A Family Doctor: Is that the worst or the best that you can be?

2008
Cheng, Michelle

I rejected a job offer at a successful e-commerce company when I was accepted to medical school. While I enjoyed being a software developer, I knew that it was not my calling. I applied to medical school because I wanted to have meaningful interactions with people while continuing to solve problems on a daily basis. I wanted a career that integrated my interests in a wide range of topics including foreign languages, music, and athletics; the more I knew about the world, the better I could relate to my patients. I knew that medicine is a career that meets these goals, and I knew that family medicine specifically, would be a career that I would love.

Once in medical school, I quickly became disillusioned. I was surrounded by people who looked down on family doctors, who aimed for specialties with the highest income-to-work ratios. We were taught by sub-specialists and did not even meet a family doctor until clerkship in third year. I distinctly remember a lecture about diabetes in first year. Having not done typical pre-medical undergraduate studies, I was not familiar with even the basics of the disease. By the end of the lecture, I still had no idea what diabetes meant to a patient, but I did know about the lecturer's research on insulin receptor receptors. I also remember a comment that one classmate made to comfort another when she complained about her low grade on a recent exam: "Don't worry, the worst that you can become is a family doctor". I felt angry and defensive about my goals of becoming a family doctor. To channel some of this energy, I became involved in an Interest Group in Family Medicine as Advocacy Coordinator. While I felt that we made small steps towards positive change, I could not help but feel that I had to prove to my classmates that I was good enough to be something other than a family doctor.

If preclerkship disillusioned me about medicine, clerkship renewed my faith in it. I enjoyed learning practical material, I had meaningful patient interactions, and I got along well with the allied health teams. I also had some outstanding family medicine preceptors who were not just teachers but also mentors. It was in the clinic of one of these family medicine mentors during my third year of medical school that I met Mrs. N. She brought her newborn girl to the office for her six week old visit. We discussed the baby's reflux and determined that she was generally healthy. When we screened for postpartum depression (PPD), we became concerned that Mrs. N was having difficulties.

Mrs. N had a history of obsessive-compulsive disorder (OCD). She had been on a selective serotonin reuptake inhibitor (SSRI) previously, but was stable off medications for a few years. I elicited symptoms of PPD and OCD, and it was clear that she met criteria and needed help coping. My preceptor and I made sure that she had enough supports and asked her to make an appointment for herself. When I saw her a few days later, I practiced the active listening skills that I had learned from a psychiatrist and gently prodded her with difficult questions, challenging her anxious and depressed thinking. I do not remember doing or saying anything extraordinary for her. I do remember listening to her, restarting her on an SSRI, explaining cognitive-behaviour therapy to her, and connecting her with a therapist.

These encounters with baby and mother beautifully illustrated to me how unique it is to be a family doctor. During the baby's appointment, we uncovered an issue with the mother; we switched gears from pediatrics to psychiatry. Family medicine requires this kind of flexibility and dexterity, making it a career that is continually exciting and intellectually challenging. What is even more special, and truly unique, is that as family doctors, we have the continuity of care to support our patients through their struggles and to follow their progress. Mrs. N and her baby helped confirm my suspicions that I would love family medicine.

A year later, long after I had forgotten Mrs. N's real name, my sister was on her family medicine rotation with the same preceptor. My sister and I rarely speak on the phone, but she called me one day and asked, "Do you remember Mrs. N?". The name did not ring a bell. "You saw her in clinic last year, she was a new mother and had postpartum depression and OCD ... " "Oh yeah! Of course I remember her. Why do you ask?" My sister proceeded to tell me that she had seen Mrs. N in clinic, that Mrs. N had mistaken my sister for me, and my sister explained that she must have been thinking about me. Then Mrs. N told her, "I'm so grateful that I met your sister. She was incredible with me. She pushed me to change, even though I didn't want to. If it weren't for her, I wouldn't be alive today." My sister passed this feedback on to me to warm my heart. Indeed it did, and I can only imagine how fulfilling it must be for our preceptor to see Mrs. N and her family flourish as they overcome obstacles over the years to come.

Now when I tell people that I am a family medicine resident, and I say it loud and proud. When medical students ask why I chose this field, I look them in the eye and tell them that I truly believe that family medicine is the best specialty. I tell them that although I applied to medical school with family medicine in mind, I knew it was the right choice for me because I enjoyed and did well in every rotation in medical school, confirming that I am a generalist. I have been told that my eyes light up when I start talking about how rewarding it is to work in a family medicine clinic, about how great it is to be on the front-lines and helping people make differences in their lives to promote health. If I feel this way after spending only weeks to months in any given family clinic, I look forward to the joy of following patients over the years in my own practice.

Although internists, pediatricians, plastlc surgeons, and psychiatrists have tried to convince me to switch into their specialties, I chose and continue to choose to be a family doctor. So to that classmate back in medical school, I say, "The best that you can become is a family doctor".

Theme: Patients | Patients
Theme: Physicians | Médecins
Theme: Relationships | Relations
Theme: Teaching and Learning | Enseignement et apprentissage

Stories in Family Medicine | Récits en médecine familiale [Internet] Mississauga ON: College of Family Physicians of Canada. 2008 --. 

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