To My Fellow Introverts at STFM Conferences

2016 Sonya Shipley Head Shot

Sonya Shipley, MD

Furtive glance on the elevator whispers, “I see you.  I know you.  I am you, and I am glad that you are here.” Your mutual silence is comforting to my decidedly stimulated brain.  I see you artfully arranged on strategically placed couches with your noise canceling headphones in place. I am, admittedly, a little envious of your first claim of right to the couch. Though there is ample room for another body, I dare not interrupt your solitude.  I respect your space; your battery is recharging.

The elephant in the room, albeit an often very quiet elephant, is the introvert. But, I see you soaking in the new angles of old information and familiar angles of the new.  I hear your thoughtful probing of the presenters, and I can see the speed of your mind formulating unheard of combinations of inquiry. I see your new ideas, your new projects, your new plans; your newness. I, too, have claimed this newness.  This new invigoration, this new energy, this new resolve, this new commitment. The kind of newness that is only barely adequately described by sentence fragments because it defies and even mocks correct grammar and syntax.  It just IS.  And it IS comfortable in its own skin & its own presence.

We are basking in this new. We have quietly recommitted ourselves to this weighty mission and the ideals of family medicine. We are doing whatever it takes. We are stepping out of our comfort zones—putting ourselves out there. We are taking to heart the lessons of the day.  

To the presenters of the writing session, I heard you. We all heard you. I am bettered by your take home message; someone somewhere always wants to listen—needs to hear.

To my fellow introverts, thank you for bringing your offerings to the table. Thank you for the caffeine you ingested and the brief sojourns into the sunshine and the corners that you occupied in the name of recharging. Though I do not know all of your names, I saw you. I know that you will all go home and earn Tomatoes (especially, my new east coast friend who inspired this turn of phrase). Tomatoes, you say?  Yes, Tomatoes.  From the grateful patients who will bring you the work of their hands—these treasures born of gratitude—for the work that you will do.

Family Medicine Residents Are Underutilized Resources for Quality Improvement

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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.

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Exercise Your Empathy

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“All advocacy is, at its core, an exercise in empathy.”

—Samantha Power, Former US Ambassador to United Nations, Penn Commencement Address 2015.

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Joseph W. Gravel, Jr, MD

On the day The Society was officially born, on Friday October 27, 1967, I was in Miss Steinman’s second grade class at the Samuel Huntington Elementary School in Norwich, Connecticut focusing on my penmanship that would later be destroyed by 4 years of medical school.

Two weeks earlier our “Impossible Dream” Red Sox, a perennial doormat who had finished in 9th place the previous 2 years, had lost Game 7 of the World Series to the St Louis Cardinals after winning the American League pennant. This followed a summer of massive urban riots, particularly in Newark (23 killed, more than 1100 wounded) and Detroit (43 killed, 1189 injured). Catholic priest Philip Berrigan was arrested on the same day as STFM’s founding (10/27/67) with other members of the “Baltimore Four” for pouring blood on Selective Service records to protest the Vietnam War.  That week’s Time magazine cover showed marchers at the Lincoln Memorial with the headline banner “Protest! Protest! Protest! Protest! A Week of Antiwar Demonstrations” after 70,000 had marched. The #1 song on the Billboard charts was “To Sir With Love” by Lulu (from the film of the same name) about an African American teacher (Sidney Poitier) dealing with social and racial issues while inspiring students in a rough East End of London school. The Andy Griffith show was the top-rated TV show on our black and white (with a rabbit ears antenna) Philco television with three channels (and no remote, kids!). Three of the most popular movies in 1967 were “The Graduate”, “Guess Who’s Coming to Dinner” and “Bonnie and Clyde.” Twenty-year-old Syracuse student Katherine Switzer, registering as “KV Switzer” became the first woman to officially run in the Boston Marathon; during which the co-director jumped into the street and tried to forcibly remove her from the race and subsequently disqualified her.  

It was in this milieu of protest, advocacy, and social change that family medicine and The Society was born. The timing of STFM’s founding 50 years ago was by no means coincidental, but part of a larger tapestry. To me, STFM has always excelled more than other academic organizations at operationalizing what Rudolph Virchow described as “physicians (being) natural attorneys of the poor”.  This also includes, to STFM’s credit, a rich diversity of professional disciplines integrally involved with teaching family physicians.

There has always been a palpable sense of taking our collective social accountability seriously, activating an underlying STFM culture of realistic idealism working to “transform health care through education.” Developing excellent teachers in an unusually supportive, collegial environment has made STFM the envy of other specialties.

Although we look back during this gold anniversary year, STFM has always been much more future oriented—empowering learners to create a better health system and world through our shared values, put into action every day. STFM embodies the Olympic motto of Citius, Altius, Fortius—faster, higher, stronger—allowing us to exceed our own individual abilities by being supported by our colleagues, and without all the cost overruns of an Olympic Games!

Like the 1967 Red Sox, who had a fantastic season but came up one game short, we all know we haven’t gotten “there” yet eitherthere is still a lot of work to do to make those STFM ideals become reality for all our patients, families, and communities.

Our continued advocacy—speaking truth to power on behalf of those without a voice—which increasingly includes America’s middle class- and leveling the playing field through the best possible (primary care- based) health care, is needed now more than ever. Exercise your empathy and be an advocate!