Family Practice

I’m at the annual meeting of my state family medicine association this weekend, sitting in the business sessions; I see a lot of women and there are some medical students and residents and that is a great thing to me.   I’m catching up with some residency friends, some of whom are a lot more involved in my Academy than I am, and some of whom are budding members of the Old White Guys Club™ coming in hung over after a night of drinking and smoking cigars and eating Denny’s.  I am not a budding member of the Old White Guys Club™, and I never will be.  I will one day, if I let myself, be old.  I will always be white.  But I will never be a guy.

In my row, there are two Old White Guys™ and me; our president-elect is a woman who used to be my advisor in medical school.  I’m looking around the room at all the white hair and at all of the newer people around me, in between exchanging hugs with men and women alike, thinking about drinking single-malt bourbon and smoking cigars and how that is the kind of party I will not be invited to any time soon, but they are all so glad to see me and when I was a medical student, I was the only one who came sometimes, and maybe it’s familiarity alone that makes them glad.  I’m thinking about how when you do a search on my state Academy’s home page for “GLBT” or any other permutation, or “gay”, that there are no results, but the AAFP Advocacy committee is considering resolutions with titles such as “Healthy benefits of Same Gender Marriage – Not Just a Social Issue” and wondering if maybe I should have brought a resolution to the table this year, in this state, on the issue.  After all, we are family practitioners.  And for the first time I’m putting something on my CME needs assessment, when they ask what you feel like you need more education on.
But all of that is inside my head, and outside I’m making small talk with the Old White Guys™ in my row and taking a good-natured ribbing from the other doc in my town for seating with a different district (I have privileges in two counties, which are in two separate districts).  I’m renewing some old acquaintances with people who would never invite me to drink single-malt liquor and smoke cigars but who are happy to have me on their commissions.  Among all of this I’m bustling out between sessions now and again to feed the Cap’n, since we didn’t think to ask if we could have a fridge in our room so we have no stored milk, and the topic turns at one point to women in medicine.
“We have a PA in our office, has school-aged kids, and all the dance recitals and things are at like 3:30.  So we try to accommodate her, but…”  And he’s talking about how the men in the office never take time off to go to their kids’ things; how it seems like they’re put-upon sometimes to accommodate this woman’s needs.  I’m cringing inside, already, and I know I have to say something – because this is the secret core of the Old White Guys Club™ in medicine: we can’t let women in because they won’t put the work first.   So I make my opening gambit. 
“But they ought to.  They ought to be as much a part of their children’s lives as the mothers are.”  I believe this; I believe that children need all of their parents to be involved with them.  And I believe that this is part of feminism, that if we are only going to argue that women ought to be able to work just like men that we are not making the argument that all people are created equal.  Men ought to be able to work just like women too.  And I’m ready to argue this one against him but he makes a surprising turn right about then, and breaks ranks with the Club™.
“I think that’s part of what’s happening in medicine – you have 50% of medical school graduates being women, and it’s changing the face of it.  There’s more focus on family.  I don’t have kids, but I bet if you asked a lot of the kids in my generation, they wouldn’t say they had a bad father – because it was mostly fathers, then – but they’d say he was never there.  I think we need to find some balance.  I think men should be able to take a few weeks off when their wife has a baby.” 


Balance.  There’s the word that defines my entire struggle with family medicine; the complex and delicate dance between personal concerns and patient care.  It’s something I’ve felt acutely through two pregnancies, through struggling with breastfeeding and pumping and working, doing midnight deliveries and coming home to a husband who’s just finished feeding the baby a bottle because he didn’t know when I would be back.  It’s sending my nurse over with a note to pick up my daughter from daycare because at 5 PM I still have patients to see.  It’s children who know where the crayons and the snacks are on the OB unit and Saturday mornings spent watching DVD’s in the doctor’s lounge.  It’s something every female physician with children I know struggles with. 
We spent some time talking about it, he and I – a childless Old White Guy™ and a young woman with two kids and a husband with his own professional aspirations.  The culture is changing, but slowly, and I’m afraid it’s only changing for some of us.  I hear physicians bragging on forums about only taking two weeks of maternity leave; of coming back after surgery before they would ever release a patient; of missing their children’s activities and family vacations and all the wonder of growing up.  They veil this under the guise of it’s for the patients but I wonder sometimes if it’s really hubris; if we as a profession have become convinced that the sun can neither rise nor set without our surgical intervention. 

I disagree.  I think we have forgotten Luke’s admonition of “Doctor, cure yourself!”  There is a need for balance.  There is a need for us to be models – not only in our professional lives, but in our personal lives.  How can we talk to people about their children when we do not even know our own?  There is value in school plays, in sports events, in dance recitals and taking your children to the museum.  There is just as much value for men as for women, and perhaps even more when your child has all of his or her parents there.

I do primary care.  I do preventative maintenance.  I spend hours every day talking with patients about taking care of themselves, about balancing their lifestyles, about making choices that make them healthier.  It makes you a better person, taking care of yourself.  It makes you a better doctor, taking care of your personal life.  And if it takes an influx of women into medicine to make that change then so be it. 

But I don’t understand why it has to.