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.
Whitney LeFevre, MD
During most of my adult life, I’ve felt called to help close the achievement gap that exists in our country. So I deferred medical school to teach middle school math and science in inner city Baltimore with Teach For America. During my 2 years of teaching, I found that while I loved my students and I loved teaching them algebra and life sciences, I felt called back into the field of medicine. I saw that the best way for me to close the achievement gap was to return to medicine to find ways to address the many social determinants of health that kept my students from success.
In medical school, I was the education director for the MedZou Student-Run Free Clinic. The clinic both teaches medical students the joys of primary care and provides health care to the uninsured. My time at MedZou not only inspired me to become a family physician but also gave me the opportunity to create new programs to teach medical students while providing quality care to those in need. It’s at this intersection—the intersection of helping those in need while also stimulating medical students to be future family doctors for the underserved—where I truly feel I am able to fulfill my calling to close the achievement gap in our country.
In residency, I worked in an urban underserved environment with a predominantly Spanish-speaking population. Our patients had many social issues, including homelessness, addiction, food instability—the list goes on. In a place of great need like Lawrence, MA, I was motivated by how much family medicine was valued there. My patients deserved doctors who are full-spectrum trained and committed to quality, access, and patient-centeredness. And that’s what they got.
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.