Thursday, April 1, 2010

Shining Knights and heroic family doctors

Not long ago, I attended the Shining Knight Gala, a fundraising dinner that benefited the trauma surgery and injury prevention programs at Virginia Commonwealth University Medical Center. The highlight of the evening was the dramatic presentation of the story of a young man who had suffered severe, life-threatening injuries in a car accident and, through the skill and dedication of first responders and the VCU trauma and rehabilitation professionals, was stabilized and over several months gradually restored to health. In recognition of their extraordinary efforts, all of the clinicians involved in this young man's care were awarded the "Order of the Shining Knight." As fire fighters, emergency medical technicians, emergency room physicians and nurses, trauma surgeons, and rehabilitation specialists trooped on to the stage to shake Virginia Governor Bob McDonnell's hand and pose for photos with their award (while their patient looked on happily from a nearby table), it was impossible not to be deeply moved.

It struck me somewhat later that there is no primary care analogy for what I witnessed that evening. General internists will not have the satisfaction of being recognized for the patients who didn't have heart attacks or strokes because of the blood pressure medications or aspirin they prescribed; family physicians and pediatricians won't be given awards of merit for all the children they "saved" from measles, mumps, polio, and a host of other vaccine-preventable diseases. While primary care physicians certainly provide acute care services for a variety of ailments, the greatest impact of our work is ultimately unmeasurable: all of the poor health outcomes that might have happened, but didn't.

Does this mean that there are no heroic family doctors? Far from it, but recognizing our behind-the-scenes efforts - and reinforcing of the appeal of the primary care specialties to medical students - is certainly more challenging. But I'm cautiously optimistic that the 2010 Residency Match results, which saw a 9% increase in the number of U.S. graduates choosing family medicine residencies and modest increases in interest in general internal medicine and pediatrics, represents a turning of the corner. With the millions of people expected to gain health insurance over the next several years, this country will need every primary care clinician it can get.


  1. I will share this widely, Kenny. This is also the plight of public health: How often to we wake up saying "I so glad I don't have cholera today! Thank goodness for clean water!"

  2. I am going to forward this to our pediatrician who we love so dearly.

    He and his associate diagnosed over a year ago an insanely rare cancer in our toddler that "most" doctors would have blamed on constipation. They saved her life. After a harrowing year of chemo and surgery, she was cured. Months later, she did come down with a viral infection. It was the same wonderful pediatrician who suggested a touch of pneumonia that might not show up on film because of her dehydration, started antibiotics, called the outpatient pediatric cancer clinic to recommend she come in for IV fluids and then cautioned about the potential severity of the pneumonia once her body was hydrated. The clinic scoffed at the pediatrician's diagnosis. 24 hours later she had full blown pneumonia, was not breathing and passed away.

    He too has shared his own experiences in interviewing residents pursuing careers in either family medicine, primary care and general pediatrics. My family has been lucky to have him as our doctor and confidant.

    It is one of the most noble professions.

    On the flip side, I have a friend who continues to add on fellowship after fellowship to make his specialty the "most special" and thus help secure his future and potentially offset his exorbitant student loans.