Remembering why I decided to be a doctor

Part 2 Medical School

Summer of 1999 was one of the happiest times in my life, as I had finally accomplished my dream. Prayers had been answered, and I was grateful. I spent 5 days backpacking in Montana in Glacier National Park, and before leaving for Norfolk, VA (Eastern Virginia Medical School), I celebrated with family and friends. On day one of medical school, at our white coat ceremony, I was 28 years old and on top of the world.

I assumed I would make some lifelong friends in medical school, thinking my classmates and I would share common goals and values. Within a few weeks, I sadly realized that was not true. Don’t misunderstand this statement as judgment. I did not dislike my classmates at all, but I realized fairly early that I thought differently from most of them. For example, I chose EVMS for the school’s focus on community health and primary care, yet most of my classmates intended to specialize. Many of my peers would express condescension toward primary care, especially family medicine. As part of our training, we spent time with a primary care mentor in the community. While many of my peers dreaded this clinical elective, I preferred my time learning in a patient care setting to the seemingly endless hours in the classroom and lab. Because many of my peers planned to apply to competitive residencies (family medicine was not competitive at that time), there was a competitive culture, where students would boast about scores on tests and compare with classmates.

In contrast, I was always very practical and often frustrated by the details we were expected to learn, which did not seem pertinent to actual patient care. I remember one day raising my hand in immunology class and asking “why do we need to know all this?” Ironically, this knowledge of immunology would be very relevant in 2020 when I was dumbfounded by the worldwide nonsensical response to SARS-Cov-2 and again in 2021, when I declined an untested “vaccine” that colleagues recommended I take, despite my robust immunity after a very mild infection.

During my community rotations, shadowing a family doctor, I observed the frustrations many physicians were already experiencing in daily practice. Time was limited with patients due to decreasing reimbursement from insurance, Medicare and Medicaid. There was very little time to conduct a thorough history, much less build a relationship with a patient. Understandably, doctors were quick to hand out a prescription to every patient, which was expected by most patients, even for mild upper respiratory complaints. As a graduate of Johns Hopkins University School of Public Health, I had been thoroughly brainwashed to believe the solution to all of these daily practice issues was a single payer healthcare system, similar to the NHS in the UK. The faculty in the family medicine department at EVMS would echo this belief. Having worked for the Federal government and leaving that job based on obvious ineptitude of bureaucracies, I should not have been so naive.

A few life changing experiences starting in second year of medical school would change my views of government run healthcare, government social programs and my political views would drift further right. In February 2001, God answered a prayer and I met Chris, to whom I have been married for 21 years. When we met, he was living at Kentland, a busy volunteer fire house in Prince George’s county. In July 2001, I started my third year clinical rotations, and Chris moved in with me (at which point my parents finally cut me off financially at the age of 30). Even at 24, six years younger than me, his life experience and wisdom would influence me profoundly. He had nearly died at age 11 from Guillian Barre Syndrome, which I believe gave him perspective and toughness unrivaled by anyone I had ever met. He was one of the few men I had dated who did not need to be “fixed.” In fact, he played a major role in healing my heartbreak, after several toxic failed relationships. Over the next several years, we would endure several very stressful, traumatic events together.

Third year rotations at EVMS took place at several local hospitals, including the VA hospital in Hampton, Virginia. My internal medicine, surgery and psychiatry rotations were all at the VA hospital, which in hindsight was a blessing. Medical students had more autonomy when training at the VA than at the local hospital systems. Within a few days of my internal medicine rotation, after having rotated at Norfolk General, I made several observations about the care given to our veterans, including:

1. In general, the facilities were older and less clean.

2. Nurses and discharge planners were less motivated, less helpful, and not as friendly.

3. Doctors, including residents and attendings were more likely to delegate much of the medical care responsibilities to the students.

4. Veterans were generally more appreciative of care provided than patients in the private hospitals.

5. The electronic medical record at the VA was easy to use and highly functional for patient care.

The experience at the VA provided a glimpse into the realities of a potential “single payer” health care system in the United States. While billing and financial transactions would potentially be less complicated, I could clearly see that quality of care would be compromised for everyone. At the time, it did not occur to me that removing all middlemen from the care would be the only way to provide affordable, individualized, ethical care.

On September 11, 2001 I was rotating on outpatient internal medicine, and we watched the chaos unfold in between patients. One month later, I was back at the VA on my psychiatry rotation. Many of our hospitalized patients were homeless veterans with addiction who knew how to get hospitalized when they needed shelter. They knew they had to say they were suicidal in order to get a bed. The experience was very eye opening to me, in that I realized we weren’t having a long lasting impact on most of our patients. Psychiatric medications seemed to help only temporarily, and many people stopped their meds due to intolerable side effects. Twenty three years later, mental illness is more common, despite the availability of even more medications. Over the years, I have been more hesitant to prescribe psychiatric medications as a primary care physician. The alternative, sending to a psychiatrist, however, often leads to an even longer list of meds. Maintenance medications for opioid addiction are an exception, in that I have found them to be life saving for many people. Still, there is no denying that these meds cause dependence and hormone disruption and can be very difficult to discontinue.

Compared to year one and two, I thrived during my clinical years. I enjoyed every rotation and learned that my strength was engaging with individuals one on one, taking a thorough history, and developing a plan for treatment. Ultimately, I settled on family medicine, which would allow me to develop relationships with people and families over time. Based on my experience with a family physician, I believed a trusting relationship between doctor and patient was essential for effective healing and wellness for the patient. As the first physician in my family and having grown up “middle class,” money and prestige never played a role in my decision to pursue medicine as a career. I was recruited by every residency program in the state of Virginia, and was awarded “Outstanding Family Medicine Student” at our 2003 class banquet.

In September 2002, Chris proposed and we began to plan our wedding for June 2003. He finished Norfolk police academy in 2002, and we decided to remain in Hampton Roads for my residency. I matched with Portsmouth Family Medicine residency in March, an unopposed family medicine program at Maryview Medical Center, a community hospital. We bought a house in May, got married in June, and I started residency in July 2003. Just that year, the accrediting body for residencies in the US had passed a regulation prohibiting interns and residents from exceeding 80 hours per week. More on that later…