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Monday Jul 03, 2017

Mixed Emotions: Reflections on Finishing Residency

Today, as I write this, is my last day of residency. For the past three years, I have lived and worked in Washington Heights, a neighborhood in northern Manhattan. The population is largely Spanish-speaking, and many of the community's residents are originally from the Dominican Republic. I am now more familiar with the latest reggaeton or Latin pop that I hear on the streets than I am with mainstream American pop music.

Standard features of my daily walk to and from our residency practice include passing by the apartment supers washing the sidewalks in the morning, and men playing dominoes across from the Dominican restaurants in the evenings. The sights, sounds and smells of Washington Heights foster a sense of community, which is what drew me to my residency program in the first place.

Here I am (far left) on graduation day with Columbia University/NewYork-Presbyterian Family Medicine Residency classmates (from left) Quang Huynh, M.D.; Lara Harisay, M.D.; Elyceia Dortch, M.D.; David Jang, M.D., and Sharon Chacko, M.D.

The patients at our family medicine health center represent a cross-section of the rich and vibrant neighborhood. On any given day, I see familiar faces when I walk into the waiting room: the mother of the baby I delivered, the elderly patient whose home I visited after her hip fracture, the man whose A1c just won't come down, and the 9-year-old girl who loves telling me about her best friend. I see the security guard chatting with patients, the medical assistants hugging patients who are their close friends, and front desk receptionists greeting people they have known for years. Many patients insist on seeing their primary doctors, who often are faculty members who have practiced here for 20 years.

It took me a year and a half to get used to residency. Intern year was a steep learning curve with lots of emotional ups and downs. There was little time for personal life, and almost all learning was experiential.

During my second year, I finally got the hang of outpatient medicine, trying to see patients within 20 minutes, following up on labs, forms, and keeping up with coordination of care. Through my patient encounters, I felt myself becoming a real physician. I developed my own independence and self-worth in my practice of medicine. Medical school taught me the science of medicine, faculty members and my preceptors in residency taught me the value of the patient encounter, but it was my patients who made me a doctor.

I started telling patients that I was leaving the practice about five months before graduation. I wanted both me and my patients to have enough time to adjust to the idea that there would be a transition of care to a new physician. I have worked with many of my patients for the entire three years, and I was concerned that they might feel abandoned.

About a month ago, I started to worry that I had done them a disservice by developing such a strong relationship with them when I knew that relationship would be relatively short. I admit, there's ego involved in that statement; after all, being a patient at a residency clinic means knowing that doctors will leave when their training is completed.

Actually, it was me who needed to start processing the change early. I looked forward to the opportunity to practice independently, but I didn't want to lose the comfort of having a preceptor. I was used to the way things functioned at our practice, regardless of how hectic things were on a day-to-day basis. I needed time to prepare for the fact that I would miss every one of my patients, even the more challenging ones.

Over the course of our third year, my classmates and I applied to fellowships, started our job search, applied for licenses, took our board exams, finished our research projects, and started planning for our eventual entry into the real world. We had our graduation celebration a few days ago. Today, the last day of residency, has arrived without much fanfare. Signing out patients to the rising second-year residents, sometimes with strict followup instructions, has been a bittersweet experience, like a child letting go of her mother's hand. 

Residency is an amazing and enriching time because of the bonds we form with all those who teach us: our mentors, our co-residents, and -- most importantly -- our patients.

Lalita Abhyankar, M.D., M.H.S., is a family physician practicing in New York City. You can follow her on Twitter @L_Abhyankar(twitter.com)

Posted at 03:02PM Jul 03, 2017 by Lalita Abhyankar, MD, MHS

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