The stories we find ourselves in

Siu, Winnie

How good a day I feel I've had as a family medicine resident is usually inversely proportional to how much I wish I was a resident of a different specialty. They are not often, but on these days, I wish desperately that I had a smaller scope of practice, and an arsenal of limited investigations and tests to determine whether this patient and his or her problem truly belonged to me. And if I determined that they did not, I could sympathetically send patients on their way and rest assured that their problems were not mine.

What is obvious and overwhelming about family medicine is that everything is within our scope. From hair loss to toenail fungus, we field questions all day long from patients who look to us to let them know whether what they are experiencing is normal.

Family doctors, it is said, need to be comfortable with uncertainty. Phrases like “we'll keep an eye on it” and “let me know if it changes”, however overused and undesired, are part of our daily conversations with patients in order to manage the unknown.

How is it that a certainty-lover like myself ended up in a specialty the most general and uncertain of them all?

I fell in love with the stories.

Perhaps it would be more precise to say that I love the life narratives I encounter. Consider the young woman who meets me soon before she becomes a bride, who comes back a few months later, giddy with excitement over a positive home pregnancy test. Then, I receive a phone call that she is miscarrying. I see her days later and acknowledge her heartbreak, arranging follow-up. In a few months she is pregnant again and I meet her husband during prenatal care. Soon, I am making sure my pager is with me always so that when she goes into labour I am there to deliver her baby. I exam them both in the hospital before discharge, and see the baby two days later in my office to being newborn care.

Continuous narratives like these are, I think, seldom encountered, in medical specialties outside of family medicine. The late Dr. Mimi Divinsky, family physician and narrative medicine pioneer in Canada, wrote, “Perhaps it’s exactly in this way that we family physicians differ from other specialists, whose main challenge is diagnosis and asking, “What’s to be done?” Ours is more likely to be following patients with chronic illness and asking, “How are you going to manage?”

I am blown away by the stories that are entrusted to me, how patients allow us to see, literally and figuratively, the most intimate and vulnerable parts of them. The stories do not belong to me, yet I am a part of them. And there is a thread from the fabric of that narrative that becomes intertwined in the tapestry of my own.

Family medicine as I see it is a promise of a service for certain, but more than that it is a promise of a relationship. I tell a patient, I don't know exactly what is causing your recurring stomach pains, and I don't have a quick fix for the stress you are feeling taking care of your ageing parents, but I do promise that I will walk with you through this.

It took me a long time to realize that the patients I thought were the most difficult were patients for whom I had no absolute answers. Often what was most difficult was not the patient but dealing with my own frustrations at not being able to definitively solve his or her problems.

As I near the end of my family medicine residency, maybe the most important thing I could have learned is this: Listening to, and genuine acknowledgement of, patient stories can be powerfully therapeutic. Sometimes, it is all that is required. Other times, it is the only thing that keeps our patients going when we have run out of things to offer. As family physician and humanitarian Dr. James Orbinski wrote in his book An Imperfect Offering, “when there are no easy answers, stories are all we have.”

I suppose in many ways it would be easier if I was a physician of a different specialty. But then I might never get to see how my patient manages. I might never get to see how the story ends.

Theme: Birth | Naissance
Theme: Patients | Patients
Theme: Physicians | Médecins
Theme: Relationships | Relations

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




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