In our last
Progress Notes installment of the year, med student Devorah Donnell asks us all to resolve to be part of the change we want to see in primary care. Read her story, then take the pledge to be part of the change. Help make everyone's New Year happy and healthy!
By Devorah Donnell
I met my patient who sat with her eyes fixed on the floor, looking skeptical and tough but on the verge of tears. In her presence, the room felt sad and dark despite the sun streaming in through the blinds. Ester was a 50-year-old female who had gone to the emergency department because her co-workers thought she was having a heart attack, but when it was deemed non-cardiac chest pain that was most likely associated with anxiety, she was sent to the psychiatry office where I was rotating. As we discussed her severe depression and suicidal thoughts, multiple health concerns, and family history of death at a young age, she shared with me the most important factor: She had never been to a doctor. At 50 years old, she had seen a doctor for the first time that she could remember the day before in the emergency department. She had never seen a primary care doctor.
One year earlier, while signing up patients at UConn’s free mobile medical clinic for migrant farm workers, I greeted a family that timidly approached the big, empty metal warehouse where we were set up on a farm. Guillermo stood next to his wife who held their 6-month old infant fussing in her arms. After I asked who would like to see a doctor, Guillermo and his wife signed up, explaining that their infant did not need to be seen because “she was not sick.”
Neither Guillermo nor Ester understood that everybody needs primary care. Nor do the patients I meet who have an orthopedic specialist, endocrinologist, and cardiologist, but no primary care physician. We live in a culture that doesn’t value comprehensive, preventive medicine. And this devaluing of primary care begins where health care providers are trained.
Most people who enter the health care professions do so wanting to do the best for their patients, get to know them well, and keep them healthy, which is what primary care with its emphasis on prevention and long-term relationships is best suited to do. I’ve seen primary care help a 40-year-old woman finally quit smoking, a 54-year old male with hypertension start exercising, and a 26-year old female better control her diabetes so she could start trying to get pregnant.
Yet when I express my passion for primary care, the reflex responses I get usually include “You’re too smart for primary care,” “All they do is refer out,” and “Primary care is a waste of a medical education.” As a student already feeling the challenge of swimming against the current of specialty medicine, it is especially discouraging to hear these types of remarks from mentors, professors, family, and friends. Primary care makes a significant impact on the lives of those who have access to it. People need good primary care physicians, but the unrelenting pressure to subspecialize in medical school sways bright-eyed students away from primary care. Our culture – both in and out of medical schools – values specialty medicine and devalues primary care so much that it seems like everyone knows why not to go into primary care, but no one knows why it’s so important.
The Primary Care Project aims to change all of that. It is a campaign to collect 5,000 signatures on a pledge that declares signees’ belief in the value and indispensability of primary care and the urgent need to train more practitioners in the field. The signatures will bring together specialty and primary care providers, students, educators, leaders, and most importantly, patients – the ones who have the highest stake in the future of primary care. These signatures will be a tool for student organizers to demonstrate that we want policies, curriculum and a campus culture that are conducive to regrowing the primary care workforce.
While most readers of this blog know what it’s like to feel alienated and alone in the midst of the discouraging remarks and sub-specialty-oriented curriculum in health professionals training programs around the country, your friends and family may not even know that this goes on. So while you spend time with them this holiday season, why not tell one of them about it?
I’m asking each of you to sign the pledge
and join me in making a New Year’s resolution to discuss the pledge with at least one non-PCP friend or relative—uncles, aunts, cousins, parents or those childhood friends that you only see over the holidays. The pledge can be a great tool to start the conversation about primary care, promote education about its realities, and revitalize primary care through changing the primary care culture in both medical and patient communities. As patients are the ones who stand to gain the most from a revitalized primary care workforce, if they knew the ways in which some schools and medical institutions undermine the training of that workforce, they could possibly become our most vocal supporters.
Let’s do something starting right now so that everyone will one day know that they need primary care and that they can get it. Together, our voices can bring change.
Devorah Donnell is a 3rd-year medical student at the University of Connecticut School of Medicine in the Urban Service Track and Combined B.S./M.D. Program in Medicine. Interested in primary care and community service, she is co-president of the UConn Family Medicine Interest Group chapter and she was a coordinator in 2012 of UConn's Migrant Farm Worker medical clinics, where she has been volunteering since 2005. Devorah enjoys being involved with Primary Care Progress, its Coaching Team, and bringing primary care advocacy to her community as the founding president of the UConn PCP chapter. She loves traveling, baking, and spending time with family and friends, and looks forward to a career as a primary care physician.