Saturday, December 11, 2010

Family Medicine: I Love It

I love being a Family Physician.  My mirror agrees.  It is an amazing privilege to get to hear people's stories about their lives, families, careers, struggles, goals and dreams.  Over 150,000 patient encounters later, I'm convinced that people matter and they care for each other.  Their resilience is impressive.

Sometimes they need a little help to clarify where they're headed, especially when they're lying on the exam table moaning with pain of one sort or another.  If they can't sit up it's about 50-50 that they need a hospital and 50-50 they have a significant mental health problem.  (Just an observation over the years).  There's a high probability that they need an injectable medication if they can't sit up, maybe Toradol, Penicillin, Rocephin and /or Phenergan.

People will let the family physician know who is drinking again, if given the opportunity.  Sometimes, the offender is a person who was in my office recently singing the praises at how much money he's (almost always a he) now saving by not drinking anymore.  The truth filter comes up for the physician to try to clarify who's "truthing" the most.   Over the years, I've come to realize that the alcoholic is lying to themselves more than me.  They start to believe the lie and feel that it's true.  So when they tell it to me, they feel truthful. In the alcohol treatment health professions, they have a saying,"If their lips are moving, they're lying."

People care about each other in families.  Our practice focuses on families, so we only take families as patients, like the whole household or none of them.  Family members often come in together in twos, threes and fours.  They will share information and concerns about one another with the family doctor.  Sometimes they can't figure out what to say in front of the designated patient so they call in a message to the doctor before the visit, listing their concerns.  This happens most often with cognitive decline, alcoholism and chemical abuse in our practice.  The caller is trying to help in the best way that fits with their comfort and communication style.

People have more special requests near the end of the year.  Most are insured and may require information for the IRS to get their tax deducations.  They may need renewals of special apparatus prescriptions, such as their breathing equipment or C-PAP for sleep apnea equipment.  They want to know which insurance companies are still OK, to explore for their health insurance annual decision and why we're concerned about insurance company X as indicated by the sign in every exam room and the waiting room.  "Should we switch insurance companies now?", they ask if they are covered by that plan. It's hard to tell, I answer, but this company suddenly eliminated a dozen or so family physicians from their plan as providers in mid-plan year in another Ohio city, severing the physician-patient relationship for many senior citizens.  That concerns us a lot.

Christmas is meaningful for most of our patients, who reside in suburban cities and towns where unemployment is over 10%.  They have to watch their money closely since the next job lost might be theirs.  In spite of that, they have optimism about Christmas for themselves and their families.  Less money means less shopping and more togetherness with family and friends.  The non-Christians are comfortable with the mention about Christmas by other patients from their community.  In our local communities, the people seem to respect each others religious preferences. 

Another aspect of family medicine in the winter is infection such as viruses, strep throat and influenza.  We see infected persons daily and notice that the meaning of their illnesses vary from person to person.  One sick person with strep throat might need to be well the next day for a college final exam, while another is pleased to get a couple days off in an isolated room from family.  It's satisfying to help people understand the meaning of their illness and to validate them as people who matter.

Each day in Family Medicine is a unique one with well and ill people wanting to optimize their health while minimizing their expenditures.  I love it!


  1. We get a lot of special requests in palliative medicine too. I am an expert at filling out FMLA forms. in the hospital no doc seems to ever want to fill these out, but they can be such a cause of anxiety for family until they are done.

    Great post. Sorry I missed it the first time.

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