2015 AAFP National Conference

In 2014, the California Academy of Family Physicians, in collaboration with the California Legislature, declared it the Year of the Family Physician. Well-deserved recognition and immense energy was focused on the role family doctors play in bringing positive change to the United States health care system and improving the quality of life for Americans across their life spans. Exactly one year later, the American Academy of Family Physicians held their annual National Conference in Kansas City and it was clear the burgeoning excitement around CAFP’s campaign had elevated to the national level.

Medical students, residents and family physicians from across the US gathered in Kansas City to talk about the changes they made in their communities and pursue a sense of belonging amongst thousands of people who were motivated by similar ideals. As a fourth-year medical student on the verge of applying to residency, I felt extremely validated by my choice to go into family medicine. At the conference, I was surrounded by people who were genuinely happy with their choice of specialty and who were driven to family medicine by its deliverance on what many would call “the original promise of medicine.” That is, giving health to all people, at all stages of life, regardless of their status in society or origins.

Discussions focused on ways to increase access to care, lower costs and redefine preventative care for at-risk populations. It quickly became apparent that not only are family physicians a cheerful lot, they are incredibly progressive and interested in their roles in upgrading the American health system to meet the requirements of the Triple Aim. In one sit down session, I even had a fellow medical student turn to me and whisper under her breath “I had no idea that family docs were on the forefront of all these changes and cared so much!” Having been a part of the CAFP Foundation Scholars Program for the past three years building skills in leadership and health policy, I was deeply grateful to have recognized my peer’s thoughts early and having been mentored in being a part of that change.

Overall, the AAFP National Conference was an immensely positive experience. I had the chance to meet with many fellow Californians and hear their thoughts about where family medicine was going and what they wanted to do about it. Despite all the negative press that exists about the dire state of American health care, the conference reassured me there is hope and family physicians are up to the task of tackling the problems head-on.

A Unique Preceptorship Experience

“If anyone can help this weekend, please contact me!” Every summer, you see the same kind of email blasted over various mailing lists at our medical school. Why? Well, at the University of California Davis School of Medicine (UCDSOM) we have seven student-run clinics (SRC) and a big challenge we face each summer is a decrease in the number of medical students. Medical students do all sorts of amazing things over the summer. Some do research or travel abroad. Others return home and spend time with their families.

As a CAFP Foundation scholar, I developed a preceptorship experience unique to my future career goals and the resources available at UCDSOM. Originally from Puna, HI I wanted my summer to focus on developing skills needed to practice medicine in a rural community. Of the seven SRC’s at UCDSOM, the Knights Landing One Health Clinic (KLOHC) is the only site located in a rural area. At KLOHC, we don’t see a lot of children or do much of women’s health so I also decided to spend some time working with a rural family medicine doctor in Placerville, CA and shadow an OBGYN in my home state of Hawai`i.

Knights LandingIn addition, I was chosen to be a KLOHC Co-Director which meant that I was also privileged enough to spend many first and third Sundays of the month throughout my MS2 year at KLOHC. However, since I had more time during the summer months, I also spent Saturdays at Clinica Tepati and a few of our other SRC’s. Both Clinica Tepati and KLOHC primarily serve Spanish-speaking patients so for medical students like me, we rely even more heavily on our undergraduate volunteers who translate. At the time, I was very grateful for the work the volunteers were doing but I never really thought that I was developing an entirely different skill set—how to work with an interpreter.

I am currently on my Primary Care Clerkship in rural Oakdale, CA. About half of the patients speak Spanish. I pick up a few words here and there but I still rely on translators. I often find myself remembering those weekends spent at the KLOHC working in partnership with our undergraduate team members. I am so grateful for their guidance and assistance, but most of all, their ability to make me a better provider. Knowing that I need to check in with the translator before we walk-in to a room (so that we can decide where we will be standing and how we both expect the flow of information to go) makes us look much more like a team.

