Sunday, March 5, 2017

On Family Medicine

I wondered during undergrad if I could do medicine and "have a life". I didn't have a lot of first-hand contact with physicians, and had just started to consider a career in medicine, so I really didn't know what a medical lifestyle was like. I knew it could be incredibly demanding and busy, but I wasn't sure how much flexibility there would be. In the end I suppose I still didn't really know, but I figured if others did it, I could figure it out too.

We had the chance to get early clinical exposure at my medical school. I had always planned to do family medicine, so every Wednesday afternoon in my first year, I would take the bus to the family medicine clinic of Dr. B. Dr. B's patients adored her. She truly listened to them, and was clinically excellent too. Seeing patients -- real people with real problems! -- was thrilling. I get a reminder of this from time to time in my office when I have early medical students join me. Looking at a tympanic membrane is exciting to them! It's a great boost. 

During medical school, I went through the "cardiology! neurology! infectious diseases!" rotation in my mind, until it was clear that being a generalist was what I wanted. Internal medicine was tempting, as I actually enjoy learning minutiae, but I loved women's health, pediatrics, and doing preventative care. The flexibility of a career in family medicine was unmatched in my eyes. So from clerkship onward, I continued to feel that family medicine was the right fit for me. 

I now have a family practice of about 1200 patients in a small group practice, and see patients for about 30 hours per week.  Charting, results and other paperwork takes about 8-10 hours a week.  I block one day off every month for self-care or catch-up time - with young kids, if I have to cancel a clinic due to their or my illness, it’s nice to have a day available to re-book patients. I can book off in advance for appointments for the kids or myself, or fit in local CMEs or meetings related to some community health work I do. The demands of my practice - and of home - fluctuate from week to week, but generally it feels like a good balance. 

I ran into a lovely, well-meaning non-medical friend a little while ago. "How's work going?" she asked. "Ah, it's been a long week." I said. "Lots of coughs and colds?" she mused. "If only!" I thought. I tell this to students a lot: family medicine can be very challenging, medically, and very draining, emotionally. So rather than things like a chest cold or plantar wart being boring and mundane, they can be a very welcome break from the challenging things we see at times.  The medically complex cases are invigorating, and the emotionally draining cases, highly meaningful; the "mundane" cases act as a much-needed foil. And above all, when you know your patients like you do in family medicine, it becomes much more about caring for the person in front of you than about the particulars of their issues. 


  1. I'm glad you have found a balance. I just watched ZDoggMD's first television show - Facebook show really - on health 3.0. Our goals. Seems you have found your goal in Canada. As a pathologist, I feel a little bit short empathizing with clinicians. I'm hidden behind the scenes, but I feel the struggle. The system makes it so hard to care for, and develop a relationship with, the very person we worked and strained and sacrificed for: the patient. Kudos to you for finding your balance. Nice post:). And I can empathize on the coughs and colds. Our coughs and colds are gallbladders and appendices. But for every easy case I am challenged tenfold by daily difficult cancers. Your post makes me realize I am not alone.

    1. Thanks Gizabeth. I have conflicted feelings about my "balance"; to be clear, I do not always feel so balanced. I could take on more patients and 'help more people', but then I would have to practice faster and be more stressed and I feel I have to maintain my energy to provide good care. I'm grateful to have a choice in that - in Canada as family physicians we don't have to be tied to any hospital/system for the most part, and have a lot of autonomy. However this is starting to change and it's not all bad - our system has major issues too and the autonomy of physicians has its downsides for the system. I appreciate you saying that about your tough cases - it helps to remember that I'm not the only one struggling with decisions on a daily basis. Sometimes as a generalist you can get caught up in 'well if I were a specialist I would just *know* the diagnosis' but that is not always true either of course.

  2. Great post! As a first year medical student (with kids) considering family medicine, I was very inspired to read your post. All the best!

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  4. Loved this! I'm a 4th year and will be starting residency in family med in just a few short months and I'm so excited!! There was some lure to be a specialist but I just could not shake the idea of being a generalist. The only other things I strongly considered were peds and obgyn and, well, family med just made sense since I could both those things. I'm so looking forward to starting residency and taking care of my patients!


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