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Friday Sep 01, 2017

A New Intern's Reflections From the ICU

As a fresh intern, only a few months removed from my short white coat and medical student bubble, I have already experienced quite a range of emotions. And, in an effort to develop effective wellness habits as a resident, I have tried to make a concerted effort to spend time actively reflecting on each day during my hourlong commute home.  

[Chalkboard showing an EKG tracing that culminates in a pink heart drawing]

As family physicians tend to do, I often feel deeply invested in the "whole package" of health and wellness for my patients. Because I work in a predominantly low-income, urban community, empowering my patients to achieve that whole package can be challenging. What has become abundantly clear through my daily reflections is the essential role a longitudinal relationship with a family physician plays in helping people heal and stay well. I always felt that I understood this concept well as a medical student, which is why I chose a career in family medicine. However, one month of clinic and long days in the ICU have given me a deeper appreciation for the value family physicians provide at all levels of patient care.

One of our greatest strengths as family doctors is our ability to approach patient care through a holistic lens. There are certainly many political and administrative roadblocks to providing this type of care, but it remains a significant part of our vocational identity and sets us apart from our subspecialty colleagues. It allows us to avoid mere Band-Aid solutions to medical problems that are fundamentally rooted in psychological factors and social circumstances. I have learned that this is just as true in the ICU as it is in the outpatient setting. Acute management of common issues such as substance dependence, gun violence, mental illness, domestic violence, sexual abuse, and elder abuse and neglect should not always be limited to administering IV antibiotics, weaning pressors, and ventilator management. There is no doubt that psychosocial factors can put patients in the ICU as well as prolong their length of stay, and ignoring this reality is a symptom of the overarching malady in our country that places an emphasis on sick care rather than on health care. Family physicians are an important part of the remedy for this problem, and we have unique perspectives to share with our colleagues in the intensive care setting.

From the clinic to the ICU, we have so much that we can offer patients that can't be accomplished through an order in the electronic medical record, such as guiding post-extubation breathing exercises at the bedside of a traumatized patient admitted to the ICU after sexual assault. Or reassuring an embarrassed patient who soiled herself after a GI bleed that she does not need to feel ashamed for being sick. Or listening to a patient in clinic describe his experience with depression and seeing his visible sense of relief when reassuring him that feeling sad is not his fault. Simple, humanistic actions that promote a patient's sense of well-being are just as real and physiological as the subcutaneous heparin they received for deep venous thrombosis prophylaxis that day. These actions should not be dismissed as the exclusive territory of family medicine; rather, as family physicians, we can be leaders in helping our colleagues in all specialties recognize the value of relating to patients and to one another on a purely human level.

Some days, my reflection on the ride home is tearful, some days I feel incredibly frustrated, and some days I feel joyful with a sense of accomplishment. I hope that this simple exercise helps me to process what I learn, to be mindful of why I chose this career path, to stay motivated as a patient advocate, and above all, to remain human.

Lauren Abdul-Majeed, M.D., M.P.H., is the student member of the AAFP Board of Directors.  

Posted at 05:03PM Sep 01, 2017 by Lauren Abdul-Majeed, M.D., M.P.H.

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