This is just an example of one of the many things I learned working at the KLOHC. While the third year of medical school is very exciting, it can also be very intimidating. This will be the most exposure we have had working with real patients since starting our journey to become physicians. Without the SRC’s and our undergraduate team members, it could have very well been the first time I had the opportunity to work hands-on with patients. Talk about being stressed out!

In conclusion, I want to say mahalo (thank you) to all those at the CAFP Foundation, the KLOHC, and to all those physicians who act as preceptors! Without each and every one of you, future physicians would not have the opportunity to learn how to become our next generation of primary care physicians equipped with various skills to work with our diverse patient populations.

Mini-Med School for Vallejo-area Elementary Students

The heart of family medicine is prevention, education, and living as a part of the community in which you live and serve. This is precisely what drew me to first volunteer, and then subsequently coordinate Mini-Med School for local Vallejo elementary school students. We took our supplies and volunteers on the road and set up shop at the schools. Our seven stations of fun usually took up the afternoon, with participation ranging from anywhere between 50 and 100 kids.

Directions given to both elementary and medical students before starting

Directions given to both elementary and medical students before starting

The general flow of the Mini-Med School was a rotation between seven different stations. They first learned a little bit about the topic and then participated in a fun, interactive activity. At the end, they would answer questions for prizes and fill out their bookmark diploma to explain one thing they had learned at the station.

Elementary students then read their statement to one of the medical student volunteers and were awarded a sticker for “passing” that station. At the end of the day, the elementary kids had a bookmark diploma filled with stickers that proved their Mini-Med School graduation, thus reminding them of all of the fun things they had learned.

 

Now, a quick description of all of the stations 

Doctor Senses is a station with all of the fun doctor equipment – from stethoscopes to reflex hammers and otoscopes. Kids learned how to listen to their heart, find their reflexes, and discover what doctors might be looking for in their ears. The hope in all this is to both interest these young kids in medicine, but also normalize and reduce “white coat anxiety” via fun interactions with people in those white coats. It also allowed them to actually touch and try out the equipment a doctor may use.

The Germs station was by the far the messiest, making it a student favorite. Unsuspecting elementary kids would gather in a circle and a conversation about germs would commence. One unlucky kid would get “sneezed” on (a big, theatrical sneezer was armed with a spray bottle of warm glitter water). The mess was a wonderful reminder of how quickly and how proliferative germs really are. The group usually continued by learning how to sing “Happy Birthday” as they wash their hands and how to properly sneeze into one’s elbow.

The Bones station utilized the anatomy lab’s bone boxes and consisted of a race between two tables to lay out a skeleton from head to toe. It was truly amazing to watch elementary kids puzzle their way through bone positioning as they placed them against their own arms and legs to judge length and shape.

The Exercise Physiology station was another fan favorite because what elementary school kid doesn’t want to be racing around, jump roping, or doing jumping jacks? They began by talking about the heart as a muscle and how it must be strengthened, just like your arm or leg muscles. Then they learned how to take their pulse and guessed whether it would be faster or slower after they did some exercise.

Brain Lobe Twister was a game that our fabulous neuroanatomy professor, Dr. Puder, designed and created. Kids learned the four main lobes: frontal, parietal, temporal, occipital. They then proceeded in normal Twister fashion – yellow temporal, green parietal, etc. It was a perfect introduction to the brains for the next station.

Our amazing Dr. Puder also provided real brain specimens for our Brains station. Kids donned colorful goggles and gloves and got to hold, touch, and learn about real brains and spinal cords.

Rethink Your Drink was a conglomeration of several different programs and activities I found online. Since sugary drinks may be one of the greatest health issues this newest generation faces, we considered it imperative to give them exposure to the facts. Each student picked a set of three drinks (Coke, MinuteMaid, Vitamin Water, etc), and received a box of sugar cubes. They were to use all of the sugar cubes and arrange them in piles in front of the drink according to how much sugar they thought was in each. Then the medical student helped them compare that with the actual answers and talked to them about the health risks of drinking these beverages. They also talked about healthier options like water and milk.

