“So what are you smoking for Christmas, Doc?” Those were the first words out of the mouth of one of my patients this morning. John (not his real name) has been my patient for more than 20 years, and he and I both have a shared love for smoking meat. I talked about my Thanksgiving smoked turkey; he talked about his smoked chuck-roast tacos. Back and forth we went for a few minutes until finally we moved on to his office visit.

I walked out of the exam room some 30 minutes later with what could best be described as an internal smile — a sense of satisfaction and accomplishment, an honoring of my commitment to medicine. It’s the exact opposite of what one physician recently described in an online family medicine forum: “I dread coming to work most mornings. I put on an act all day for patients and seem interested in how they are doing, but inside I really could not care less.”

This online stranger made my heart sink. They were experiencing burnout to a major degree.

THE REALITIES OF PRIMARY CARE: ESSENTIAL BUT STRAINED

In 2022, the American Heart Association (AHA) updated their concept of the eight things necessary for cardiovascular health (CVH), called Life’s Essential 8 (LE8).¹ It’s a great foundation for keeping patients healthy, and it’s the same stuff we as primary care physicians talk to our patients about every day: eat healthier, get more exercise, stop smoking, manage weight, control cholesterol, manage blood sugar, manage blood pressure, and get healthy sleep. So it wasn’t surprising that in 2024 the AHA specifically called out the essential role of primary care: “Because of its central role in patient care and health care delivery, primary care is ideally positioned to help people achieve optimal CVH through LE8.”²