My entry into primary care was a rather straight-forward and boring one. Here’s the rundown: for unknown reasons, 5-year-old me tells her elders she wants to be a general doctor when she grows up, “to help people”; 5-year-old gets positive feedback for this future profession declaration; thoughts of becoming a doctor continue to light up brain’s reward center as this 5-year-old ages; now 17-year-old enters college pre-med; med-school and residency follow, and in 2008 at age 28, 5-year-old girl’s dream is fulfilled as she’s booted out on her own into the world of family medicine.
What keeps me in primary care is perhaps less cliché and more selfish: I like the person primary care has helped me become.
My relationship with primary care is complicated, as many relationships are. It has not been the idyllic profession 5 and 17-year-old me envisioned. Though, I suppose to 38-year-old me, this should come as no surprise.
It’s been a roller coaster ride of love, hate; give, take; passion, apathy; reason, nonsense; community, detachment. This ride is not for naught. Primary care has changed me; and though it has not fulfilled me in ways I had expected it to, the end result so far has been life-enriching.
Jenny was recently diagnosed with rectal cancer, a variety of which has a standardized treatment protocol of chemo, followed by surgery from which most need a temporary colostomy. The prognosis is excellent with this standardized treatment plan. Jenny refuses surgery. She cannot envision a future life worth living with a colostomy. She has met with a psychologist, psychiatrist, 3 surgeons, an oncologist and myself multiple times, and after various discussions we agree she is of sound mind without an untreated psychiatric comorbidity. She readily admits to knowing this is an unusual stance to take but that her life goals and priorities are different from ours. Where once I saw life and in firm lines of black and white I now see nuances and gray.
I first interacted with 25-year-old April at a local pharmacy prior to her landing in my patient panel. She is a pharmacy technician in a loud chain store bustling with people. In our interaction at the pharmacy she was brash, curt, unfriendly. When I met her one-on-one in the office I found her to be a lovely person, and quickly learned she struggles with a serious eating disorder and severe social phobias. Where once I cast premature judgement, I now have more compassion.
My stomach churns every time I see Betty in my schedule. She doesn’t “believe” in western medicine. She has tried every supplement and cleanse under the sun and countless spinal manipulations in the name of health and disease prevention. I recently learned of her hellish past, watching her barely teenage daughter die in a traumatic accident and shortly after her husband leaving her after revealing a “double life” he was living with another family. Where once I only felt anger in the face of ignorance and pseudoscience, I now see a human trying to make sense of their world with all it’s uncertainties.
I had met with Matt multiple times for weight loss counseling. We had reviewed healthy eating and exercise guidelines at length including the importance of decreasing calorie intake, and largely focusing on not drinking sugar given his heavy intake of pop. At one follow-up visit he was excited to have finally taken my advice of cutting out the pop, only to have replaced it with honey-sweetened tea (“I heard honey is healthy!”), at a net gain in calories consumed per day. At a subsequent follow-up visit he was excited to have replaced his sweet tea with coffee — accompanied by 1/2 cup of heavy cream per 8 ounce cup of coffee (“It doesn’t have sugar, and I heard coffee and heavy cream is healthy!”), at yet another net gain in calories consumed per day. Both visits measured non-negligible weight gain. Where once I was easily annoyed by hearing poor choice after poor choice, I now see most humans doing the best they can with the cards they are dealt, and seeing these missteps as further learning opportunities for both me and the patient.
These are but a few examples I can think of in the moment; my 10 years of practice so far have been chock-full of life lessons that have made me a better doctor and, I hope, a better human.
Though I don’t know what first gave me the idea, 33 years ago, to eventually become a family physician, I am grateful for the singular focus younger me had leading me into primary care to be able “to help people,” not the least of which is myself.
Melissa Kwak, MD is a full-time family physician in Yorkville, IL. Patient names have been changed for confidentiality.
