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Tuesday May 19, 2020

Pandemic Shows Intern the Power of Family Medicine

As a medical student, I was drawn to family medicine for its spirit of innovation, adaptability and willingness to take in stride anything that walks through the door. I wanted to be the type of doctor who valued and considered the role of public health, working to create and play an integral role in a strong and equitable health system. I wanted to be broadly trained, able to bend my scope of practice to fit the needs of my patient population.

[resident face mask blue light]

Jordan Hoese, M.D., M.P.H.

I was told by lots of folks in medical school that this was naive and idealistic. In our system of market-driven health care and increasing specialization, they said, that type of medicine and approach to health either didn't exist anymore or never could.

Fortunately, despite going to medical school in a major metropolitan area, I met family medicine mentors and role models who assured me that what I envisioned is, indeed, possible. And now, as a family medicine resident in the midst of the COVID-19 pandemic, I am happy to report that the spirit of family medicine is not only alive and well out here in the real world, it's also supremely well suited to meet the ever-changing needs of communities during a crisis.

Here in Klamath Falls, Ore., our local health care community is primarily composed of rural family docs, who on any given day can be found working in our primary care clinics, the ER, the ICU, labor and delivery, the operating rooms, the medicine and pediatric floors, our public health department, our top hospital leadership positions, and a variety of community-based health-oriented organizations. Although there's plenty of space for a full-scope family doctor in more urban settings (as my medical school mentors showed me!), I chose to train in a smaller, more rural community. I not only wanted experience practicing broadly in a setting with limited resources, I also wanted to have ample opportunities to get involved and learn how to effect systemic change at a local level. When I visited here for the first time, it was obvious that these family doctors, including the residents, had their fingers in every pie, helping to create and staff a strong, accessible and cogent local health infrastructure. I wanted to be a part of this community … little did I know my intern year would be an initiation like no other.

From the early days of this pandemic, family doctors throughout our health system had task forces in every department coming up with ways to decrease community and workplace exposures, preserve healthy workforces, and continue access to quality health care delivery across a spectrum of settings and needs. And residents have been involved every step of the way in the design, implementation and ongoing monitoring and evaluation of each of our areas of pandemic response. It is not unusual for us to be so involved; our family medicine residents (and faculty!) are such a major part of the local health care workforce here that we are treated like colleagues, and we feel the responsibility to our community that comes with that title and role.

As examples, we've had a designated, quarantined flu-testing site since February -- long before actual COVID-19 testing was available -- where patients with respiratory symptoms could go get ruled out for the flu without putting others at risk and receive targeted advice based on their results. We've had designated COVID-19 units and workflows in our hospitals and clinics alike, and our residency and other clinics integrated telemedicine and phone visits seemingly without batting an eye. For weeks, we have had a designated COVID-19 phone pool, staffed mostly by residents, for triaging symptoms, ordering tests, interpreting results and providing guidance to members of our community.

Perhaps most importantly, and thanks to the tireless efforts of our local family doctors and residents, we had early and widespread access to COVID-19 testing in both inpatient and outpatient settings. We had drive-through testing in March, and by early April, you didn't even need a physician order -- anybody could be screened to see if they were an asymptomatic carrier. We've also been antibody-testing our staff and the general community for several weeks now, and ours was one of the first hospital systems in the country to roll this out. At the time of this writing, our rural county leads our state in per capita testing, all thanks to the hard work of our local health care community, including a whole lot of family medicine doctors.

So many of the core tenets of family medicine lend themselves to a robust pandemic response -- comprehensiveness, coordination, collaboration, contact and even continuity. As a resident, I can speak on the phone to a patient about a COVID-19 result, have a telemedicine visit with them, and see the ripple effects of their illness and exposures on the community as they and the people they know have contact with our health infrastructure, whether that's at the health department or in our ERs or the ICU.

Of course, it takes a village, and to suggest that our local community's success in preparing for and responding to this pandemic was only the work of family doctors would be to ignore the hard work of our colleagues in other specialties (especially those working in the ER and ICU), the community and support staff. But disrupting health systems takes creativity and flexibility, and I'd like to think that the reason we are all able to work together so beautifully is because of the local culture of innovation our family doctors are brought up in and have continued to build for years and the tone they set daily by bringing all they have to the table to do what's right for the patients and population they serve.

My training and education have been disrupted in multiple ways as we respond to this pandemic. But as I consider what I was looking for a year ago, as a fourth-year medical student on the cusp of training as a rural comprehensivist, I realize I am learning every day from very real examples of how to be exactly the type of adaptable, community-oriented doctor I want to be. And for that, I am so proud and grateful.

Jordan Hoese, M.D., M.P.H. is a first-year resident at Cascades East, Oregon Health & Science University's rural family medicine residency. She is passionate about providing comprehensive care in low-resource settings and the role of family medicine in building strong and equitable health systems. When she's not at work, you can find her running, hiking, raising chickens, cooking plant-based meals, posting pictures of her cats on the internet, or on Instagram(www.instagram.com) or Twitter @drjordhoes.(twitter.com)

Posted at 04:39PM May 19, 2020 by Jordan Hoese, M.D., M.P.H.

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