I believe in what I do. I am a general internist and at a time when policy makers are considering how best to replace the dwindling ranks of primary care doctors, I believe that everyone deserves a good one.
I was nine years old when my mother was diagnosed with Multiple Sclerosis and I watched for two decades as my father, with only a high-school education and no health insurance for his family, navigated a hopelessly confusing health care system. “I took her to the best neurologist in Miami,” he explains absently. But when the neurologist’s treatments failed, she had no one to look after her. As her physical and mental states worsened and she drifted in and out of hospitals, she collected a cadre of specialists—pulmonologists, nephrologists, infectious disease docs. But it seemed like she had no one to really care for her and was simply careening from one crisis to the next.
I stayed in Florida for my undergraduate work and then went off to medical school at Yale. I had some vague notion that I could do better for people like my mother.
During my fourth year of medical school, still unsure of exactly what I was going to do, I was able participate in an exchange program between Yale and Cambridge University. I did my primary care rotation in England, working alongside the GP’s. An elderly woman who had surely lived through World War II brought in a bit of her urine in a rinsed out jam jar to be tested for infection, “less bother for you this way,” she smiled. Another woman the doctor suspected of having lung cancer was rushed off to a nearby CT scanner, returning to her GP to figure out next steps. From examining the mundane to the complex, dealing with the pleasant to the gut-wrenching, these were the doctors on the front lines. And I wanted to be one of them.
My mother passed away shortly before I graduated from medical school. She had a doctor caring for each failing organ system, but no doctor caring for her. A few months later, I went to Boston to do my residency in internal medicine. I graduated three years ago and have learned that in seeing the big picture it is sometimes possible to make a diagnosis when no one else can. I have learned when to hold out a prescription and when to just hold a hand. And I have sadly discovered that there are those who think that what I do can be replaced with information technologies and so-called “care teams.” Surely necessary, but not nearly sufficient.
Because of decreasing reimbursements, increasing paperwork, and loss of morale, virtually no U.S.-educated M.D.’s are electing to go into general internal medicine anymore, while seasoned professionals are switching to “concierge medicine” or leaving altogether. But I will continue as a primary care doc for as long as I can because I believe that we all need to be cared for.
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