This is a finalist in the 2015 STFM Blog Competition.
Our first indication that my pregnancy may not be quite as smooth as we originally thought came around 6 weeks when I experienced some spotting. It was days before Christmas, and knowing that our ability to get care may be limited in the coming days, my husband, a family medicine doctor, reached out to his colleague, Dr Justin Edwards, in hopes we might get a quantitative hCG before the holiday. Not only did Dr Edwards order the tests and let us know the results as soon as they were available, but he also offered the kindest support during a time that would have been otherwise unbearably nerve-wracking. We had a good Christmas because of Dr Edwards.
A few weeks later, just when I started to feel less anxious about my pregnancy following our first little scare, I began experiencing episodes of tachycardia. The episodes increased in length and frequency over time and quickly became refractory to vagal maneuvers. Not only did Dr Edwards identify the diagnosis following a Holter monitor study, but he also presented me with the appropriate medical management options. Furthermore, he listened patiently as I routinely—and I’m talking at each visit “routinely”— agonized over taking pregnancy category C medications, and would gently remind me of the current literature suggesting that my medication would not harm the baby at this point in the pregnancy.
Then at one of my appointments in the third trimester, I was measuring small. At the same appointment, Dr Edwards performed an ultrasound and found that my amniotic fluid levels were on the very low side of normal, and it appeared my son was quite small. I had enough medical school under my belt at this point to be terrified, and I could also see the worry in my husband’s face. Dr Edwards sat with my husband and me and enumerated the reasons this may be happening, and reassured us that my son still appeared to be healthy. In those moments that Dr Edwards talked with us, our very scary news seemed more manageable. The weeks that followed were certainly filled with some anxiety and careful monitoring, but ultimately my son’s delivery was exactly as I had imagined and he is now a healthy, happy infant.
I initially hesitated to write a response for the call for submissions of “What does family medicine mean to me?” for a couple of reasons. First, I tend to think “doctor as patient” stories are overdone, and I don’t think doctors should only be able to acknowledge the need to relate to patients after their own experience with illness. Second, I’m a fiercely private person and having my pregnancy saga on the Internet for anyone to read admittedly makes me a bit uncomfortable. Ultimately I decided to submit a response, however, because this experience has truly strengthened and invigorated my passion for family medicine.
Family medicine requires an academic rigor that is often underestimated but was expertly demonstrated by Dr Edwards. While Dr Edwards did have me consult with subspecialists with each complication to make sure his plan was sound, at no point did he shy away from caring for me or make me feel as though I was out of his scope of practice. From an academic perspective I find this to be tremendously exciting: in no other specialty does one have the opportunity to vacillate between the spectrum of generalist and subspecialist the way that a family medicine physician does. Using just me as a patient, for example, Dr Edwards was the primary source of management for routine prenatal care, routine postpartum care, as well as both cardiologic and obstetric complications. He also delivered my son, and will serve as my son’s primary pediatrician and care for any acute pediatric complaints.
On a more personal level, it was remarkable to me just how comforting it was to have one physician that had the medical knowledge and capability to integrate all of my care. It should be noted that I got tremendous care from the subspecialists I saw, and by no means do I think that family medicine can replace the expertise of these other physicians; however, where I truly became confident about the decisions I was making regarding the complications of my pregnancy was in my visits with Dr Edwards. He was the individual that offered guidance, counseling, and support when my husband and I—both in the medical field—looked him in the eye and asked, “What do we do?” Family medicine doctors are not just looking at a snapshot of the patient; rather, they are treating the whole individual and serve a vital role in bringing together the care received from multiple specialties and physicians. The impact that responsibility has on the patient cannot be understated, and my own “doctor as patient” experience helped me realize what a privilege it is to be a family medicine physician and serve as the individual that can help a patient piece it all together.
So now when I think about what family medicine means to me, I find that I am enticed and motivated by the requirement to continually challenge yourself academically as you meet the needs of each patient through a dynamic process of delving into different subspecialties. I find that I am hopeful I can be as compassionate and effective as Dr Edwards, who truly epitomizes what it means to practice full spectrum family medicine, in helping patients integrate their care. Most importantly, I hope that I can play my cards right as I progress through medical school so that I may have the privilege to call myself a family medicine doctor in the future.