The future of primary care is as bright as we choose to make it

I decided to become a doctor at the tender age of eight when I met my first patient — my grandmother, Grandma Sylvia. After spending two years in the midst of the Liberian civil war, she arrived in the United States with diabetes, hypertension, obesity and nearly blind due to glaucoma. One of my new chores was helping administer her daily insulin injection.

I also had the privilege of accompanying Grandma Sylvia to her doctor’s appointments during which she saw a different doctor every visit. Each office visit she had to retell portions of her medical history to the often hurried young physicians (who I know now were probably medical residents). I noticed the stark difference between the lack of rapport Grandma Sylvia had with her primary care doctors compared to the close relationship I had with my pediatrician, whom I’d known my whole life. It was then I decided to become a geriatrician so that I could offer personalized, high-quality patient care to patients like my grandmother.

As I matriculated into the George Washington School of Medicine & Health Sciences, my desire to study internal medicine only strengthened as I studied comprehensive adult medical care. Once I entered the internal medicine-primary care residency at George Washington Hospital, I learned that I truly appreciated seeing a wide age range of patients. Plus, with the baby boomer generation aging — I had no shortage of geriatric patients on my patient panel. By the end of residency, I decided to remain in general primary care rather than specialize in geriatrics.

The birth of my son in 2013 brought yet another shift in my practice perspective, though I didn’t recognize at the time. While being a new mother was a joyous time, it was also quite stressful as I transitioned from residency to a busy chief residency year. I had gained 60 pounds during pregnancy and retained 40 pounds through stress-eating and a lack of physical activity. It wasn’t until moving to Richmond in 2014 to join Bon Secours West Internal Medicine that I realized my unhealthy habits were catching up with me.

Much like previous studies have shown, I no longer felt confident advising patients about a healthy lifestyle that I was not living. As I became aware of this gap between what I was preaching versus what I was practicing, I decided to prioritize stress management and regain my health.

I started by training for the 2015 Monument 10K, followed by the 2015 Richmond Half Marathon, and eventually completed the Richmond Full Marathon in 2016.

Through my weight loss journey, I gained greater empathy for my patients as they struggle with their own weight loss-management issues. The more I practiced internal medicine, the more I realized that attempting to treat obesity-related comorbidities such as diabetes, hypertension, and depression is shortsighted without striving to correct the obesity. In my quest to improve my understanding of the disease of obesity and its management, I learned of the American Board of Obesity Medicine (ABOM). By the end of 2016, I was 40 pounds lighter and board certified in obesity medicine.

Today I realize my experiences in primary care practice have brought my life full circle. Of course, primary care is not the utopia I imagined in childhood (but then again, what is?). We face a myriad of challenges such as time constraints, increasing administrative duties that continue long after clinical hours and decreased patient access to specialty care (e.g., psychiatry).

Yet, I am still passionate about being a primary care physician. Daily, I have an opportunity to connect with a diverse group of patients, including some just like Grandma Sylvia. It is very rewarding to building lasting relationships with my patients that impact their present and future health. My patients appreciate having a “medical home” to meet their health care needs. While this can be a daunting task at times, it keeps my primary care practice interesting. I can honestly say I have never had a boring day at work! As I look to incorporating obesity medicine management into my practice of primary care, I am even more excited.

My personal experience in primary care has been:

  1. You must start with yourself: Prioritizing and optimizing my own health has made me a better doctor.
  2. Carve out your own niche: Finding focus areas within primary care has enhanced my daily practice.
  3. Be realistic and flexible: Acknowledging the limitations of primary care enables me to create solutions.
  4. Remember why you started: Many of the previous “perks” of primary care are long gone. Your motivation has to keep you grounded on those tough days.
  5. Remember your own “Grandma Sylvia’s!”
  6. We all have own belief systems, so I invite you to remember your own and why your commitment to care truly matters. For me, my personal commitment to provide compassionate, Christ-like care keeps me centered.

The future of primary care is as bright as we choose to make it. There are many challenges, but with dedication to finding innovative solutions on an individual and system level, primary care doctors will be able to offer quality comprehensive care to patients that does not overwhelm or consume our own well-being.

Sylvia Gonsahn-Bollie is an internal medicine physician and can be reached at her self-titled site, Sylvia Gonsahn-Bollie, MD, and on Twitter @fittmd.

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