Family Medicine Vital Signs

By Joel Wecker, MD

Most of the time people have reasons for their actions. Different backgrounds, values, and situations guide them to completely different paths. Values are not tested in the jobs we take or life path we are on but on the individual interactions we have everyday. I never would have expected to be a doctor 20 years ago, but here I am, about to finish residency and wondering how much my reasons for continuing in medicine parallel my reasons for getting into medicine.

20 years ago I thought I was afraid of blood. I passed out the first time blood was taken and never felt inclined to help those who were injured when I was young. But over time I was exposed to the medical field through personal battles with ulcerative colitis and depression, family medical problems seen first hand in my grandparents and sister, helping a close friend get through the first year of college with some serious orthopedic problems. Through all of these encounters I was becoming more familiar with a field that had originally seemed foreign. Exposure to medicine is what helped me come to realize the possibility of helping people through healing. Ultimately, that is what I was searching for, a way to help people who were truly in need. There are countless ways to help people, but I linked the way that I was helped most (through medicine related to ulcerative colitis), with things I liked (science and hands on work), and opportunity (of which there is plenty in medicine). This lead me on a long path to where I sit today.

The long path has been riddled with challenges, which likely will not come as a surprise. Getting into medical school has become outrageously competitive, and once you are in you have plenty to struggle through. Then residency is one of the toughest challenges I have yet faced. I always wanted to go through the “hoops” of medical school and residency without being “changed.” I wanted to be able to stay focused on the goal of helping those most in need. But our advanced medicine comes with some difficult challenges. One of these is financial. When the average graduate comes out of medical school with a debt of  $250,000 it is tough to focus on other people’s problems. Unfortunately, some of the most important jobs are some of the worst paying, though loan repayment is a great option with some positions. Then there is the difficulty of being in a constant “work” state of mind. In school, you study and then you may have time for work on the side and other interests. But residency is a time-sucking job that allows room for very few old hobbies and even less time for growing outside of work, commonly in a totally new town. I used to be very active in volunteering in the community but have found little time to do this in residency. Not only is it difficult because I work lots of hours and have a new job/rotation every month, but also I am fairly new to Salt Lake City and it takes time to learn a community before you can really contribute to it. That being said, volunteer work was central to my life before residency and I have had to establish a new identity to get through residency.

So how do we stay focused on those reasons for getting into medicine during residency? Well, this is the perfect time to practice those reasons for getting into medicine in our day-to-day activity. Social injustice is all around us, and residency puts us into the mix of it. We work with the homeless, abused, disabled, tortured, and suffering every day. The shear numbers of people that we see in a large variety of settings makes social justice a daily issue. We can be advocates for social justice by treating all patients equally regardless of their background; they should not be faulted for the situations they have been thrown into. To paraphrase a doctor I worked with at Cook County Hospital, “We will treat every patient to the best of our abilities using evidenced-based medicine, regardless of whether they will continue this on their own; we will do what we can.” Sometimes these patients can be thought of as difficult, maybe not adhering to diet, medications, or some other expectation that we have for them. Unfortunately, these expectations may be out of reach due to language, financial problems, anxiety, or other issues. And this is where we get to be active in social justice during residency! We get to dig right into these issues and try to make changes. Many times it is something simple like coordinating a medi-van, interpreter, surgeon, or just getting the patient to carry their medication with them.

We can be very helpful in many situations, however when poverty plays a role, resources are often scarce or there is not much hope of change in the near future, then we are able to be there for these patients, by declaring our insecurities and limitations while still offering our support. This points out one of the most powerful tools I have come across, compassion in the face of inability to create change. This is helpful not only to the patient but also to the provider, as often there is unrest in our hearts when we cannot help these people. Residency takes over your life but also provides the opportunities to make something of it.

Joel Wecker, MD is a third year Family Medicine Resident at the University of Utah School of Medicine.