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Wednesday Jan 03, 2018

Being a Family Physician Requires 'Courageous' Commitment

The arrival of the new year inspires us to look forward to the future and reflect on our past accomplishments. While reviewing some end-of-the-year archives, I came across a lecture I did for a local group of health care professionals titled "Seeing Your Own Blind Spots."

[compass pointing to commitment]

I recalled researching the topic to prepare and stumbling across a quote attributed to a Maori writer named Hiwi Tauroa that defined a word I had never previously heard: aroha. Tauroa noted that the word, when expressed properly, imposed a commitment of a relationship with all people with whom one has contact.

"Aroha was a commitment," he wrote. "It was challenging commitment. To express it to its fullest required courage. It would require hard work to develop this particular kind of relationship and to express it to all people at all times."

Those of you who still have access to the personal statement you wrote for medical school or residency may want to retrieve it before reading any further. If you don't still have it, I am certain you still recall some of the thoughts you shared in it about why you wanted to become a physician. During my decade of service as associate dean of student affairs and admissions for the Wright State University Boonshoft School of Medicine, I have read hundreds of applicants' personal statements. Most contain one common element: a desire to make a difference in the life of others. Basically, what the writers are detailing is their personal ambition to achieve aroha by becoming a doctor of medicine.

If you were able to reread or recall your medical school or residency application personal statement, it likely validates the reason you chose the specialty of family medicine as your professional vocation. We each sought aroha by our commitment to valuing longitudinal professional relationships with our patients, their families and the society in which they live. Unlike any other medical specialty, the intellectual bedrock of family medicine is the concept of establishing aroha with the patient's entire family and the population health dynamic in which they exist.

Before the specialty of family practice was established in 1969, Gayle Stephens, M.D., wrote several essays defining what it meant to be a family physician. In his landmark publication The Intellectual Basis of Family Practice,(www.aafpfoundation.org) Stephens wrote that he saw the family physician as a "drug" and postulated, "It is necessary for the physician to learn how to use himself and his relationships."

These are two intangible medical instruments family physicians use with every patient, across their practices. And they are what make our jobs the best in medicine.

As you reflect on the youthful ideals and ambitions that led you to the specialty of family medicine, ask yourself if you have learned how to truly use the full extent of both your personal capabilities and the professional relationships you have garnered throughout the years. As I watch each student progress though their years of rigorous medical education training, it becomes evident which among them possess an enduring spirit of courageous aroha. They tend to be the class leaders -- not for notoriety, but because they selflessly want to make a positive difference in the lives of their peers and their school. For example, they might serve as officers of the campus family medicine interest group.  

They envision the big picture of how strategic preventive medical interventions throughout the human lifecycle are the mainstay of public health. They do not fear the challenges or ambiguity of providing continuous personal medical care. They are not drawn to the enticement of single-organ-system-based subspecialties or the allure of convenient, short-term medical interventions.

Whether you were aware of aroha or not, each family physician reading this message initially possessed the internal courage to become the socially conscious "drug" that Stephens wrote about more than 50 years ago. You were willing to do the hard work of developing enduring professional relationships with a diverse community of patients. You took on the onerous challenge of truly caring for the health of our public.

Tauroa described aroha as being "exciting, but very, very exhausting." We see excitement in the eyes of our residents and students who attend the AAFP's National Conference of Family Medicine Residents and Medical Students. Each year, attendance grows as word spreads about the wealth of career- and life-enhancing opportunities available at this event.

In contrast, many of us who have toiled in the trenches of medical practice for years feel dissatisfaction with the inability of our health care system to care for the large number of patients who remain underserved. U.S. family physicians provide 193 million patient visits each year, yet more FPs are needed.

Making a difference in the life of so many is an exciting prospect, but it is an exhausting journey. The burnout we experience in primary care is in part due to the enduring flame burning within us that seeks constant verification that we are making a difference. The same relevance and value of the specialty we saw so clearly in our youth is dimmed by the exhausting task of attempting to be the heroes and heroines of medicine in our respective communities.

Sometime this month, take time to rewrite your professional personal statement. Be certain to include intentional verbiage regarding how you will use yourself as a tool to balance your personal and professional ambitions. Also articulate how you will create paths of professional life excellence others will seek to emulate. Use your knowledge gleaned from a lifetime of human relationships as a professional accelerant to light the symbolic torch of the AAFP so that others will see our specialty's intrinsic value more vividly.

The excitement that once brightly shined within your spirit continues to be fueled by aroha. Do not allow it to prematurely be extinguished by the darkness of professional burnout. Instead refocus it to illuminate your own professional blind spots and to reveal grander opportunities for the future.

Carrying the torch of aroha high is exhausting, but it is worth the effort if we use it to solve the perplexing problems of today and pass a better tomorrow on to our next generation of family physicians committed to making a difference for all.

Gary LeRoy, M.D., is a member of the AAFP Board of Directors.

Posted at 12:53PM Jan 03, 2018 by Gary LeRoy, M.D.

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