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Larry Bauer has once again posed questions to a group of us “Family Medicine Bloggers.” I find them interesting questions because, as someone who trains family Physicians, I often get asked about training philosophy. In addition, because of changes in accreditation requirements and work hours, there is often a question among educators as to whether we are leaving out the best part of medical training. Larry has posed two questions:

In your training, what 3 things (maximum) were stressed/emphasized to you regarding how to take good care of people?

In your experience, what 3 (maximum) lessons have you learned about taking good care of people? (if you had just three suggestions to pass on to students and residents regarding how to take good care of people, what would you say?)

My medical school training was at Tulane and my clinical training was mostly at Charity Hospital (also known as “The Big Free”) in the mid 1980s. It was a different time and a different place. There were no work hour restrictions, there was very little contact with attending physicians in conjunction with patient care, and as a student you had the distinct impression that you were an important part of the health care team (and occasionally the only thing standing between your patient and death).Everyone, from the dean down to the intern on the serviced stressed one thing:

“Know Your Patient!”

In a place like Charity, this could not be overemphasized as to call the “health care team” stressed would be a generous understatement. Although the health care environment our resident learn in today is quite different, I still cannot overemphasize the importance of this.

The hospital had open bay wards where everyone could see everything. I still have a distinct memory of me as a 3rd year medical student watching a gangly white medicine resident trying to describe in very technical terms (using the barium enema image as a teaching tool) what Crohn’s Disease was to an impoverished African-American patient who clearly did not believe that the image was of his insides, much less that his insides were defective in some way. It was clear to me from that day forward that I had to:

“Speak the patient’s language.”

It may be through a translator or to the patient and a parent, or to the child of an elderly patient, but it is less important for me to be accurate than it is for me to be understood.

I did my first year of residency at Portsmouth Naval Hospital in Internal Medicine and stayed on working the Emergency Department for a year waiting to become a Diving Medical Officer. As a ED doc walking in with one year of post-graduate experience, I could not be accused of being over-confident in my abilities. Many of the residents who had been with me throughout my PGY1 year were still in training and I interacted with them on a regular basis. I was functionally the “admit resident” and they were my consultants. The ED staff and my colleagues  hammered home to me the lesson that:

“Medicine is a team sport.”

Never be afraid to ask for help. Always accept criticism and try to improve. Know what your role is in the health care team and hope that everyone else does as well. Put a good team in place and good care follows.

After I finished dive school, I was stationed in the clinic in Kaneohe, Hawaii. I got the job because no one else wanted it, based on rumors of what the job might entail.  At the end of three years I had made a bit of money on a condo, seen almost everything to see in Hawaii, made friends for lifetime, learned I wanted to do Family Medicine, and had a wealth of experience in leadership positions. In other words:

“Make the best of the hand you are dealt.”

Admittedly, raising your hand to volunteer to go to Hawaii isn’t like agreeing to fight “a land war in Asia” but it might have turned out badly.

I did my residency in Family Medicine at South Alabama. Ellen Sakornbut knew that I wanted to do Academics and challenged me to acquire and maintain OB skills (I still take OB call 20 years later). In her words:

“OB keeps your practice young.”

As I find myself caring for an increasingly aging patient base (despite miraculously not aging myself!), I am grateful for that piece of advice  when I see a pregnant patient in my practice (often, these days, the child of one of my older patients).

The last lesson that I learned in medical school and had emphasized in my internship, Navy career, and residency is this one:

“Always do the right thing.”

Of course, trying to figuring out what that is can be tricky!

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There are a group of bloggers who are family physicians or friends of family physicians and WE are trying something a bit different. Laurence Bauer, who is the Chief Executive Officer of the Family Medicine Education Consortium is coordination this effort. We are trying to educate ourselves on the effect of social media as well as trying to determine what the effect of social media actually is. Larry is offering a guest column today which several of us are cross posting.

The Dreams of the Founders of Family Medicine

Laurence Bauer, MSW, MEd

It is important to realize that many in and out of medicine told the founders they would not succeed. The cynics believed that the dominant forces in medicine were too entrenched and there were too many societal forces working against the idea of a generalist renaissance in medicine. After all real medicine involved care of hospitalized patients; anyone could care for the people “out there”. But the founders dreamed big, bold dreams; they were a determined and visionary group.

They dreamed of a cadre of talented and competent Family Physicians that would serve the people in all the communities of our nation. The rich, the poor and all in between in rural, urban and suburban communities all needed access to a Family Physician. They believed that the practitioners in this specialty would focus on the needs of their patients and communities and would protect people from the medical industrial complex as much as possible

They dreamed that a new academic specialty would emerge whose core would focus on issues surrounding patient management and the care of the whole person in their community.  They believed that medical education was moribund and harmful and in need of a compassionate and thoughtful revitalization.

For the founders, the biomedical model was inadequate. They believed that it is not possible to be effective as a physician without understanding the contextual issues that influence a person’s life. The biopsychosocial model, the power inherent in relationships and the abilities and skills involved in creating facilitative relationships needed to be integrated into medical education, practice and scholarship.

They believed that medicine was a profession that involved more than a technical set of skills and a high income. They accepted the responsibility to care for the whole person; mind, body and soul.

They believed that the practice of medicine required team work among the medical and helping professionals and that the patient was to be an active partner in the care process. In fact, it is the patient’s goals and agendas that drive the healing process.

They believed that life-long learning and the need to continuously upgrade one’s knowledge and skills was critical to the practice of medicine.

They dreamed of generations of leaders who would rise to take their places and extend their efforts.

They believed that Family Medicine was more than another group of medical practitioners. Family Medicine should serve a transformative agenda that changed the academic medical centers and health systems so that they would better serve the people and communities.

They were willing to bring other generalist colleagues to their ranks. They respected the pediatricians especially who wanted to contribute to Family Medicine’s early development. They sought a relationship with psychiatry and mental health professionals. They had a comfortable relationship with the general surgeons and all their colleagues who respected the value of a generalist practitioner.

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