Osman Sanyer MD
As a teaching family physician, I am frequently asked, by friends, students, and colleagues working in other areas of medicine, to share my thoughts on which skills and traits best define the specialty of family medicine. My customary response is, I suspect, fairly similar to the response that would be offered by most family docs. It’s something that varies in length and enthusiasm based on my energy level and the audience.
My “stock answer” is a mash up of talking points that includes some combination of the following: Family physicians are able to treat the entire family for ninety percent of the health issues that may arise in a household. We integrate prevention, community health concerns, lifestyle modification and an understanding of social and emotional circumstances into the advice and treatment we offer to patients. Family doctors are fortunate to have the opportunity to develop relationships with the people who seek our care that will often last for many years. The mutual understanding about communication styles and personal preferences fostered by these longstanding patient-doctor relationships allow us to work for and with our patients in a model that is collaborative and usually based on shared decision making between doctor and patient.
All in all, fairly predictable stuff (and accurate as well).
In follow up, people often ask me what it is that family doctors are best at doing, seeking a comparison with other types of physicians. It is harder to generate a simple answer to this question. That said, I am more motivated to come up with a meaningful response, as this question touches on the aspects of my career as a family doctor that I find to be among the most compelling.
I’ve come to understand that we are best at two things:
- At our best, family docs are very good at knowing what we don’t know, where to find the answer, and how much time we (doctor and patient) have to safely find that answer.
I think this is a fairly straightforward and self-explanatory part of the response. The second part is more interesting, and harder to define.
- Family docs are experts at hearing, remembering, and retelling the stories of our patients.
There is plenty of literature supporting the healing power of narrative storytelling, and story listening, in treating illness and trauma. These acts of remembering and retelling can be a challenge for a busy family physician. Depending on the practice structure, most full time family physicians will care for a population of 1400 to 2000 patients. That is a lot of stories to remember well, both for detail and impact.
One way to remember our patients’ stories is to write them down. History is replete with physicians who are best remembered as authors. Starting with St. Luke and Maimonides, traveling forward to Copernicus, Locke and Keats, to modern times with the likes of Chekhov and William Carlos Williams, and most recently writers like Sacks and Verghese, there have been hundreds of physicians who have remembered and told their patient’s stories through published writing.
Most of us will not have the skill, time, and motivation to write down these stories from our patients for publication. I think, however, the exercise of writing for ourselves, can help us find meaning in the stories, both for our patients and for ourselves. There is not a preferred writing form, simple journaling is as effective as any other format.
A number of workshops and exercises for writing physicians have encouraged the use of shorter formats. Paring a story to 55 words, 12 words, even 6 words, requires the writer to drill down on the aspects of a story that are the most critical. The exercise in brevity requires us to find the heart of a story. The work required results in lasting memory and, more importantly, a lasting sense of meaning. I think we all are better doctors, and more able to see the richness of our daily work, if we practice writing, whether in short form or longer.
Personally, I find the 55 word format to be my favorite length. It allows enough latitude to tell a story without having to work too hard on choosing the words. But, the writer is still required to make choices of economy in finding the phrases that capture the most important images from a story. We are required to hear and remember with intention. And, when we do so, we are better doctors for it.
In closing, and to support the points above, I offer the following:
God took your only child. Punishment, you said, for whom you chose to marry.
Your grief withered you.
Futile months of visits, tests, and worried calls followed.
Then, unexpectedly, you returned smiling…. healed.
Sharing your dream of approaching the near blinding light, and the boy who took your hand and
turned you back… to live…
Osman Sanyer, MD is a Professor (Clinical) in the Department of Family & Preventive Medicine at the University of Utah School of Medicine.