Author Archives: stfmguestblogger

The One Place I Always Felt Safe and Never Judged: My Family Doctor’s Office

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Leanne Chrisman-Khawam, MD, Med

Growing up in a small town, the daughter of homemaker and a sometimes self-employed laborer, we never had health insurance. There was always worry. Would there be heat? Would there be food?  Would someone encounter an illness or injury that would financially, catastrophically wipe out the family home?

I remember feeling that there was one place I felt safe and never judged—my family doctor’s office. At school, I did not have the right hair or clothes. Certainly, all kids grow up with some form of feeling inadequate, but when one is poor, external locus of control augments any feeling of inadequacy. When one is poor and comes from an underrepresented minority, multiply that by 1000. But my doctor was the consummate professional. I never felt judged. I felt safe and cared for.

These life experiences led me to hold the long view of family medicine—as a solution for social ills and our healthcare spending crisis. Early in my career, I entered academics to pass the professionalism and professional identity that I saw in my family doctor. It was easy for me to emulate him, even in my homeless care work, because I often see my younger self had the unthinkable happened. Those are not just homeless people. Those are my people and I would have been one of them had the circumstances been different.

But how does one pass on the sensation of empathy for someone in poverty or in different circumstances?  I worry about what I am seeing more and more: cynicism and labeling in how we approach each patient. Even as I embark on an exciting, new journey to create an accelerated program in family medicine, I worry that the students who approach these challenges come in warped by our geo-political polarization. One way or the other.  Right or Left.  Conservative or Liberal.

Yet, I continue to have hope in the resilience and kindness of the human spirit, and I am hopeful as I interview new amazing students seeking a place in our transformative care continuum. This new accelerated 3-year program will include early longitudinal clinical care with a continuity panel and a focus on health systems, quality improvement, population health, and leadership.

One of the things I hope we instill in this new program is an ability to be truly reflective. I hope each student will learn to really listen and reflect on one’s skills. Professional identity occurs in meeting each patient without cynicism but with empathy by this process.  I hope that each of these students grows into the family doctor I had when I was a child: the family doctor that made me feel safe and never judged.

An Evolving Perspective of Whole Patient Medicine

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Evelyn Figueroa, MD

Zoe,* a 35-year-old law student, often missed and rescheduled appointments for her toddler Elias.* I have supervised Elias’ visits with the residents since his first newborn visit 2 years ago. Although I have only seen them with the residents, Zoe identifies me as their primary care physician and has always scheduled Elias’ visits during my teaching clinics. I have examined this cute little guy at every visit and thought I knew this family well.

I knew that Zoe and Elias were struggling because of the issues we discussed at every visit: finishing law school 90 miles away, struggling to maintain her breast milk, and single motherhood. Zoe’s tired face showed determination despite her challenges. Little Elias, in a loose diaper, always clung to Zoe’s tiny frame, a fact that initially made me think he was simply on the small side. Despite multiple no-shows, we gathered enough data to construct a disappointing growth trajectory. Was it failure to thrive or constitutional small stature? Medical advice typically consisted of dietary counseling aimed at boosting calories and more frequent follow-up.

Recently, I recognized Elias’ name on a resident’s schedule. Anticipating their typical tardiness, I asked the front desk to register Elias regardless of arrival time. When they came a little late, they were quickly ushered into to an exam room. The resident reported that although Elias had normal development, his weight remained below the first percentile.

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Hashtag Mentorship

Randall Reitz

Randall Reitz, PhD

#researchismypants
#takeitlikeahurdle

Mentorship has been around since the era of The Odyssey.  In the poem, as Odysseus prepares to leave for the Trojan War, he entrusts his son Telemachus to the tutelage of his trusted colleague, named Mentor. Our modern usage of this term extends from Homer’s character, but mentorship has evolved greatly in the nearly 3,000 years since (and now occasionally involves hashtags).

I recently had the privilege of being a small-group mentor with STFM’s Behavioral Science/Family Systems Educator Fellowship (BFEF).  I worked alongside Jill Schneiderhan, MD, to provide guidance to four early career behavioral medicine faculty and it was the highlight of my year.

My own small group was smitten with hashtags. They provided a pithy lingua franca to describe and unify our experiences. The two hashtags at the top of this post linger most in my memory.

#researchismypants came from a tear-filled (joy and sadness) discussion during our final dinner together. One of the fellows declared that she had just sworn off wearing pants. I observed that “research is my pants” and that I had just sworn off research. Neither of us could further abide these noxious crimps on our preferred lifestyle.

#takeitlikeahurdle came from the ride home on Highway 5 after that dinner. One of the fellows observed that she had recently sprinted across the same interstate earlier in the day, yelling for her husband to leap over the median “like a hurdle”.

 

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Randall’s BFEF Small Group

 

These hashtags encapsulate much of the tension of early career professionalism. People entering a new field face the dual pressures of being as helpful and generous with their colleagues as possible (to ingratiate themselves to the system). They also need to begin to delimit the scope of their job descriptions so that they maintain sanity and high self-expectations for work quality. The new professional needs to bring both positive energy and expertise to the projects they take on (ie, #takeitlikeahurdle) but also assert the confidence and negotiating skill to decline opportunities that aren’t a great fit (#researchismypants).

Each of the fellows successfully navigated experiences that embodied this tension, whether it was making a tough decision to change residencies for a better fit, standing up to a challenging colleague, enduring with pride the difficulties of relationship strife, or confronting unhealthy expectations from their department. It was an honor to scaffold our mentees during these trials. It was a thrill to watch how our charges came through stronger.

By my estimation, the BFEF Fellowship is an eminent example of modern mentorship.  What does it look like?

  • Intensive face-to-face mentorship at two STFM conferences and the Forum on Behavioral Science Education
  • Individual, small-group, and large-group meetings
  • Monthly small-group phone calls
  • Weekly synchronous and asynchronous points of contact (ie, email, project feedback)
  • A professional learning contract to personalize and guide the experience
  • A community of volunteers that support the mentors

This fellowship is one of many run by STFM, including training programs for leadership, practice transformation, teaching medical students, and medical journalism. These great offerings are constantly looking for faculty, advisors, and trainees, and I highly recommend you apply. Having experienced STFM training as both a mentee and mentor, I can attest to the richness of the experience from both sides.

#mentorshipalwaysevolves
#mentorshipneverchanges