“Please don’t take offense, but can you tell me why you chose to go into family medicine?”
A nurse at the community hospital asked us new interns this question on our first day of residency. Her tone was dismissive, implying, “You could have chosen anything, but here you are, throwing away your career, community standing and income to do primary care.”
We took turns answering her question.
“I went into family medicine to keep people healthy instead of patching them up when they got sick.”
“To care for the whole person instead of an organ system.”
“To care for patients in the context of the families and communities they live in.”
I thought of the dusty roadside villages in Central Africa where I had weighed and vaccinated babies while providing prenatal care for young mothers, conducting clinics in which every fever was invariably malaria, dispensing quinine and medical advice for a pittance. Health needs were palpable, from the scrofulous lump on the spine in untreated TB to the grossly swollen liver and spleen of advanced schistosomiasis. Villagers needed basic primary care services to prevent disease, treat illness, and promote reproductive health, starting with clean water and good food, with access to nurses and doctors and the magic medicines waiting to cure on the shelves of the dispensary.
Though I had chosen to become a doctor so my signature could allow me to dispense lifesaving therapies to people who might otherwise die, I began to resent my drug-pushing role in America. I was a Pez dispenser in a white coat, spitting out prescriptions — the middle man in the lucrative practice of getting drugs to the highest bidders. People without insurance struggled to be seen. Patients without money didn’t get their meds.
Our health system is designed to maximize profits, not health. In Africa, and in America, children die of preventable and treatable illnesses that are neither prevented nor treated for wont of financial incentives. Diseases that affect millions are considered orphan diseases because there is no paying market for the drugs. Eflornithine, the only medication effective against arsenical-resistant sleeping sickness, was taken off the market in Africa (lifesaving, but no buyers) while being repackaged as a depilatory in the states (frivolous, but lucrative). Lives are at stake and money wins.
Why did I do family medicine?
“I believe health is a human right and not a commodity,” I began. “And we need to do everything we can to make sure everyone gets the care they need. We need prenatal visits for all pregnant women, vaccines for all children, yearly visits for everyone. We need to make it easy for people to see their doctors so they can treat earaches before ear drums burst, high blood pressure before they have heart attacks, or control diabetes before they lose their kidneys and their sight. To do this, we need more primary care doctors. I am here so the system can change. Health is too precious to be a luxury.”
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