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Wednesday Jun 19, 2019

My Message to Students: Why Family Medicine Matters

I have been working in health care since I was a teenager, but I didn't initially plan to be a primary care physician. In fact, it was an interest in surgery that led me to medical school. In retrospect, I have found family medicine to be the embodiment of everything I ever thought life as a physician should be, but not necessarily what I thought it would be.

[feet in front of three arrows]

I didn't consider family medicine, at first, because I lacked insight into the variable lifestyle and broad flexibility of the field. I was also intimidated by the thought that primary care was so general that it required an immense knowledge base. Conversely, I felt that surgery was so tactile and specialized that I could develop proficiency in a few technical procedures which I could spend the rest of my career perfecting. I later discovered that the complexity of family practice is what gives it its intrigue, and the skill required to navigate the field is what makes it an art. The broad scope of the specialty makes it possible for a physician to find a niche that fits his or her unique needs and practice style.

Some students are drawn to primary care and get connected to family medicine early, or they might find their calling at an event like the National Conference of Family Medicine Residents and Medical Students. That wasn't me. In fact, I was somewhat late to the game. So, here's what I wish I could say to every first-year student to ensure they don't miss the opportunity to have the best job ever, which I realize -- six years into practice -- I have now.

I love what I do, and that makes all the difference in the world. Patients can see it, and many have become dear friends. This week, in addition to receiving a couple of thank you notes, I was hugged by two patients. One was an elderly man I consoled after he lost his son in an accident, the other was a patient I helped counsel through a complex medical decision.

Like most weeks practicing in rural southwest Missouri, I performed a small lesion removal, managed multiple diabetics, optimized asthma and COPD therapies for a number of patients, treated many cases of hypertension, ruled out a couple DVTs, treated a few individuals with behavioral and mood disorders, managed complex pain, treated A-fib and CHF, rounded at a nursing home and saw patients at an addiction recovery center. I did all this while collaborating with four midlevel providers who assist me in providing coverage in the nursing home, urgent care and addiction center.

During a different week, I might be traveling to meet with state representatives or to give a talk to a local organization or physician group about treating alcoholism and opioid dependence in primary care. Despite a busy practice, I find I have the time I need to spend with my wife and our growing family.

So how did I get here? No one told me this could be my future. It was not until my core rotation in family medicine as a third-year medical student that I discovered how diverse, interesting and fulfilling the life of a family physician could be. It's worth noting that not every student is required to do a family medicine clerkship (just "primary care"). Getting the right exposure to a specialty in medical school is critical to making decisions regarding the next step in in our training. What if I had missed that experience?

Prior to that rotation, my idea of life as a family physician was one of long hours traipsing between house calls, setting broken bones and responding to distress calls from worried moms in the dead of winter. Of course, it's possible that I watched too many episodes of "Dr. Quinn, Medicine Woman" as a kid.

It's not to say that couldn't be the chosen reality of some other family doc, but I just couldn't imagine spending all those years of school and end up isolated, under-resourced and poorly paid. Happily, I have found family medicine to be surprisingly adaptable and immensely rewarding, both financially and as a career path.

I believe family medicine is the heart and soul of the medical field. It encompasses pieces of all the specialties and is the doorway by which many patients get more specialized care. Before we had specialists, we had general physicians who delivered broad-scope medical care. Everything we know about medicine was built on the shoulders of generalists who paved the way for more highly personalized practice.

To me, family practice goes beyond primary care for the individual. It's about relationships and caring for entire families across multiple generations. It's more than a medical science. There is an art to good bedside manner, to instilling hope, to building confidence, to providing comfort, to educating, to giving counsel and to inspiring change while tailoring treatment plans that are best suited to the patient.

As family doctors, we provide something intangible and unquantifiable, which subspecialists cannot match, nor can algorithms or protocols replace. We are the consummate physicians, deftly navigating the full breadth of the health care system, incorporating expertise from all the various specialties into our daily clinical repertoire. We are eager to learn and many of us strive to expand our scope of practice, but we are comfortable with what we don't know and are always ready and willing to consult with subspecialists or refer if needed.

We are family physicians. We are the friendly local docs who become like members of your own family. We are the cornerstone of the medical home. May we always remain at the heart of primary care, bringing highly integrated comprehensive health care and preventive medicine to the modern age.

If you are like me and know you made the right choice, consider precepting students in your own practice. Never forget the importance of what we do for our communities as family physicians and what it can mean for students to see it.

Kurt Bravata, M.D., is a family physician who practices primary care, geriatric medicine and addiction recovery in rural southwest Missouri.

Read other Fresh Perspectives posts by this blogger.

Posted at 01:25PM Jun 19, 2019 by Kurt Bravata, M.D.

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