This past month, I was rotating through a primary care pediatrics clinic. This was my first “real” experience with primary care. While I did shadow a physician in community internal medicine as a first-year student, I didn’t yet have the clinical decision-making skills by which to critically evaluate my experience. And so, this month has been really eye-opening for a lot of reasons. Here are three big lessons I learned during my time there:
- Primary care is gutsy. People usually think of surgeons as being the “tough guys” of medicine. The cowboys. The ones who can do anything and everything. The ones with the guts. But I’ve discovered that primary care providers (PCPs), too, have to be really gutsy. It takes a certain self-confidence to be able to manage so many different pathologies at once, often in resource-limited settings no less. As jacks-of-all-trades, PCPs have to be able to practice at the maximum of their own capacity but also know the limits of that capacity. For example, does everyone with X problem need a doctor who specializes in X, or can the PCP do the work-up and at least initiate management on his or her own? In reality, it can be really challenging to figure this out.
- PCPs often have to get involved in people’s personal lives but also have to accept that they can’t fix everything that’s broken. Sometimes people do things that are not in their own or their family’s best interest. Having just completed pediatrics, some of the things I saw that bothered me most were parents who smoked inside the home around their asthmatic children, or women who continued to use substances while pregnant, or people who threatened their kids in front of me. Yes, you can advise, counsel, use motivational interviewing techniques, get CPS involved, beg, plead. But medicine, even when partnered with the best of resources, has boundaries, and sometimes you just have to be okay with “I really, really, really tried.”
- Providing primary care in resource-limited settings must be one of the hardest things a person can do. The clinic I worked in was located in an area that is in the bottom 10% in the U.S. by median income, top 10% by average household size, and bottom 10% in percent married individuals. I’ve lived in this area for the last almost three years on account of it being walking distance to school. But it wasn’t until now, being in this clinic, that I really saw what all of those statistics could mean for an individual’s health and well-being. Despite the many challenges that come with the territory, I saw my attendings treat each and every patient with such respect and compassion. And they’ve been doing this work for decades. I can imagine it’d be easy to get jaded and start feeling like you’re on a never-ending hamster wheel when your patients’ lack of access to resources limits to some extent what you can do. But somehow, the physicians who do this work have what seems to be an unending reservoir of compassion, empathy, and energy to keep going, to keep facing it all, and to keep giving their patients the best shot possible at a healthy life despite the odds. It’s given me a profound respect for PCPs everywhere, and particularly for those who devote their lives to the care of the underserved.
This experience was truly an unforgettable one, and I’m so grateful to have had it. It’s certainly made me a better future physician, as well as a more conscientious citizen of this great city of Baltimore.
