Kathryn Freeman, MD
This past spring, I consciously moved away from learning clinical skills and spent time at two conferences: the National Medical Legal Partnership Conference, and the Family Medicine Advocacy Summit. There, instead of learning about medicine, I learned about stories.
When I reflect on what I learned in medical school, it was all about taking a patient story and converting it into a formal presentation. We spend years training our residents to boil down a patient’s history into discrete facts in a defined structure, using medical terminology to convey a message that only other physicians can understand. But that only allows us to communicate with each other, not with the world around us, or with the people, partners, groups, and leaders who have the potential to make a larger impact our patients’ health.
Dan Nguyen, MD
I think it’s time for family medicine to rock the boat. Family physicians, and especially family medicine residents, are uniquely qualified to promote quality improvement by standardizing patient care processes.
As a family medicine intern at an urban academic institution, these past 6 months have been a blur of rotations. Every 4 weeks, we start a new service and drink from a fire-hose of learning the intricacies of “how-to-be-a resident.” Our intern training is the most diverse; we rotate through inpatient services in OBGYN, pediatrics, family medicine, internal medicine, general surgery, intensive care, and the emergency department.
For inpatient services, there are common tasks that all residents perform. We answer pages, place admission orders, write progress notes, discharge patients, sign-out the patient lists, etc. We have access to the same electronic medical record, the same resources, and are unified by an academic institution.
What dawned on me is that every service seems to coordinate patient care completely differently. Every 4 weeks, I would re-learn how to do the same types of tasks but with different methodology. The most glaring disparities I noticed were in how different services handle transitions of care, especially patient sign-out.
Kathleen Rowland, MD, MS
Change is here, and more is coming. In medicine, we often perceive change, especially external change from hospital systems or payers, to be a threat. We feel a loss of control, which can lead to anger, resentment, and burnout.1 A survey of 3,000 US physicians done by a staffing company found that 58% of physicians who left medicine in 2013 reported doing so because they didn’t want to practice in an era of health care reform. This is more than stated they left because of economic factors such as malpractice insurance or reimbursement concerns (50%).2 The changes we face can feel overwhelming, and we have to take measures to make the changes less daunting.
Being resilient does not mean that we become pushovers. The goal of teaching resilience to change is to increase the sense that we are able to react to, triage, and adapt to changes while maintaining the core of who we are: physician teachers and healers. We can fight unwinnable battles or choose good ones. We can hold out on changing until the demand to do so is punitive, or we can adopt the change at a comfortable pace. We often do not choose the changes we face, but can choose the way we respond. As we restore that independence, we can reduce our risk of burnout and increase our satisfaction with practice.