Category Archives: Family Medicine Stories

It Is Time to Serve as a Primary Care Physician

By Sumi Dey, MD and Harland Holman, MD

It’s time to serve as a primary care physician.

This is what we tell our students. Why? Because the US Department of Health and Human Services estimates that by 2025 the United States will be short 35,000 to 44,000 adult care primary care physicians. We believe this is a crucial time for medical students to become interested in serving as primary care physicians. If future students will not prepare to care for our nation’s needs, who will?

If a student asks why they should be primary care physicians, this is our answer.

Americans who regularly visit their primary care physician have a 33% lower health care cost and 19% lower odds of dying than patients who visit only specialists. According to the Report on Financing the New Model of Family Medicine, if every American had an established relationship with their primary care physician, it would reduce national health care costs by $67 billion per year.

Primary care access is correlated with more equitable distribution of health within a population and can mitigate the adverse effects of income inequality. This is especially important in the United States, where minorities and economically challenged people are struggling to access regular primary care.

Countries where patients have established relationships with primary care physicians have lower depression and suicide rates. Mental health problems including depression and anxiety are part of patients’ everyday life experience, and often primary care physicians address mental health at almost every visit. According to the National Alliance on Mental Illness, more than 70% of visits to primary care physicians are associated with psychological issues.

Establishing a long-term, strong relationship with a primary care physician plays a crucial role in early disease diagnosis and prevention. The Centers for Disease Control show that disease prevention is important in creating healthier communities and productive lives, and in reducing overall health care costs.

Primary care physicians provide continuity and preventive care for a wide range of medical conditions and undiagnosed health concerns. They also serve as the framework for building a strong health care system that ensures positive, cost-effective health outcomes and health equity for the nation, especially in underserved populations.

Students, it’s time to serve as a primary care physician.

From Journalism to Medicine: Not Such a Huge Leap After All

Ranit Mishori, MD, MHS

Ranit Mishori, MD, MHS

Now that I have stacked up a good number of years in medical practice, I am one of those doctors who gets asked from time to time to talk about my career with medical students and junior physicians, answering questions about how I chose my specialty, how I like life in academia, and how I balance being a doctor, a spouse, and a mother.

Part of my answer always includes my late start in the field. I was nearly 30 when I decided to give up on a life in journalism and go back to school and become a doctor.  For a decade before that, I was a newswoman, a radio producer, and then a TV producer and editor, and I worked in Jerusalem, New York, and London. I covered wars, natural disasters, politics, terror attacks, international affairs, and some fluff stories as well. Yes, I must confess: skateboarding squirrels, surfing dogs, and high-heel races are some of the memorable news stories I shared with the world.

And when I share this, the most common comment I get is some variation of, “Wow, journalism to medicine sounds like 180 degrees!”

I thought so too at the time I started making the switch. But eventually I found it not to be a radical change at all. To the contrary, my decade in news prepared me well—better than any of the required organic chemistry or physics courses—for a life as a medical doctor.

Here’s why:

It’s all about storytelling.

One of the things that many students feel most nervous (and excited) about in the first 1 to 2 years of medical school is interviewing patients. This is what we call in medicine taking a history: a process that is at least as important as doing a physical examination. Indeed, I would argue that its impact is often greater than diagnostic testing or lab results in reaching a diagnosis and creating management plans.

For me, history taking felt like being back out on a story, behind the camera, getting the facts and making them make sense. Doing this well, in either context, is an art in itself: knowing when to press, when to let go, asking open ended questions, letting silences linger, paying attention to what’s not being said. These are crucial skills that we, as medical educators, try to teach medical students from year one to the end of their training and beyond. And they were skills I acquired in journalism.

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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.