category in the 2015 STFM Blog Competition.
One year ago (read: before intern year), pretty much the most exciting part of my fourth-year emergency medicine rotation was having my pager go off. BZZZZ!!!!!! I leapt into action, excitingly reading the text page: “Leg lac in E9.” I was on it.
Suture kit in hand, I burst through E9’s thin emergency department curtains with abandon—I was going to fix this. The “leg lac” turned out to be a wonderful 95 years old, Mrs F, who had fallen onto her wheelchair. The skin on her lateral lower leg was pushed aside, leaving exposed subcutaneous fat (of which she did not have much) and the fascia of the muscle below. Accompanying Mrs F was her daughter and her husband and Mrs F’s other daughter’s daughter—suffice it to say, it was a crowded curtain-room. Two hours and 30 sutures later, I knew the family’s story: how Mrs F, great-grandmother of four, had been living independently but recently was hospitalized due to difficult to control hypertension, how Mrs F’s daughter and son-in-law wanted Mrs F to live with them, but she fiercely wanted her independence—“I can get around!” and how the same stubbornness that had gotten her through 95 bitterly cold Minnesota winters had now come to this, a crossroads.
The fact that I can still remember this family’s story, 16 months later, exemplifies what family medicine means to me: the chance to be a part of the lives of patients and their loved ones. I was drawn to medicine because I believe that everyone should have the opportunity to be in the best health they can at whatever stage of life they are. As a family physician, I see myself effecting individual change by being part of patients’ lives rather than thinking that I will save them.
Lest doctors get too big for their britches, let us be humbled that on average, health care accounts for only 10% of a person’s overall health. As a pre-med undergraduate majoring in economics, I struggled with the fact that merely becoming a physician would not help me change the world. Policies and environment played a much larger role, yet medical care focused on diagnosis and treatment of an individual’s signs and symptoms. How, I wondered, could this gap be bridged?
When I first read Family Medicine for America’s Health’s mission statement, I had to read Dr Glen Stream’s long, compound sentence a few times: “The goal of FMAHealth is ambitious: to transform from our current poorly integrated, disease-focused, expensive, fee-for-service funded non-system to a highly integrated, patient-centered, primary care team-based, health promoting, disparity eliminating, professionally satisfying, and cost-efficient true system.” Dr Stream covers a lot of ground with these words, but the ones that really resonated were ambitious, health promoting, and disparity eliminating. This is a call for family medicine to get involved with policies and innovation that will shape the entire health care environment.
In family medicine, I can do more than suture complex lacerations. During those 2 hours, I understood Mrs F’s and her family’s struggles and sought to find them better resources. When I saw that Mrs F had been readmitted to the hospital a few days later, I visited her. The recognition that lit up her and her daughter’s faces when I entered the room made an impression on me that ultimately convinced me to submit my residency applications into family medicine.
Family medicine isn’t about saving the crashing patient, administering miracle drugs, or restoring someone’s sight. It is about being a part of the lives of our patients, ideally growing with them but also seeing them through their struggles. Primary care has a dual meaning: we are the first people that patients see and the main interface between patients and the health care system. As Dr Stream points out, we have the opportunity to promote health and eliminate disparities by treating patients equally, before they get sick—and, by affecting that other 90% of health by getting involved in our communities and in policy. Mrs F was not, and never will be, a “leg lac”—she is a great-grandmother and the family matriarch, and I will always consider her and her family my first family medicine patients.