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The Road to Family Medicine

This blog post is a finalist in the STFM Blog Competition.

Jeanne Wigant, MD

Jeanne Wigant, MD

On the highway, en route to an important destination, you notice a sea of red before you. Traffic is at a standstill, and you reluctantly take your place in line. Glancing at the clock, then the line of cars inching along, the uneasiness in your stomach grows. Do you trust the GPS telling you to stay the course, or your instincts pulling you toward the next exit? This was exactly the scenario I found myself in 8 years ago. I was in the midst of a successful business career when I realized my desire to improve others’ lives as a physician was more important than any size salary or fancy corner office. I trusted my instincts, took the next exit, and walked away from everything I knew in favor of the unknown winding road before me.

Initially, the angst was distracting; I could only focus on the unfamiliar road itself. I involved myself with causes and positions that felt most comfortable coming from the business world but worried I was letting what seemed to be familiar ‘landmarks’ distract me from what my true route was intended to be. I was identified as a leader amongst my colleagues, university, and community, and was called upon to serve in numerous leadership capacities. It wasn’t until I began to appreciate how I could leverage this to call attention to issues I was passionate about that I realized what an invaluable trait this was for the future leader of a multidisciplinary healthcare team. I began to trust myself and could sense I was headed in the right direction.

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Why I Chose Family Medicine

 This blog post is a finalist in the STFM Blog Competition.

Mawusi Arnett, MD, MPH

Mawusi Arnett, MD, MPH

At the start of my internal medicine clerkship in medical school, I learned that I had inherited a “difficult patient.” He was 28 years old and had been admitted overnight for hypercalcemia and poorly-controlled sarcoidosis. During sign-out, the overnight resident shared that my “difficult patient”, Mr Johnson, was “non-compliant” with his medications and was threatening to leave against medical advice (AMA). Like a dutiful medical student, I shuffled to Mr Johnson’s room to check in before rounds. Maybe I’d gain some insight and garner some early-rotation good will, I thought. “You’ve done this before,” I reminded myself as I paused outside of room 1354. One swift, sharp breath to steel myself against…I wasn’t sure what. Two knocks and in: “Mr Johnson! I’m Student-Doctor Arnett. How are you this morning?”
Thirty minutes later, the story had shifted and I remember it like it was yesterday. I sat at Mr Johnson’s bedside while he sat slouched on the bed with his legs swung over the side. I don’t know whether it was his familiar eyes that turned down at the corners like my brothers’ or whether it was the pragmatism around the explanation of his life and choices, but I couldn’t for the life of me see Mr Johnson as “difficult.”
Had he skipped months of medications? Sure, but who wouldn’t if, like him, they were affordable. Had he missed his last several primary care and rheumatology visits? Absolutely, but with an understanding of his financial instability, how could he afford his copay? Had he asked to leave AMA before his calcium levels had normalized? “Definitely,” he stated calmly, “and I still plan to.” Mr Johnson shared that he essentially had two full-time jobs. Not only was he a home health aid, but he was also the primary caretaker of his bedridden mother. To complicate matters, his mother had advanced sarcoidosis and insulin-dependent diabetes complicated by kidney failure. If he stayed in the hospital overnight, not only could his home-bound clients miss out on care, but his mother would miss her meals and insulin doses.

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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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