Doing it all

Larry Bauer recently e-mailed me with a question, “Does anyone in your practice deliver babies?” He was contacted by a journalist who wanted to talk with a rural FP who “does it all.”

No, not currently, but the question got me thinking about who, anymore, does it all. At one time, I thought I did: I delivered about 20 babies a year, enough to stay modestly proficient, but relied upon an OB/GYN to do my C-sections and bail me out when the circumstances required. I also admitted and rounded on our hospitalized patients, had ICU privileges, made home visits, and visited the nursing homes. Here, too, I must qualify: I shared hospital duties with three colleagues, so that my patients- those admitted during my off-weeks- never thought that I did it all. I only did it all part of the time. The rest of the time I chaired hospital committees, attended wakes, led Hospice family meetings, got elected to the school board and parish council, and sang with the community choir. I was doing it all except staying home with my young family.

My father, a GP from Iowa, did a better job of doing it all. He, delivered babies, yes, but also administered anesthesia, performed appendectomies, removed tonsils, repaired hernias, and took his own call. Always. Doing it all may have did him in, as he died of a heart attack at age 49. He also drank too much as a means of coping with work stress; when he drank, he argued with my mom as a means of coping with domestic stress. My father’s generation would question whether the FP who delivers babies but fails to cast fractures or perform surgery is really doing it all.

Two years ago I stopped doing it all, or at least all that I was doing. I hated the hospital environment: treating by protocol, ever under the watchful eye of those who played the power rankings, often caught between the two places that I needed to be. I was “there” because I felt it was part of the total package; there because my patients needed, or least expected, me to be there; there because of the intensity of the relationships, the adrenalin of the ER and ICU, the gratitude of new mothers and exhausted hospice families, and the simple satisfaction of doing it all.

Its been hard for me to adjust to forfeiting that satisfaction, to knowing exactly who I am as a doctor, or who I am within the specialty and who family medicine is within the larger profession. It has been impossible for us to find consensus. As with any group, our greatest enemies are with factions within us.

I still take pride in doing it all, which nowadays includes caring for Medicaid patients, treating opioid addicts with Suboxone, running an elder men’s support group, teaching occasionally in a family medicine residency program, and sitting on a medical school admissions committee. I have been doing this for a quarter century in one community, and believe that geographic stability has been a boon to both my patients and me. This is what I do. But my unique contribution, my fulfillment and joy is really this: I offer my patients a relationship. I provide them conversation, friendship, and hope. I attempt to do this for every one at every ever visit, and sometimes succeed. Sometimes, even when I am unaware of that success.

This is the first in a series of weekly blogs on the life of a medical director in an evolving rural family practice. Seaport Family Practice (www.seaportfamilypractice.com) is one of 26 practices in the Maine Patient Centered Medical Home Pilot, and one of 36 practice nationwide who participated in the National Demonstration Project (2008-2008). We will be joined this summer by three young providers- two family physicians and one physician assistant. Their arrival will double our provider hours and halve the average age. I hope to continue writing, and am planning a several month sabbatical next summer. These themes and activities will occupy my thoughts and utterings, but medicine is only part of my life in Belfast, Maine. In some ways, it simply allows me to be “here,” to pay the bills and provide a very privileged entry point into my neighbors’ lives.

Thank you to those who read this blog, and who respond, but most importantly who count me as their friend. For all the times I have misused and ignored you, take consolation in finding a part of you in what I have become. In what we are becoming together.

David Loxterkamp
21 February 2010