Tuesday, August 4, 2009

Physicians and storytelling, Part II

In 2003, while in my second year of family medicine residency, I wrote a personal statement for a leadership award that described the intertwining of my writing and doctoring ambitions into the occupation of a "physician-storyteller." I didn't win the award, but from my current vantage point, it still resonates. (This is the second of two posts.)

One story that I have found particularly compelling during residency is that of patients with HIV/AIDS. In July 2002, I did an elective rotation in Lancaster General Hospital’s Comprehensive Care Center, a Ryan White Care Act supported medical clinic. I was impressed at how the present-day management of HIV had become similar to that of other chronic diseases such as asthma and diabetes. Yet patients sometimes take their life-prolonging prescriptions sporadically or not at all. Curiosity about the reasons for these self-imposed “sustained treatment interruptions” (STIs) prompted me to join a fellow resident and attending in surveying our patients’ understanding of STIs and how it influenced their adherence to complex medication regimens. As part of this project, I personally reviewed the charts of nearly one hundred patients to collect information about past medical and social histories and am now involved in the analysis of this data. We plan to communicate our findings at the next Pennsylvania Academy of Family Physicians Research Day.

The service and research opportunities that I have enjoyed in residency would not have been possible without my program’s unwavering support and flexibility. That flexibility was severely tested during my internship year, when the program endured a crisis of change. The retirement of the only Program Director we had ever known, along with a decline in applications to family practice nationally and new resident work hour regulations, prompted the program’s most significant curricular revisions in a decade. As a member of my residency’s work hours committee, I became a tireless advocate for redesigning the intern schedule in a way that was more humane in terms of post-call duties but preserved the crucial educational value of those on-call nights. At the start of my second year, I and another resident formed an intern support group that meets monthly with a community preceptor to further bolster morale. These changes effectively reduced the burdens placed on current residents and made our program more appealing to prospective applicants. My positive experience in improving the working conditions of my fellow residents encouraged me to run for, and win election to, the position of Chief Resident. This year I’ve tackled several major administrative hurdles: scheduling for a block conference curriculum; developing an emergency plan for inclement weather days; and transitioning from a single continuity office practice to urban and rural tracks.

Of physicians, English professor Brian Ferguson-Avery wrote in JAMA: “Their years among the human animals have shown them futility, sadness, compassion, and the occasional hard-won triumph. As a result, they can better consider the big questions posed – and sometimes answered – in books.” I could not agree more. Although I have just begun my career as a family physician, my experiences in community service and resident leadership have melded with my writing talent to make me a better storyteller to my patients in every chapter of their lives.