Treating the whole person

For the most part, family medicine has been a lot what I expected it to be. Of course, rural medicine has its own natural flavour–each encounter begins with, “How’s the family? Getting ready for harvest? Oh, how was your trip to ___? How’s little ___ enjoying the second grade?” Everyone is intimately acquainted with every detail of one another’s lives. Not in a bad, gossipy way, but in a wonderful neighbourly way. I’m so pleased to see what true family-centred medicine means.

But it also means a lot of smokers, drinkers, bad eaters, and non-exercisers; a lot of hypertension, diabetes, cholesterol, obesity, and a general lack of ownership about one’s health. A lot of “Well, it runs in the family,” and a lot of “It’s not realistic for me to change now.” These patients have frustrated me from the get-go, even before starting medical school. Now, to see them deteriorate in front of my eyes, watch them repeatedly stop taking their meds or go on a binge or do something silly, while expecting you as a rural health care practitioner to take care of their whole being, is aggravating to say the least.

Well, today I witnessed family medicine being conducted in the exact same clinic, in the exam room next door, in a completely different way. (I work with a pair of preceptors who happen to be married and work in the same clinic–adorable, and truly admirable that they don’t drive each other crazy.) But I guess when sitting in with the husband, I didn’t realise I was seeing an inherently biased population–men, mostly older, mostly suffering from various chronic illnesses. As it turns out, the wife seeings almost all women, younger, healthier, incredibly proactive, incredibly responsible women. Where his practice is a lot more about simply keeping blood sugars at bay, or numbing that joint pain for a few weeks, and repeating the same advice to nearly deaf ears about eating well and exercising, hers is about holistically treating a person’s mind, body, and spirit. She takes long appointment slots ask questions about emotional health and depression to nearly every patient. She is extremely rigid with her screenings, mammograms and paps and the like. She gives her patients all the time they need to get out every last concern. I am just so surprised that family medicine can look this way–the way I’d always idealised it in my head, but never thought it could be a reality in our modern times.

I don’t mean to judge the male preceptor at all, when he’s absolutely doing the best he can with the workload he’s been given. And there are absolutely disadvantages to one where there are advantages to the other–I’ve already seen quite a few of his patients squeeze day-of appointments, and he can easily book someone in within a few days. Her wait times are already weeks long. By nature of his demographic, he is overburdened with unhealthier individuals. By nature of women’s *cough inherent awesomeness cough* and willingness to take their health seriously, her job is made easier. (A recent poll in my own medical class showed about 20% of male students having ever done a complete physical, vs. almost 100% of female students.) And she gets to spend more time hearing out emotions and details and actually ask the question, “Is there anything else at all that’s bothering you?” where he simply can’t make that time with every single patient.

I guess I’m just pleasantly surprised about how holistic and complete family medicine can be. If I ever did have a desire to go into it, this is exactly the kind of practice I would set up.

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