This is a finalist in the 2016 STFM Student Blog Competition.
For my eighth grade graduation my aunt gave me a card that read, “It’s the journey, not the destination.” I loved it. I wrote it on other people’s cards. I think it was my senior year yearbook quotation. It made so much sense to me.
Last year, as a bright-eyed second-year medical student chugging all the family medicine lemonade at the AAFP National Conference, I attended a session about caring for communities that argued, “It’s not the destination, or the journey. It’s the direction.”
All these years of journeying, and I was focused on the wrong cliché?
When I step back and think about direction, I notice a certain pattern: humans travel in circles. If anyone told 9-year-old me that there would be signs on the road warning, “Don’t Pokemon GO and Drive,” I would be ecstatic. But in 2016, the necessity of such signs stirs up a cocktail of disappointment, amusement, and irony. Turn on the news, scroll through the latest hashtags, or read the paper (if you know where to get one)—history still seems to repeat itself. Therefore, when prompted to answer where I see family medicine in 10 years, it made sense for me to look 10 years back. In 2006, an AAFP editorial written by Dr Sanford J. Brown, “Reinventing Family Medicine,” opens with, “Our specialty is ailing.”
After outlining the defining skill sets of family medicine: practice management, wellness medicine, information technology, home visits, family dynamics, and community medicine, Dr Brown concludes with:
“The fight for privileges to do procedures saps our energies and is one that we will eventually lose, not only because specialists are better trained to do them, but because in this day of consumer-driven health care, our patients will select the doctors with the most experience and best track records to do their colonoscopies, colposcopies, cardiac stress tests, C-sections, hernia repairs, and critical care. Perhaps no other specialty trains its residents to do so many things they will never use in practice, while spending so little time training them to do what most of them will wind up doing—clinic medicine.
To maintain the dynamism of our specialty, we must define ourselves by what we can do better than everyone else, not by what everyone else is doing.”1
I agree with Dr Brown in that we define ourselves by what we can do. Furthermore, I believe we must define ourselves by who we want to be for our patients. As family physicians we are advocates for our patients throughout their lives, through specialty visits, insurance changes, and health care reforms. We practice clinic medicine as active members in our communities. Contrary to Dr Brown, I believe that what everyone else is doing is extremely important to us. In the growing age of inter-professional health care teams, care coordination is becoming increasingly crucial in providing quality care for patients. As a future family physician, I want to voice my patient’s concerns and best interests in the medical jumble of specialties, insurance policies, and health care system red tape. I am inspired by family physicians involved in policy and practice model transformations, and I hope that more physicians-in-training recognize the role family medicine plays in the delivery of care. We assert ourselves in the processes that shape our patients’ experiences because we stick with patients from beginning to end. As patient advocates and community leaders, we must lead health care into a direction that improves health care for everyone.
Everything in my journey through medicine is the hardest thing I’ve ever done. The MCAT was the hardest test I’d taken, that is, before USMLE Step 1. A full history and physical OSCE was the hardest thing I’d ever done, until I had to convince a veteran who had avoided hospitals for 40 years and lost 50 pounds in a matter of months that he needed to finish his GoLYTELY so we could tell him he had end stage colorectal cancer. Unlike many decisions in my medical journey, choosing family medicine was not hard. However, like all my previous hardest-things-ever-done, figuring out the direction of family medicine will be a challenge. What direction is family medicine heading towards?
I believe family medicine is directed towards becoming leaders for change. As physicians-in-training, we have worked countless hours and made too many sacrifices to work in a sick care system that we are not confident provides the best quality care for our patients. Family medicine physicians play the ultimate advocate for our patients, their families, and our communities. We listen to the struggles of patients fighting to overcome health care barriers. In order to empower our patients, we must engage in leadership roles and national discussions. By doing so, we will be able to create change in the systems that often fail our most vulnerable patient populations. Ten years from now, family physicians will continue to grow as agents of change, directing our health care system to provide comprehensive, cost-effective, patient-centered care. Knowing who family medicine physicians are for their patients and communities, I know I will choose the journey of family medicine in any direction. I still believe in the journey, and I am hopeful in the direction that family medicine is moving towards.
- Brown S. Reinventing family medicine. Fam Pract Manage 2006 Apr;13(4):17-20.
Very inspiring – well articulated!
Nicely done and hope this inspires many more advocate current and future family medicine and specialty doctors to have this same direction and energy…it is sad to see that the US has one of the poorest medical system support globally when it is the richest in knowledge, technology, and advancement…medicine has not been about saving lives, but more about revenue!!!
I echo what upou have written!
This is such a great piece. Wonderfully written and such an important message 🙂
Great voice which shows passion and dedication. As a teacher, I was very impressed by the mind, the feelings and the direction of this young lady involved in the medical field. She is a true model of tomorrow’s generation. We need more bright, articultate, honestly driven people to carry their future and profession with honesty, pride and deep thinking.
Thank you for sharing!!
I totally agree! Our current healthcare system definitely needs improvement and family medicine practitioners need to be leaders for change in order for this to happen. We will need Family Med doctors who will have strong leadership skills to push the system in the right direction. Inspiring piece!
It’s amazing that there are still
People out there that is not afraid to make a difference in people’s life. Sometimes we have forgotten our humanitarian values because of strains from insurance companies. Kudos to your work and I hope you would continue to go towards the right direction.
Very inspiring piece! It is wonderful to see such a refreshing, progressive perspective on the future of primary care. Keep up the great work!
Very thoughtful. I’m eager to see you among the future leaders of family medicine
Having been a family physician for over 40 years, I have seen a lot of changes and I’ve learned that adapting to them when I’ve felt it was appropriate has kept me happy with my professional life. The core responsibility as advocate for my patients will never change.
You have many good points in this essay.
Dear Lex, You have picked up the torch. Forty years ago I was in your shoes and I had many of the same thoughts about the almost new specialty of Family Medicine. But I too am concerned that we have been going in circles. Scope of practice, maintaining the doctor patient relationship as a sacred space, worrying about the financing of medical care are all still being discussed as they were 40 years ago. I really thought we would have solved some of these problems before I retired. I will tell you Family Medicine is the answer for what our patients need, but it is going to take a much bolder fight by physicians on behalf of them to get the profit making administrative waste out of healthcare.
I want to echo the feeling by Dr. Lewis. I’ve been practicing for 40 years also. It is great to see the family physicians coming along have such insight!
Connecting with your patients makes all the difference. Loved the essay.
Very well written. Keep up the good leadership!!!
Advocating for your patients is basic , now advocate for your professional colleagues as well. Be a strong group, promote professional satisfaction among Fam Med doctors by moving healthcare in the right direction. Continue to persevere, lead, and inspire your colleagues. The future needs more fam med docs!
It is very encouraging to see junior colleages in our wonderful field who actually “get it”. Much success to you moving foward!
I want to be that type of doctor too!
Great piece — proud of you working as an agent of change!!
Wonderful piece, Lex!! Continue to be that agent of change that you are!