Family Medicine Vital Signs

by Katie Myrick, MD

Family medicine residency is hard. Turns out, learning how to be a good doctor for all types of patients and disease processes doesn’t come easy. Here are some notes on how to navigate some of the challenges I encountered in the process.

Challenge #1:

As a resident, you’ll often be an off-service learner. This is hard for two reasons. First, things will often be unfamiliar. You’ll start most rotations with a new cast of bosses and co-workers and a new patient population with new pathology. Sometimes it’s hard to keep up. Second, you will often be, as one of my co-residents described it, playing in someone else’s house. You’ll have to follow their rules and adhere to their standards, but you also may be subject to a different level of scrutiny.

The silver lining:

You’ll become facile and adaptable; you’ll learn a lot about medicine; and you’ll make new friends.

The advice:

• Stay curious: When appropriate, ask your specialist colleagues questions. Store the pearls you learn in your phone.
• Stay humble: Accept feedback graciously. You will learn a lot this way.
• Enjoy not being the expert: Some day, the buck will stop with you. Enjoy the privilege and freedom of being the learner.
• Be a team player: If you remain engaged and pitch in to help, even if it’s not strictly your responsibility, you will be offered more autonomy and more opportunities.
• Make friends: The reason for this is 3-fold: 1) If you have friends at work, you will have more fun; 2) It’s nice to have friends outside of your specialty–it helps you maintain balance; and 3) Every family doctor needs a rolodex of specialty friends that they can curbside when they have a question about something weird or new.
• Be patient with yourself: At the beginning, no one expects you to know as much as your colleagues who are in more specialized programs. Be patient with yourself while you learn.
• Shake it off: if someone is rude to you or dismissive of you, don’t take it personally. Life and medicine are hard. Sometimes, people don’t prioritize niceness and patience with trainees.

Challenge #2:

You’ll struggle with the idea that some people doubt your authority because you’re a “jack of all trades and master of none”.

The silver lining:

You’ll realize you are a jack of all trades, and that what you have chosen to do requires a very intelligent person. The list of your skills will be very long. When it comes to things that are beyond your level of expertise, you’ll be excellent at triaging.

The advice:

• Take pride in your work. The specialty you have chosen is difficult, but it is very important. You are valuable–not only to your individual patients, but to the system as a whole.
• And if you need to feel seen… Watch Dr. Glaucomflecken’s “How to Ace Your Family Medicine Residency Interview”, and then read the comments 🙂

Challenge #3:

You’ll have a lot of clinic. Depending on the structure of your residency, you may even have to split your day between your continuity practice and another service.

The silver lining:

The transition from residency into attending practice will probably be easier for you than for your colleagues who, upon graduation, have a lot of clinic but didn’t do much of it during training.

The advice:

• Decompress: Use your commute to and from clinic to unwind with a phone call, music, or meditation.
• Set yourself up for success: When possible, finish your notes between patients, and finish your notes before you go home; you will feel much better if you do.
• Regroup: Take a breath or a moment between visits; your next patient won’t notice if you come into the room one or four minutes later, but this time might make a world of difference to you.
• Trust the process and be kind to yourself: Clinic is hard, but you will get better at it over time.

Challenge #4:

Because of your availability as a resident, you will find yourself seeing patients with more medical and social chaos.

The silver lining:

What doesn’t kill you, makes you stronger. While you are managing the poorly controlled diabetes, hypertension, and chronic pain of a patient with cluster B personality traits, you’ll not only be learning about diabetes, hypertension, chronic pain, but also how to set boundaries, make an agenda, and develop therapeutic relationships. And if, despite all your empathy and efforts, it doesn’t work out, you’ll learn how to diplomatically ‘break up’ with a patient and send them on their way to someone who might be better disposed to help them.

The advice:

• Set realistic expectations: It took years for the patient to get this way; you’re not going to fix them in 3 visits (or maybe your whole residency). Be proud of the little victories.
• Maintain emotional boundaries: Absorbing the emotional burden of a patient’s challenges will not help you help them. You’ll be more effective if you can maintain some level of objectivity. An attending reminded me once that the best way to help someone out of a hole is not to jump down into the hole with them. Take a deep breath; stay above ground; and give them the tools they need so they can start climbing out.

This is, by no means, a comprehensive list of the challenges you will face in your residency; it’s just a list of a few things that felt specific to primary care training. You might feel unsure about your career path or your ability to survive these three or four years, but one day, you’ll be at the end looking back and admiring all that you learned and overcame during the journey. And then, finally, you’ll look forward to all the people that you’ll help in your career…and all the nights that you’ll get to sleep without interruption in your own bed, the weekends off, and the psychological security that comes with familiarity and routine. Keep your chin up. You’ll get there.

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Dr. Katie Myrick was born and raised in Asheville, North Carolina. She received both her undergraduate degree (B.S. in biology) and her medical doctorate from The University of North Carolina at Chapel Hill. Her professional interests include full-spectrum care, public health, health services research, care for Spanish-speaking populations, care for the underserved, obstetrics, pediatrics, and reproductive health. In her time outside of work, she enjoys spending time with her husband Wood, running (for sport or pleasure), hiking, cooking, thrift shopping, and keeping up with her family and friends. Katie chose the University of Utah because of the thoughtful community of residents and faculty that she met when she visited. During residency, she wanted to nurture her interests in pediatrics, obstetrics, reproductive health care, and care for the underserved while continuing to improve her mastery of the Spanish language. She found that she could do all of that (without having to sacrifice natural beauty or access to the outdoors) at The U!