Primary care physicians are heroes too

Not long ago, I attended the Shining Knight Gala, a fundraising dinner that benefited the trauma surgery and injury prevention programs at Virginia Commonwealth University Medical Center.

The highlight of the evening was the dramatic presentation of the story of a young man who had suffered severe, life-threatening injuries in a car accident and, through the skill and dedication of first responders and the VCU trauma and rehabilitation professionals, was stabilized and gradually restored to health. In recognition of their extraordinary efforts, all of the clinicians involved in this young man’s care were awarded the “Order of the Shining Knight.”

As fire fighters, emergency medical technicians, emergency room physicians and nurses, trauma surgeons, and rehabilitation specialists trooped on to the stage to shake Virginia Governor Bob McDonnell’s hand and pose for photos with their award (while their patient looked on happily from a nearby table), it was impossible not to be deeply moved.

It struck me somewhat later that there is no primary care analogy for what I witnessed that evening. General internists will not have the satisfaction of being recognized for the patients who didn’t have heart attacks or strokes because of the blood pressure medications or aspirin they prescribed; family physicians and pediatricians won’t be given awards of merit for all the children they “saved” from measles, mumps, polio, and a host of other vaccine-preventable diseases. While primary care physicians certainly provide acute care services for a variety of ailments, the greatest impact of our work is ultimately unmeasurable: all of the poor health outcomes that might have happened, but didn’t.

Does this mean that there are no heroic family doctors? Far from it, but recognizing our behind-the-scenes efforts — and reinforcing of the appeal of the primary care specialties to medical students — is certainly more challenging. But I’m cautiously optimistic that the 2010 Residency Match results, which saw a 9% increase in the number of U.S. graduates choosing family medicine residencies and modest increases in interest in general internal medicine and pediatrics, represents a turning of the corner.

With the millions of people expected to gain health insurance over the next several years, this country will need every primary care clinician it can get.

Kenneth Lin is a family physician who blogs at Common Sense Family Doctor.

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  • Dr. Mary Johnson

    I am already “Queen of the Yas” (my subjects routinely address me as “My Queen”), so the “Order of the Shining Knight” doesn’t bug me either.

  • pcare doc

    Despite a fondness for Narnia, I think I probably speak for the majority when I say I’m OK without the Order of the Shining Knight. How about just making the day-to-day job better? Oh, and a nice pay raise wouldn’t hurt. If only I could get my patients to address me as “Your Excellency!”

  • ZMD

    Hmm, I don’t see anesthesiologists being recognized either. You know, the other doctor in the operating room. The doctor who is giving massive transfusions of blood, starting invasive monitoring, giving vasopressors just so the surgeon can continue his heroic “life saving” procedure.

  • Drew

    I’m glad to hear that, pcare doc. It would make me a bit wary if general internists were in it for the glory and awards. I appreciate everything they do, especially my own physician. That’s why I keep going back to him.

  • DrJohnM

    Being a hero to a patient is manifested in many ways. Grasping a trauma victim from the throws of death is only one way.

    Spending time with the patient, holding their hand,and being with them in their struggles fuels the doctoring spirits. Although, less likely to earn a handshake from the governor, these great sensations keep us doctors in the game.

    We have become such great buddies. Her kind words to me are a constant. She tells me I saved her life. But the ICD has never delivered therapy.

    Good on you KL.


  • Mark Chambers

    The recent posts about recognition and recruitment have caused me to reflect on our current situation in the UK. The “vocational” title has been dropped and replaced with “specialist” training for GP. A retrograde step in my view, Seeing patients flourish from making better choices is it’s own reward.
    “To cure sometimes, to alleviate often, to comfort always.” (Osler). A privilege to be in this position.
    Mark Chambers. GP Suffolk. England

  • King of Medicine

    I can knight any one of you if you like. Being the King of Medicine allows me that privilege. All that other stuff is bogus.

  • Dana

    Though my Oncologist took over once diagnosed with Hodgkins, it was my Family Practitioner (not my OB/GYN I’d originally seen) who took a swollen supraclavicular node seriously enough to order an ENT consult and biopsy.

    There have been times when I’ve been really critical of him (mistaking oxycodone for oxytocin in conversation and refusing to let me do an A1c when random blood glucose levels were elevated), but he’s the one who wrote the orders, got the ball rolling and helped me get diagnosed Stage II instead of much further along.

    My professional career has been spent in and out of Primary Care offices – some are more impressive than others in their diabetes knowledge, but they do the lion’s share of medicine, work ridiculous hours and are accountable for knowing so much about so many things.

  • Anesthesiologist

    You Think This Is Bad?

    Try being an anesthesiologist. Intense, critical, life-saving….

    Never a thank you.

    Take your thank yous with the annual physical and run with em. Some of us get far less for far more intense and critical work.

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