The event only lasts an afternoon, but we have passed our materials and contacts on to the next class to add their own ideas and continue to better the program. We hope it will be a source of education and a connection between Touro and its community for years to come!

Summer Preceptorship in San Mateo

This summer I had the privilege of completing my 4-week preceptorship with Dr. Adam Paley in San Mateo, California. Dr. Paley, who insisted on being called Adam, is one of the kindest doctors I have ever met.

The first day of my preceptorship was interesting to say the least – I’ll just say I had a bit of a rough start. There was a major spill on one of the freeways which forced all the lanes to close and turned what would’ve been an hour and ten minute commute to a three hour commute. Not to mention, I had also spilled coffee on my blouse and did not have a change of clothes. Dr. Paley was very understanding and offered to reschedule; however, I insisted on showing up and making the most of what time I had left. When I arrived, the staff made me feel very welcomed, stained shirt and all, which turned out to be the overall feeling of my entire stay at the practice.

As soon as I put my belongings away, I was off to see patients with Dr. Paley. In a span of just a couple of hours we saw a variety of patients ranging from a young patient with obsessive-compulsive disorder who seemed to be doing well with his current medications, a patient with cancer who only had three months left to live and a 50-year-old patient with breast implants who needed a check-up.

As the days and weeks passed, no matter how different each patient’s reason was for coming in to see Dr. Paley, one thing was evident – they all absolutely loved him. Many patients have either been seeing him for years, were referred to him by a friend or were even delivered by him and were now teenagers coming in to see him for school sports physicals. One elderly religious Italian woman, who made appointments to see him every week, even told him that she knew he was going to heaven because he was so “good.” Although I do agree that Dr. Paley was very skilled at his profession, I believe that this patient meant that he was “good” as a person.

Watching Dr. Paley engage with his patients in practice made me realize that family medicine is not just about being able to treat the whole family, but in a way, also becoming like family or becoming part of the family. When asked what his secret was to forming strong relationships with patients, Dr. Paley said, “No secret, just be your caring self and give it time. The rest will take care of itself.” Dr. Paley demonstrated genuine interest in every one of his patients. In addition to knowing about each patient’s medical history, he knew a little about each one personally, often asking about specific family members, shared interests or hobbies. He also shared about his own family, particularly his son who was away for camp at the time and who he missed very much.

Spending time in Dr. Paley’s practice has taught me a lot about what it means to be a good family physician. Witnessing the trust and deep respect his patients have for him has made me think about how I want to form relationships with my future patients and has given me something to aspire to in my future practice.

A San Francisco Preceptorship

This past summer, I had the privilege of spending nearly a month at Sunset Health Clinic in the Sunset District of San Francisco. I shadowed Dr. Winston Goh, an internationally-trained family physician who grew up in Hong Kong before completing residencies in the UK and New York. As a community clinic affiliated with the Chinese Hospital, Sunset Health Clinic sees a predominantly Cantonese and Mandarin-speaking population. While I knew Mandarin, the patients Dr. Goh saw were mainly elderly Cantonese speakers. After returning from a month in Tanzania, where I relied on natives to translate Swahili for me, I felt like my travels had simply continued, albeit closer to home. It made for a very international summer.

After my first week at the clinic, I joked with Dr. Goh that he basically saw one patient: an elderly person with hypertension, chronic kidney disease, and diabetes mellitus plus-or-minus gout, arthritis and GERD. I learned that I love the Asian geriatric population. Contrary to my pre-conceived notions, most patients were not grumpy or sour; in fact, many were quite chatty with great senses of humor. To more than one patient, Dr. Koh would deliver some news that suggested a malignancy and ask, “Would you like to get this screening test or try this drug?” Sometimes the patient would agree, but every so often, he would respond, “No, I’m going to die soon anyway. I’ve lived a good long life.” In a morbid way, I admired their cavalier attitude about impending death. Though it didn’t comply with medical standard operating procedure, the simple refusal reflected a joie de vivre, a view that one’s quality of life matters more than its length.

