Family Medicine Vital Signs

by Christine Kwon, MD

As family medicine residents, it’s a given that we have to work on other services. We’re expected to adjust quickly and survive with professionalism and grace in a new environment that can feel hostile at times. Over the last two years, I feel that I have gotten pretty good at walking onto someone else’s home turf and pretending I know what I’m doing long enough to eventually become a functioning member of the team. Despite my complaining, I do actually appreciate learning with the different residencies. I’m getting a chance to work with the specialists and learn with the residents in those fields. It’s an opportunity to work with the best, so I try to take advantage of learning opportunities. However, I’ve also found myself thinking if I get one more “how do you not know what this is” look, I might flip a table.

Most other residencies produce experts rather than jacks-of-all-trades. Because of this inherent uniqueness of family medicine, I think the other residencies forget that for a significant portion of our residency we are off servicers. They forget that we have to learn more than just the medicine on these rotations. We have to adjust to a new culture, a new hospital, and a new EMR with new acronyms. We are expected to figure out how to function well on the team while stumbling through obstacles that other residents don’t have to overcome.

And yet, the more I work as on off servicer, the more I realize that we all have blinders on. They are a tool that we unconsciously use. We’re so busy trying to survive residency that we don’t have the bandwidth to consider the experiences of other residents. They help with the tunnel vision to see the light at the end of the tunnel, but they also keep us from remembering that every residency is different and prevent us from being as patient as we probably could be. These blinders impede us from remembering that things we find normal in our residency might not be so normal in other residencies. I was so busy being frustrated at the other residents for not understanding me that I also failed to understand them. As it turns out, we all have blinders on.

I have found OB to be particularly challenging as of off servicer. Anytime I’m on the L&D deck, I feel pretty incompetent. I’m never quite sure if I’m doing the right thing. But one day, as I sat trying to ‘fake it’ to the best of my abilities, I overhead an OB resident struggle to replete potassium. Trying to be helpful, I suggested doubling the amount of potassium, as 40 mEq wouldn’t be enough. She adamantly told me that she was sure the 40mEq should be enough. She whipped out her phone to recalculate how much to replete and again said, with certainty, that she was right. I remember thinking in that moment Repleting potassium is literally the easiest thing to do in the world. I was shocked she was using her phone to do the math, and that she was still calculating it incorrectly. We do it all day, every day on our medicine rotations. But I had forgotten that just because we did it all the time, didn’t mean that everyone did it all the time as well.

While I was in the MICU, I was having trouble navigating the EMR and the IM intern noticed. I think he was trying to be helpful and asked me, “So, [insert slightly longer than necessary pause and a mildly concerned look] how many inpatient rotations have you done?” I paused trying to figure out if he was only asking about adult medicine, or did OB and pediatrics count too? So, I asked him. He looked pretty surprised and admitted that he had forgotten that we did “all that other stuff.” He didn’t wait to hear my answer after that. Obviously, I know the difference between internal medicine and family medicine, but to be honest, until I had to think about it that minute, I had sort of forgotten that IM didn’t do OB and pediatrics too. Until I was truly reminded of the difference, I had forgotten that not all residents did a little bit of everything, and I’m betting that they forget that we do. The blinders we have on make it so easy to assume that our experiences are universal, which ends up affecting how we interact with other residents.

We all have our blinders on. I think it goes without saying that all residencies are not the same, but in the daily grind, it’s easy forget that our experiences aren’t universal. We expect others to be as comfortable with certain parts of medicine as we are, while paradoxically expecting them to forgive our weaknesses. Residency isn’t easy. It’s hard for everyone. It’s easy to be frustrated at that apparent lack of empathy when you’re an off servicer, but I think we all forget that we’re all exhausted and all just trying our best. We’re all so used to our own residency experience that that these blinders, that we unwittingly wear, hide the inconvenient truth that all residency experiences are not universal. To be clear, even with this revelation, I still get frustrated. But I think it has made me pause and remind myself about the blinders. It’s difficult in the moment, but I’ve found that remembering that everyone has blinders has made it a little easier to be an off servicer.

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Christine Kwon, MD, is from Centennial, Colorado, and chose the University of Utah because of the unique opportunity to work in both community and university hospital settings, the community outreach programs, and the friendly faculty, staff, and residents. Her medical areas of interest include integrative medicine, hospice and palliative medicine, international medicine, patient education, and community outreach.