Victoria Boggiano, a fourth-year medical student at Stanford University School of Medicine in Stanford, Calif., and co-chair of the AAFP's 2018 National Conference of Family Medicine Residents and Students, recently visited with AAFP News about why she has decided to pursue family medicine residency training.
Q: What did you know about family medicine before you entered medical school?
A: Growing up, I knew what it was like to be in a family of doctors -- my parents both are psychiatrists -- but that didn't teach me anything about primary care. I didn't know the difference between a pediatrician and a family medicine doctor.
The most eye-opening experience I had was through AmeriCorps the year before medical school, serving in a federally qualified health center in Prince George's County in Maryland. I was a case manager and got to work alongside a lot of family docs, and that's when I got to see the amazing breadth and depth of the specialty.
The clinic was in a health care desert, and lots of people didn't have regular health care. In broad terms, it was FPs, OB/Gyns and NPs caring for patients. But I found myself watching what the family doctors were doing, and I thought, "That's so cool; they get to do so much." The experience helped me learn a lot about the field.
Q: Stanford does not have a department of family medicine, so what family medicine experiences has Stanford provided you?
A: I feel like sometimes we get extremely lucky in life. I took a research course at the beginning of the first year of medical school and got linked up with Erika Schillinger, M.D., (an AAFP member from Woodside, Calif.) one of the most amazing family doctors ever, and she's here at Stanford.
She had this project looking at medical student reflections on their experiences in their family medicine core clerkships, and it was very transformative for me. I got to see what Stanford family medicine was about early on because right from the get-go, I was hooked up with a family medicine research project.
Q: How have you changed hearts and minds at Stanford?
A: People like Dr. Schillinger and some of the other really strong, present and vocal family medicine doctors here have helped to change my heart and mind. I aspire to be that kind of family medicine advocate. I've learned so much by seeing what they do. If I've been able to change any minds, it's been because of them.
Q: What would you say to other medical students who want to learn more about family medicine but don't have a family medicine department or have a less-than-robust department at their medical school?
A: Something I did starting my first year was to find amazing mentors. My mentors embody what it is I care about in this field and about health care and in life. I continue to try to do as much as I can with them.
Through them, I began to develop my own network. You don't need a family medicine department to be able to do that; every school is going to have strong family medicine doctors doing something at the school or in the community. Once you start to find them, don't let them go!
Q: What is it about family medicine that you find so compelling?
A: Literally, in every single rotation I think, "This is the most amazing thing." I'm on emergency medicine right now and I'm obsessed with it. As a family medicine resident, I'll do some shifts in the ED, and I will do some shifts in pediatrics and OB. Family medicine has a lot of variety, which is a good thing for all of us who like to bounce around and learn a lot about different things.
When I spend the day with a family medicine doctor, we're putting in an IUD, seeing a 5-day-old newborn, and counseling a 90-year-old about her medication list -- it's just so exciting.
On my emergency medicine rotation, it breaks my heart that I'm never going to see most of those people again. I'm with them for six hours in the ED, and it's very personal, it's very intense and then they go home or they get admitted. With family medicine, I'll have patients that I know I'll be seeing for a long time.
STORY CONTINUES BELOW
Q: Tell me about a patient encounter that left you thinking, "Wow -- now that's family medicine."
A: Two months ago, I was working on the inpatient side of the institution where I did my family medicine subinternship, and I got to see a lot more of what it's like to have that "cross talk" between inpatient and outpatient family medicine.
We have patients seen in the outpatient clinic who are referred to the inpatient clinic. One particular patient was having difficulty breathing and experiencing back pain. She was diagnosed with lung cancer, and the way the family medicine inpatient team thought about her care was really powerful.
It wasn't just her cancer and her treatment, or the fact that she needed chemotherapy and radiation. The team thought holistically about how to keep her pain under control and how she was going to be able to take care of her kids. All these other things that went beyond her having cancer and really thinking about her as a whole person.
Q: If a stranger asked you to define family medicine, what would you say?
A: When I think about what I want to be as a family doctor, I want to be reliable, present, consistent and creative. Those are all words that apply to the field of family medicine. It's care that stays with patients in a really positive way throughout whatever health care crisis or challenge or question they might be facing regardless of their age.
Q: Where do you see yourself in 10 years?
A: I've been thinking about this a lot as I think about residency and postresidency. I see myself practicing in a community setting but still being connected to an academic institution and still doing research. I've done a lot of work in Vietnam, and I'm very interested in watching the health care infrastructure in Vietnam continue to develop. I want to continue to do primary care research there, as well. Family medicine lets you do really unique global health work.
Most of all, I hope 10 years from now I have some patients I know really well and who know me. I hope we have lots of those physician-patient relationships that I covet so much.
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