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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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.