There were many firsts.  I heard my first aortic stenosis heart murmur, witnessed the classic podagra of an acute gouty attack, felt the cogwheel rigidity of an Alzheimer’s patient, and read the chest X-ray of a patient who had just been diagnosed with lung cancer. From their vivacious and energetic personalities, I often did not suspect the long list of underlying medical conditions many patients carried. I will always remember one lady – she had a hemoglobin A1C of 8.5%, congestive heart failure, hypertension and end-stage renal failure that required weekly dialysis. Yet as we reviewed her lab results that showed a decline in her overall health, she expressed a flippant attitude to taking her medications and an utter lack of interest in lifestyle changes.  It taught me that people are stubborn.

By observing Dr. Goh’s patient interactions, I learned efficiency is very important in 15-minute appointments that fill up the 8-hour workday. Through his gracious coordination, I also had the opportunity to shadow two pediatricians and an internist, whose styles of practice all differed. As I grow in this profession, I hope to develop a style that fits my own convictions and personality, while providing competent patient care.

Overall, I benefited greatly from the month of mentorship I received from Dr. Goh.  He had me see and present his English-speaking patients, deliver patient education in Mandarin to some of his dual-speakers, and learn many concepts through daily reading assignments. Having to report to him my findings the next day gave me a taste for rotations and the “pimping” that is every medical student’s (dreaded) rite of passage. To my surprise, I was also able to influence his practice – whether through catching rales that he hadn’t heard or correcting a drug that was contraindicated in the patient. Through our discussion on using statins to prevent cardiovascular accidents, I was able to challenge his notions and reference research that supported conclusions different from the norm. These collective experiences have brought medicine to life in a way that the classroom simply cannot simulate!

Taking it to the Streets

PHOPThe Pomona Homeless Outreach Project (PHOP) is a student-run organization at Western University aimed at providing support to the homeless adults and families of Pomona by serving bi-monthly dinners and monthly clinics. I began volunteering with PHOP in October 2012 and began coordinating the free medical clinics in March 2013. At every clinic we provide screenings for vision, blood pressure, and blood glucose as well as focused exams that address the unique needs of each patient. An overseeing physician is present at all times to mentor us and optimize the quality of care we provide for our community.

 

In October 2013, I sought to take the PHOP clinics to a larger scale; as a team we decided to distribute items that were fundamental to daily living in addition to our regular health care services. These items included clothes, hygiene products, and preventative care in the form of flu vaccinations. I knew this would require lots of preparation so with the help of every program at Western University, and in particular the pharmacy students, we set out to make it happen.

 

Pomona Homeless Outreach ProjectUsing media sites and flyers we advertised that we would be placing boxes by every main entrance for people to donate clothes and everyday hygiene products, such as new toothbrushes, toothpaste, soap, and shampoo. At the end of every week the boxes would be overflowing. Throughout this time I worked closely alongside the pharmacy students in getting the proper paperwork signed and delivered to meet the university and city requirements for approval. Thanks to the generous donation of the WesternU Pharmacy program, we were able to obtain 200 vaccinations in time for the clinic. By the day of the clinic, we had nearly 20 student volunteers, countless warm clothes to donate, and 100 hygiene packets for patients and their families. After ensuring that our clinic supplies were fully stocked and that every item was organized and ready to go at our site at 5:00 pm, we opened the doors to our community.

 

Overall, the clinic was an incredible success. We gave 145 vaccinations that day, donated every hygiene packet and provided 25 full medical evaluations in the span of three hours. Our accomplishments were undoubtedly due to the interprofessional collaboration exemplified by our student body, and by the unwavering generosity of our pharmacy program.

 

Events like these are a testament to the open hearts and beauty within our community. I am constantly reminded of how important it is to give back to make our world happier, healthier and stronger. Organizations such as PHOP not only make me proud to be entering the medical profession, but also the world of primary care where I can one day call myself a family physician.