Category Archives: Family Medicine Stories

A Case for Interprofessional Exchange in Family Medicine

Courtney Kasun, RN, MNSc

One year ago, I began teaching in an interprofessional student clinic.  The student clinic itself had been around for decades, staffed by students in our family medicine clerkship.  However, after a recent campus-wide push for more interprofessional education across health care disciplines, we began adding nursing and pharmacy students to our clinic and having all the students see patients as an interprofessional team.

I was slotted in as the nursing faculty at the last minute when it became evident the previously planned upon faculty member had too many obligations to manage.  Having not been in on the planning meetings,  I had no idea what to expect from the whole experience.  I was nervous and hoped I would be able to contribute something meaningful to our team and to the education of our students.  Little did I know how profoundly this experience would change my life.

One of the first insights we try to give our students in this clerkship is the chance to learn about the other’s professional training,  education,  scope of practice, and ethics.  In the first ever clerkship of interprofessional clinic, we too, as faculty, were learning things we never knew about our professional colleagues, despite having been licensed practitioners for years.  I gained a better understanding of the nuances of medical education, which has been helpful.  More importantly,  I learned from family physicians what makes family medicine different.

In formal nursing education we don’t learn much about physicians, their training, or the differences between specialties. Really, we don’t learn much formally about physicians at all. What we learn about you as a profession is what you teach us. The attitudes of nurses and the ways in which they collaborate with physicians are largely shaped by the early career encounters they have with doctors.

Nursing graduates leave school with a basic understanding of different medicine specialties; we know cardiologists deal with hearts, orthopods with bones, and so on and so forth. However, we don’t graduate with a knowledge of the subtleties or ethos of different specialties. Among the least clear distinctions for nursing is the difference between internal and family medicine. Most of us would be able to tell you that family medicine takes care of kids in addition to adults. Beyond that the distinction is vague.

Imagine my excitement and surprise when I found out how much family docs care about prevention and social determinants of health. Beyond just caring for your patients, you are concerned with public health and that, often, family physicians make their medical practice an extension of social justice principles. These are things that nurses dig. These are aspects that are foundational to to nursing’s world view.

Learning about and aligning with family medicine has renewed the purpose and passion in my professional nursing career. I was previously opposed to pursuing my advanced practice degree in family practice, perceiving that a family nurse practitioner (FNP) degree was only for nurses who want to work in “Minute Clinics” at chain pharmacies. However, since spending time working with family physicians, I decided an FNP is the advanced practice route for me and that I wanted to get the background in prevention and public health that would help prepare me to stand up with family docs and work for change in our health care system.

In addition, I have become a vocal advocate for the specialty of family medicine, as have many of my nursing students who have come through our interprofessional clinic. Three of our nursing students from last year are new graduates who are helping to open a brand new inpatient family medicine unit at our academic health center. Their lives have been changed through exposure to your mission, and they tell everyone who will listen — and even some who don’t want to— about how amazing family medicine is.

What we, as nurses, learn about medicine, or family medicine, is what you teach us. In taking the time to show us the soul of family medicine, you will mobilize your greatest advocates.

We Do Not Interrupt Our Patients

Joseph Scherger, MD, MPH

Ever notice a patient wince when interrupted describing his or her problem? It is well known that physicians interrupt their patients much of the time and usually within 30 seconds of the start of the visit. One study in Family Medicine showed that residents interrupted patients 12 seconds into a visit 25% of the time (article pdf).  We even teach interruptions as part of “controlling the conversation” and “limiting the agenda” for the visit.

In a practice where there is ample time for visits, there is rarely if ever a need to interrupt a patient. I’m now in such a setting after more than 30 years of brief office visits, and I had to train myself to not interrupt patients. What a great feeling that is! At our practice, we sit back and let every patient finish what he or she has to say. Patients notice this, too, saying they have never had a physician listen to them like we do. We learn things about patients they have not had the chance to share with physicians before.

Since we have an hour for every new patient visit, early in the encounter I ask the patient to tell me his or her story. The patient often asks, “Which story?” I say, “Where were you born and what happened after that?” It is amazing to me how most patients finish this story in about 5 minutes. As a matter of fact, I’m impressed with how brief most patients are when giving their narratives uninterrupted.

Our physicians are now demonstrating an uninterrupted communication style to medical students in their family medicine clerkships. By the time they arrive at our practice, they have already been taught to interrupt patients, so we teach them otherwise. Often, this helps them love family medicine. We look forward to training residents in uninterrupted narrative next year when our residency program starts.

Interrupting patients is a part of the paternalistic culture of medicine where the physician’s time is more important than the patient’s, and the physician knows better than the patient what the problem is. Such paternalism is unprofessional and even dangerous and should not be a part of patient-centered care.

I admire professionals who let people have their say completely. Counselors are very good at this and so are good lawyers, realtors, designers, and many others. Interruptions seem to be mainly a physician behavior.

Visits with patient can be efficient without interruptions. When patients have been given the chance to say everything they want during the visit, they are more receptive to hearing our assessment and recommendations for managing their problems. After all, patients are in charge of their care. Our job is to serve them, respectfully and without interruption.

Why Medical Students Should Advocate

Attending the Family Medicine Congressional Conference in Washington, DC,  last month was an amazing experience.

Aaron Meyer

Aaron Meyer
Medical Student

Physicians, residents, and students spent the first day immersing ourselves in family medicine action on Capitol Hill. Thought-provoking discussions on family medicine pipeline and payment reform helped me understand how these issues affect students currently and will continue to do so in the near future. Issues like ensuring continued funding for National Health Service Corps so students can follow their convictions and work in underserved areas. Advocating for a permanent repeal to the Sustainable Growth Rate (SGR) so students don’t have to worry about the financial stability of their future practices. And encouraging modernization of Graduate Medical Education (GME) funding so our training can more fully reflect who we are as family physicians.

After the first day of updates on family medicine’s governmental advocacy, we were able to meet Congressional Representatives, Senators, and their aides. The Missouri Academy of Family Physicians delegation and I were able to sit down and talk with US Representative Russ Carnahan about what we had learned the previous day. We told him about two House Bills related to GME funding reform and SGR repeal and urged him to support the future of family medicine (and possibly be a co-sponsor on the bills).

I’m a political junkie, so meeting Rep. Carnahan was exhilarating. I was so happy that I was able to talk to him about the importance of protecting National Health Service Corps funding and other issues that affect students. Reflecting on my experiences at this conference, I am 100% positive that a student’s voice is incredibly important on Capitol Hill. Hearing a student like me talk about my $200,000 debt upon graduation and how vital pipeline and payment reform are in ensuring that all patients have a family doctor is a message that all legislators need to hear.

Advocating on behalf of the future of family medicine is advocating on behalf of the future of health care in this country. I encourage all students to become involved in advocacy because we have an important voice, and we will form the backbone of the next generation of physicians.

 For more information on medical student advocacy check out these resources:

The 2014 Family Medicine Congressional Conference April 7-8

Students, Residents: Stand Up and Make a Difference for Family Medicine

Watch advocacy videos and view the advocacy toolkit