I get called “ma’am” a lot. It happens more frequently in the winter months when I’m wearing clothes that don’t give clues I’m a man. I suppose people assume that because I’m short, I must be female. When they discover the error, they are of course very embarrassed and make apologies. It is interesting that this is the response since we all make innumerable subconscious assessments every day about the people around us. Having experienced this bias first hand, it is eminently important for me to consider what shapes other individuals’ experiences, because everyone has a story. Here is mine.
When I was three-and-a-half years old, I was diagnosed with peripheral T-cell lymphoma. Following nine months of chemotherapy and relapse, it was eventually treated successfully with a homologous bone marrow transplant and full-body irradiation. Clearly, no long-term effects hold weight against saving a child’s life, but blasting a four-year-old with radiation is not a benign procedure. From the earliest days of my memory I have dealt with numerous chronic illnesses, not least of which is acquired short stature.
My interaction with the medical field began very early. Each step of my journey as a patient paved the road to my chosen career as a Family Physician. As with many cancer patients, my oncologist functioned as a primary care provider. But I saw a general pediatrician, endocrinologist, ophthalmologist, orthopedist, cardiologist, etc. Without knowing it, I was comparing the continuity of my oncologist, who I saw twice a year for two decades, to a rotating panel of specialists. These specialists had the luxury of telling me things like I would not grow more than five feet, I would have to start high school in a walking cast following an osteotomy, and that I had bilateral cataracts, so I’d have to wear corrective lenses. That’s not easy news for a pre-teen.
My oncologist, however, was always able to offer counsel about these travails, but not in the way one might expect. Rather than focus on my limitations, she lauded my school performance, my sports participation, or my musical ability. She understood my illness not as a lament for what could have been, but as a celebration of what was. Without knowing it, I was learning an invaluable lesson about how to practice medicine.
It seemed natural to pursue a career in healthcare, but at the time I barely knew what specialty choices were available, much less which was the best fit for me. I did know that the continuity of care that my oncologist offered would have to be an integral part of whatever I chose. In college, I became attracted to global health, and I went on a medical service trip to Guatemala. There, the need for healthcare was undeniable, but I would soon realize this need was not exclusive to developing nations. Returning to the US, I began working as an AmeriCorps volunteer at a community health center in a diverse and impoverished area of Seattle. I was stricken by the similarities to Guatemala, as this inner city population also desperately needed consistent, accessible, and effective healthcare. The doctors provided that care with compassion and cultural competency. With them as models, I was inspired to a career as a physician working with the underserved.
In medical school, my interest in underserved populations has continued. I am a member of CU-UNITE, an interdisciplinary track that provides clinical training in urban settings. I have taken electives in healthcare policy and advocacy to address inequity politically. I have been involved in a longitudinal research project, C-STAHR, demonstrating ethnicity’s impact on patient experiences. Through this, I have come to the conclusion that the most effective way to resolve health disparities is with broad-spectrum, community-centered primary care.
Family medicine leads the effort to make primary care available to all sectors of society. The specialty is focused on training comprehensivists to care for challenging populations, such as the homeless, immigrants, and the uninsured. I spent a month at the Ft. Lupton Salud clinic for my rural clerkship during third year. I remember waking up in the morning and being excited to go to work, a rarity in my clinical rotations. Every day was different. I might have a prenatal exam, well-child check, traumatic injury, and geriatric visit all in the same morning. Nothing in medicine has ever been more satisfying than to listen to a patient’s story and provide a mutually-agreed upon solution to improve that person’s health. We have the opportunity everyday to make a connection that could change someone’s life.
People come to the doctor with a great variety of expectations and circumstances. Often, an interaction with a healthcare provider is a very vulnerable time. Furthermore, not all people are equally advantaged and many lack access to healthcare. Family physicians understand a person’s health is inextricably linked to environment and social context. They empower patients to maintain wellness by providing care to communities that need it. With my own experience in mind, and an open ear to others’ stories, I am excited to move into the next phase of my training as a family medicine physician.