The 20th century artist, Norman Rockwell, depicted the iconic family doctor in his paintings as a beloved, steadfast soul who used some magical mix of compassion and brilliant clinical acumen to heal each patient. Rockwell’s family doctor was an avuncular, unhurried man who arrived on your doorstep with his black doctor’s bag which somehow contained everything he needed, as American and nostalgic as quilts, apple pie, and baseball.
I think the good doctor would recoil in horror if he were a fly on the wall observing the chaos that is my typical day in clinic.
A while ago I was with a residency buddy of mine, and she was trying to explain to our other friend—who is a project manager for a tech company, what it is like. She said, “Let me explain clinic. Imagine your team has to run 25 back-to-back meetings in a day—each one 15 or 20 minutes. None of those meetings have set agendas, but they all must start and end on time—sometimes simultaneously. The meeting participants may bring up any issue at all for discussion during the meeting, and you must try to figure out a solution. Meetings can be stressful. Often the meeting attendees show up late or at the wrong time, other times, they try to die during the meeting, and on at least one occasion, they tried to have a baby during the meeting. In addition to whatever comes up in the nonexistent agenda, you as the meeting chair have to take care of all of the meeting participants’ organ systems and emotional needs and screen for diseases and give them their flu shots and beg them to quit smoking. Oh, and you have to take meeting minutes during the meeting. Somehow by the end of the meeting the meeting participants have to leave feeling that you care about them and have things under control. Also, the team, has to still be alive and able to come back for more meetings tomorrow.”
Our non-medical friend looked at us incredulously. “That sounds terrible!” She said.
But you know what? It’s not terrible at all. It’s an amazing adventure filled with love, and gratitude and grit. And you all, my incredible meeting leaders, are the people who make family medicine a practice in fostering human connection. Despite all the challenges, sometimes we do heal our patients. And sometimes, our patients heal us. Sometimes we heal each other. A lot of the time, we learn that we have been doing things wrong, and that we could do them in better, kinder, more effective ways. We learn to recognize the problems in the ways we had been thinking and we are given countless opportunities to correct the shortcomings of our experience as humans. And you can see it, if you look carefully through the smoke of all the chaos, there are a million moments of beauty in that day full of meetings.
It’s in the effort that a patient made to get to your clinic, running as fast as they could, waving their arms and chasing a bus they just barely missed down the street on a scorching hot day so they could catch their ride. They showed up in clinic, only just a few minutes late because they promised you last time that they were going to take their diabetes seriously this time. It’s the patient—a man who based upon past behavior is not exactly a favorite of your staff, who shows up as a “walk-in,” unannounced on the worst day. But you squeeze them into your schedule only to find that their sole reason for requesting an appointment was so they could tell you personally that they had gotten sober. It’s your colleague, who has wrapped up their day early but they see you’re still underwater so they take a chart off your pile and see another patient so you can get home in time for bedtime stories with your kiddos. These are the healing moments of family medicine—the moments we must carefully collect like beautiful glass marbles that we place in a jar for safekeeping. And in those moments when we need healing, we pull that jar of marbles out and hold each one up, rotating it slowly and letting it reflect the light that is our connection to each other. It is this simple practice of gratitude that protects us.
That’s family medicine.
This past year, it has been my honor to serve as your CAFP President. Like the year before it, this year wasn’t exactly as I had imagined it. The irony is not lost on me that the first time I’ve had the privilege of addressing you in person happens to be in my last month of presidency. That’s ok. Flexibility is a family medicine superpower!
My favorite part of this year was the board of directors strategic planning retreat, where we made our strategic plan. Out of that weekend came a document—our new 3-year strategic plan. It’s because of this work plan, that our activities will include several things, including the appointment of a taskforce to develop a framework on how to promote and measure justice, diversity, equity, and inclusion work. All the work is very important, but it is this piece that I must confess I am most excited about. The soon to be developed task force will center the work of diversity, equity, and inclusion, and ensure that we find ways to bake these priorities into the very structure of our organization in ways that make it permanent and of primary importance, and not just a nice afterthought that happens in addition to the other work that we do. The CAFP will lead in this work and change the culture of our specialty such that future generations will consider health equity work to be as vital as anything else we do in medicine. And studying the root causes of the malignancy that is racism in medicine will be as important as understanding the pathophysiology of diabetes or any other disease.
But to do this good work, we need to ensure that our doctors and learners are healthy and have the resources they need. That is why the other three strategic goals are so important. We must redesign our healthcare system in ways that prioritize the health of patients above all else, dismantling perverse incentive structures that only serve to create barriers.
We must educate our communities and legislators about what family doctors do so it makes sense to them to support our work. And we must regain our joy. We must reject working conditions that cause moral injury, but that is not enough, we must also redefine our profession to be one that is considered a privilege to participate in because it is so rewarding and inspiring. Let me be clear, we are not asking to make the practice of medicine easy—it will never be easy. It will always be challenging, and require tremendous skill, emotional fortitude, and dedication. But we are looking to make the practice of medicine sustainable and safe for its professionals. If we don’t heal our own wounds, we will bleed on those who didn’t cut us. We must stop the hemorrhage of bright young people from our field. We must do this if we are to have a next generation of leaders. That is why this is a strategic goal for us.
I believe this organization is on the right track. I believe we have members who are, as my friend Jay Lee would say, “brave enough to become the physicians we wrote about in our personal statements.” I believe we have the brightest, most talented staff—people who can transform great ideas into action, who can turn noes into yesses, and who are honorary family physicians. I believe our CAFP Board and committee members are spirited and passionate leaders who collect marbles in glass jars and have the drive to create something bigger, better, and more aspirational than what we have now. The four goals in our strategic plan reflect who we are, and will serve as our North star for the next three years and beyond. I continue to believe that this organization is a national thought leader for our profession. We have among us, leaders who will change the very culture of medicine and society. We are proud of people like Jay Lee, and Jasmeet Bains, who grew up in the California Academy and are now answering the leadership call. Each of us here has that ability. The CAFP is an organization full of leaders. Let’s all answer that call. We have a lot of work to do, so let’s get to it.
