Diary of a Family Physician

I arrive at my integrative medicine clinic at an academic institution, and I am greeted by two eager medical students.

We see a new patient with IBS-D. We review her history and discuss diet, the gut microbiome, and gut-brain interaction. We develop an integrative plan that includes rifaximin, a low-FODMAP diet, and gut-directed hypnotherapy. She expresses gratitude for a whole-person approach.

I shift from clinician to patient for my own doctor's appointment—my fifth in 2 weeks. A colleague kindly sees me during lunch, so I don't have to cancel my own patients. The weight of living with a chronic illness while caring for others feels heavy today. I take a moment to ground myself with diaphragmatic breathing in preparation for a busy primary care clinic.

My next patient is a teenager with lupus. She has worsening migraines after starting mycophenolate mofetil. I coordinate care between her rheumatologist and neurologist. She is attending college in a region with limited specialty care, and we work to develop a plan that allows her to focus on her studies.

I see a patient who was in the emergency department for syncope. She arrives with postconcussive symptoms and anxiety. I order an event monitor and echocardiography. I also increase the dosage of her SSRI. After our visit, I introduce her to our integrated behavioral health care professional.

I arrive home, reflect on my day, and search for balance. My daughter waves from the window. I open the door, leave the day behind, and embrace this opportunity for joy.

My alarm rings, and I start my day with 30 minutes of cycling to help clear my mind. I remind myself of the role model I want to be for my patients and residents.

I arrive at the hospital. After I review charts, I walk to the nursery to discuss the risks and benefits of elective circumcisions with parents who are skeptical of the procedure.

I meet with residents for checkout and choose a topic to discuss; today we review the difference between hyperactive and hypoactive delirium and how to manage them. I love watching my residents learn and grow as hospitalists.

I walk into my next patient's room. He was admitted for acute paraplegia. MRI helps with the diagnosis: neuromyelitis optica spectrum disorder, a rare autoimmune disease with a poor prognosis. My heart sinks. I have a difficult conversation and deliver the news to him and his wife, both long-term patients of mine. It is a teaching moment for my residents. Continuity of care isn't just good medicine; it's what allows us to stand beside our patients through their most vulnerable moments.

The day is a blur of conversations and decisions about emergency department admissions, nurse calls, and coordinators planning discharges. Despite all the multitasking, we were able to perform a circumcision and triage a critical patient with sepsis.

I'm home at last. I cook dinner and settle into family time. I think about the patients I cared for, the residents I taught, and the lessons medicine offered me today. It's exhausting, but it's meaningful in ways I can't quite measure.