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Tuesday Aug 01, 2017

FPs Are at Center of Birth, Death and Everything in Between

The circle of life isn't just the name of a song from an animated movie. As family physicians, we are key observers and participants in this life cycle of our patients. I reflected on this during a particularly hectic day in my practice recently and came to the conclusion that I'm right in the middle of this circle. 

[Silhouettes of female figures aging from infant to elderly woman]

I went to work early to deliver my patient's first baby, starting a new chapter in this family's life. The mood in the room was joyous. It was a huge step in the lives of the new parents, and, of course, the entry of a new life into the world.

Unfortunately, the next thing I had to do was go to another hospital room to tell one of my favorite patients that his painless jaundice was due to a large lump in his pancreas, likely pancreatic cancer.

We discussed the ramifications, the treatment options and the life-changing issues involved with his diagnosis. His wife, a nurse, was shaken but understood what likely would happen next. She will help with the decision-making and be a great support to him.

Somehow, she kept thanking me. For what, I thought, a bad diagnosis? It was another big moment in the circle of life.

Next I was off to the clinic, where I had a sports physical waiting for me. Fourteen-year-old boys don't freely come to the doctor, so this was a golden opportunity to not only prepare him for safe sports participation, but also to discuss important issues for teens: depression, sexuality, substance abuse, school performance and home relationships.

It is yet another important life stage where the right care from physicians and good decisions by patients can have long-lasting effects.

Then I met with a woman who was trying to improve her diabetes and blood pressure while preparing for retirement. Although she thought she might have more time to work on her health, she wasn't sure about the future, including financial changes and family adjustments.

Based on her past successes, we decided she likely will do well with any future challenges and stressed all the things she has been looking forward to doing in retirement.

After a few well-child checks and chronic disease management visits, I saw one of my longtime patients who is oxygen-dependent from pulmonary fibrosis. He didn't have a living will or a durable power of attorney, so we discussed end-of-life care. He told me he never wants to be on a ventilator but was OK with other types of resuscitation. We made a plan for him to see a lawyer and to grant his wife power of attorney.

Family physicians, because of our scope of practice, are blessed and humbled by being present at such important points in the life cycles of our patients. These transition points give us great opportunities to impact their health and happiness.

The circle goes on, but it isn't only about my patients. I have talked with our residents about the transition from medical school to being an intern, and we agreed that this time is critical in their professional development.

There is a circle in the practice of medicine, as well. We cycle from med school to residency to early practice to being an experienced clinician before perhaps scaling back prior to retirement. We should give back to our profession and help others with their transitions along our way.

Robert Raspa, M.D., is a member of the AAFP Board of Directors.

Posted at 02:43PM Aug 01, 2017 by Robert Raspa, M.D.

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