The pluripotent stem cell


By Nell Hodo, MD

I am a pediatric hospitalist. And I am a family physician. This is, to say the least, unusual, and perhaps even odd.  And yet, I could not be happier in the work I do, and I feel that my training in family medicine allows me to approach patients and their families with a unique perspective. Not better than my pediatric colleagues, but not worse either, and definitely different.

I didn’t start out planning to do this with my life; I intended to be a full-spectrum family physician, with OB (and I was – for seven years following residency).  And then, I wanted to do something different, but I did not know what.  I made a list of everything I liked about my job, and everything I didn’t, everything I thought I was good at, and everything I wasn’t, and then I highlighted all the things I wanted to do more of, and the skills I thought I would like to either improve or emphasize.  The result was that I became a hospitalist.

Making a complete career change was scary; there were a lot of disorders and conditions that I had not managed in a very long time…or ever.  I had been a community physician for so long, to be the sole attending physician at night covering dozens of medically complex patients in a tertiary care hospital – it was daunting, and in the first months I was terrified I would make a mistake, that I would do something stupid, and that I would be an embarrassment to my field.  I was afraid that people would say, ‘well, of course she did that, she didn’t know differently, remember, she’s not a pediatrician’, or (worse), ‘I don’t think we should have hired a family doctor’.

Well, that never happened. And in the process of adjusting to my new job, coming to love it, and (I think) becoming good at it, I realized something I had known about myself, and about family physicians in general, for a really long time: I can do anything. WE can do anything. We can provide whatever level of care is needed where we find ourselves. If we don’t know how, we can learn – as long as we are willing to do so and to work hard.

Family physicians are like pluripotent stem cells, capable of changing and evolving to fit the needs of their community, their job, their skill set, their interests.  We are capable of being and doing anything.  I think the fact this is the case explains the variability we see in our field.  We all know family docs who do OB, or see kids, or do a lot of procedures, or have expertise in geriatrics, or do nursing home work, or do urgent care…we might know some who do all of these, and we definitely know family docs who do some, we may know those who do none of these, but choose to focus on something else entirely.  We all know this variability exists within our field, but what we may not know is that we are ALL capable of doing ALL of these things, even if we do not at present. If we need to learn a procedure, we can; re-privilege in something we haven’t done in a decade – with proper mentoring and proctoring, we can; take on a totally new area within medicine – we can; switch jobs completely for whatever reason – we can.

Part of the reason we can do these things is the nature of our training. Not just the broad base in medicine across the lifespan and physiology and pathophysiology, but also the firm grounding in mental health/psychiatry, the biopsychosocial model, and practical skills such as practice management, all of which family medicine training provides.  When and where in medicine do you not need to understand how mental health affects physical health? Or how to provide motivational interviewing? Or some basics on the business of medicine?  I have found that my background in these areas, which came from family medicine residency and then family medicine practice, has served me well in my hospitalist role.  It is a different approach, a different perspective; not better, just different.

Most importantly, however, for our flexibility as family physicians, is that as generalists we know that we will never know it all. We live with uncertainty every day. And so, it is perhaps not a stretch for us to admit lack of knowledge, and then fill the gap; to look at something new, and decide to take it on.  Just as we might read up on the rare diagnosis one of our patients was just given in order to better care for her in clinic, we can teach ourselves, or seek appropriate teachers of, the skills and knowledge required for whatever type of work we choose to do.

My personal career path has been, well, circuitous. But it has never been boring, and I do not think it ever will be!  And if that ever changes, well, one thing I know for certain is that I can choose to go in a different direction, and be successful in it – I have my family medicine background to thank for that.  You just never know what that pluripotent stem cell might turn into next…..

Nell Hodo, MD is a pediatric hospitalist in Salt Lake City, Utah.

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