My primary care frustration is outweighed by my relationships with patients

I love my job as a primary care doctor, and I enjoy sharing the joy with students who visit me at the community health  center where I work. It is terrible to read in the press (and to hear from students) that angst and frustration are the  predominant emotions associated with primary care. While there are sources of frustration in what I do, these are  overwhelmingly outweighed by the satisfaction of building relationships with my patients. Truth be told, these relationships  also improve my life, as I see the difference that a caring, careful physician can make in the lives of patients and impart that  sense of purpose to my students.  Last summer, I had one of my most rewarding teaching experiences.

I learned of the Stoeckle Primary Care Scholars program through a network of dedicated primary care doctors who work  at Harvard Medical School. I was invited to submit a project proposal involving primary care in the community and was  matched with an amazing first year student (JK) who had an interest in maternal-child health. This first year student, who had come to the United States from Africa in search of educational opportunities, took up my project to design a group prenatal visit series for the local Central American immigrant population. She was hesitant initially to work with patients who spoke an unfamiliar language from a culture that she had not yet experienced, and to dive into such a rich (she saw “complicated”) area of patient care. However, we worked together to create an approach to the patients and to our task which took into account their daily lives, cultural backgrounds, and personal and educational needs.

Once JK started talking with the women in my practice, she learned that their needs, their lives, were not so very different from her own experience.  Certainly the details were very different: she was still a Harvard Medical student, and the patients were immigrants trying to make it day to day. However, their need to feel informed, to find a community, to look after those dear to them (especially their unborn children), and to make it all work within a restricted schedule – were familiar. And so JK’s hesitancy evaporated.

JK undertook a needs assessment for the Central American population of women served by our health center, studying Spanish to help her communicate with the patients. Based on her results, she built a list of educational resources and found speakers to address our groups on topics that the women found to be important.

JK spent the rest of her time shadowing me in patient care sessions. We met with multigenerational families, prenatal patients, and children. We placed intra-uterine devices, biopsied skin lesions, removed toenails, and performed colposcopies—exciting hands-on opportunities for a pre-clinical student. We counseled depressed patients, offered advice for parents, and managed chronic diseases. She joined me in procedure clinics, administered vaccines to infants, worked with our family planner, and worked with patients in English, Spanish, and Portuguese. She also enjoyed a special connection with my Muslim patients—a faith with which she is particularly familiar. Through these sessions, JK came to understand the role of family life in health and the amazing nuances that are discovered by a physician who cares for multiple people in the same household.

At the end of the summer, we launched the prenatal group visits. In the first session, JK presented a talk on culturally appropriate prenatal nutrition (rather than talking to them about having whole wheat bread with their turkey cold cuts, she suggested adding vegetables to their rice and beans).  Seven months later, the group continues to meet. The patients in the group are able to get information that is important to them, build a social network with their peers, and share their pregnancy experiences with other women. They bring their children to the visits and even meet outside of the group as friends.

JK learned a lot about primary care medicine, community centered care, and the importance of cultural sensitivity.  She was also able to experience the wide range of clinical experiences in family medicine—and it was fantastic. She loved the variety of her experience, the relationship building with patients. She told me that THIS felt like the sort of medicine she dreams of practicing.

Now—how can such a model be expanded so that the majority rather than the minority of students are able to have this experience?

Katherine Miller is a family physician who blogs at Primary Care Progress Notes, where this piece originally appeared.

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  • Anonymous

    Dr. Miller you sound as one of the truly blessed in primary care.  It is wonderful to see that you are so patient-centered and find that personally enriching.  I do wish that more physicians would find that involvement in their patient’s care goes beyond clinical diagnosis and treatment.

  • http://www.facebook.com/profile.php?id=703892466 Bibiana Chan

    An inspirational piece for all health care providers! 

  • Anonymous

    I couldn’t agree more, Dr. Miller.  Building relationships is not only critically important for building a personally rewarding career in medicine, it also contributes heavily to the material and financial success of a doctor’s practice. 

    I’ve long realized that one of the major enjoyments for me as a physician is interacting not with patients, but with people who happen to be patients.  If you hope to remain connected to and invigorated by your work, you won’t make it if you focus on the academic and technical aspects of medicine.  “Interesting cases” are actually rather infrequent (fortunately for patients), so if you can’t derive enjoyment by treating people with common, even mundane, ailments and complaints, then your medical career (at least as a practitioner) will be grueling and unrewarding.