by Christine Kwon, MD
I’ve had a love/hate relationship with family medicine from the beginning. I started medical school certain that family medicine wasn’t for me. It was too broad. There was too much to know and I’d never know enough to be a competent doctor. So I was pretty shocked when I fell in love with family medicine during my third year rotation. As a current resident, I don’t regret choosing family medicine. I still love the diversity of the clinic visits, the procedures, and the continuity of care. The fact that I could take care of multiple generations of a family or that I could take care of children starting from the womb until they themselves are pregnant still blows my mind. As much as I love family medicine, turns out that the fears from medical school never went away.
Now that I am in my last year of training, I find myself more and more stressed about my career choice. Seriously, what the hell was I thinking, choosing family medicine?! There still is too much to know and I’ll never be an expert in anything. In a year, I’ll be my own person, practicing medicine without anyone supervising me. Patients are going to trust me to help them and I have no idea what I’m doing. Even with our bread-and-butter diseases like HTN and DM, I find myself increasingly consulting our pharmacy team to confirm I’m making the right decisions. What’s worse is when I look around, none of the other third years seem to be having this crisis, making me feel even more inadequate. With these worsening fears, I’ve spoken to more attendings about how I don’t feel ready to be a real doctor. The insight I’ve gleaned from these conversations has been pretty reaffirming and has helped me put things into perspective.
Dr. L is a crowd favorite amongst the residents and, as a more recent graduate of residency, she’s been able to empathize with my fears. She’s acknowledged my concerns and confessed that she felt the same way not long ago. She was worried that she might not know everything too, but told me that the key was just being able to know where and how to find the next steps. She continued on to tell me, “It’s impossible to know everything, there’s too much to know. We all have our blind spots.” This is not the anything new, I’ve been told this since I was a medical student. The reason it helped me was because it was her saying it. She’s basically fresh out of residency, but always seems to have the answers or knows exactly where to find them. It’s easy to assume she just knows everything and that she is inherently a smarter person at baseline, but to hear that someone who is so competent and knowledgeable was feeling this way not long ago is incredibly reassuring. She has her blind spots, like everyone else, but is still an excellent physician who I trust implicitly. The conversation gave me hope that maybe this feeling of inadequacy is a rite of passage for third years and I’m just going through it later than everyone else.
Dr. S is a physician who I greatly admire and is more than one year out from residency. I’ve always thought she knew everything and she’s considered to be an expert in transgender care and EPIC. During one of our conversations, she once freely admitted that since residency, she has let go of her musculoskeletal exam skills. She confessed that she doesn’t feel comfortable diagnosing MSK injuries and that she overly relies on the easily accessible sports medicine doctors in our clinic. Despite this self-declared hole in her knowledge, she is remains a fantastic physician and her patients love her. She is also considered to be the most knowledgeable transgender care providers in the University system. I often call her ‘the guru of transgender care,’ because she is. She has turned one of my misconception about family medicine on its head. She continues to practice general family medicine, and she has managed to become an expert in two fields (EPIC isn’t really medicine, but I’d argue that being proficient with the EMR system is as important as medical knowledge) while still recognizing her blind spot.
I’ve been particularly lucky to have such great mentors. They’ve helped me to look beyond the fear of my personal inadequacy and the future, and to acknowledge that while it is impossible to know everything, it is still possible to a competent physician. It’s comforting to know that everyone acknowledges that they have blind spots, whether they are one year or several years out of residency. I’ve always had some anxiety about telling my patients that I couldn’t provide a diagnosis to their symptoms. I was afraid that would make me seem like a fraud, confirming my imposter syndrome. They’ve helped make it much easier for me to admit to the patient that I don’t have a diagnosis right now, but that we’ll work on figuring it out together. I used to think that residency for family medicine should be longer, so we have more time to learn everything we need to know. The problem with that is that we never really stop learning. That’s the nature of our jobs. Medicine is constantly changing and when we have our hands in all the cookie jars, we have to learn to adjust to multiple constantly moving targets. When that fact overwhelms me, I just remind myself that even the best doctors have their blind spots, but they still manage to provide excellent patient care. It is impossible to know everything, and our blind spots don’t make us bad doctors. They make us human and show us where we can focus our learning for that week.
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.
Family Medicine Vital Signs 