Opportunity to Treat the Entire Continuum of Life; From Birth to Death
This essay was written for the Michigan State University College of Human Medicine's Integrated Medical School and Family Medicine Residency Program (TIP), a transitional fourth year medical school experience that continues into residency.
by Jan Liu
I first started volunteering at the Ingham County Medical Care Facility when I was sixteen. At the time, I had not considered medicine as a career, nor did I envision just how important the experience would become in shaping my future. My introduction to the local nursing facility was quite a shock. I saw patients with dementia laying in their beds calling out for help over and over again; people sitting in the cafeteria staring down at their mushy gray food in silence; silver-haired men and women in wheelchairs looking up at me as I passed by hoping that I had come to visit them. I had never encountered such a lonely place before.
I find many people do not have the patience for dealing with older patients. It can be a challenge to treat anyone in a ten or fifteen minute appointment, much less someone who has multiple chronic conditions and is taking a dozen different medications. But I feel a great sense of satisfaction in having someone confide in me, perhaps not just about their medical issues, but also their difficulties in adjusting to them. I believe much of the work in dealing with older patients and patients with chronic conditions belongs in the psychosocial realm. The goal of a good physician should be to help people preserve their independence and quality of life for as long as possible, not simply to treat disease, and not simply to extend survival by any means necessary. It requires skills like active listening, screening for depression, and thinking about ways to help people adapt to their changing conditions and remain active.
While I believe in helping people live as long as they would like, I do not view death as the ultimate failure of medical care. As a Hospice Patient and Family Support Volunteer, I completed an extensive orientation and ongoing training on end-of-life care and the dying process. My role was to work closely with an interdisciplinary team of doctors, nurses and social workers to provide emotional and physical support for hospice patients and their families. I found that oftentimes terminally ill patients feel extremely vulnerable and it is during these difficult times that hospice staff can provide the greatest support.
In an increasingly fragmented and specialized health care system, family practice is one of the only professions that provides me with the opportunity to treat the entire continuum of life from birth to death. All too often patients and their families feel abandoned when the primary care physician, with whom the patient has a longstanding relationship, transfers care to the hospice physician at the end of life. By training in family medicine with an emphasis on hospice/palliative care I hope to bridge that gap and provide continuity of care as long as the patient chooses. In this setting I will be able to develop a deeper mutual understanding with each of my patients, and be in the best position to affect their overall health and well-being.
I have long understood that adequate access to primary care is one of the most critical foundations of an effective and equitable health care system. My commitment to primary care has been demonstrated throughout my career. As the Primary Care Policy Analyst for the Association of State and Territorial Health Officials in Washington, D.C., I was responsible for providing technical assistance to State Health Departments on improving access to primary care for vulnerable populations.
Later at the Asian and Pacific Islander American Health Forum (APIAHF) in San Francisco I was able to combine my growing expertise in the area of cultural and linguistic competency with my policy advocacy skills. I was a primary advisor for the drafting of California Assembly Bill (A.B.) 2739. This bill, for which APIAHF was the lead sponsor, sought to ensure that the state Medicaid and Children's Health Insurance Programs were serving all of California's culturally and linguistically diverse populations. In 2002, I took the lead in mobilizing APIAHF's opposition to California Proposition 54, which would have banned the collection of data on race and ethnicity. I researched the impact of Prop. 54 on health, created briefing materials, established and led two statewide coalitions and gave presentations at local, regional, and national forums. Due to my efforts in this area I was invited to Washington D.C. to provide expert testimony to the U.S. Commission on Civil Rights, ultimately leading to their support of our position.
I was originally drawn to MSU CHM because of the strong history of training outstanding primary care physicians. After my experience in the Family Medicine clerkship I see now where this reputation comes from. In this clerkship, more than any other, I saw the faculty practicing patient-centered care and treating people from a holistic approach. Among the faculty are experts in geriatrics, health policy, and preventative medicine to name a few. However, it is not just the breadth of their knowledge that made an impression on me but the generosity with which they shared that knowledge with me as a learner. Already, a number of faculty members have served as mentors to me and there are many others in the department that I hope to work with more extensively through the TIP program and later as a resident.
As a family physician, I will be able to address both the need for greater access to primary care and the need for improved continuity of care through all stages of life. I know that to be effective healers we need an approach that addresses the mind, body and spirit of the individual, as well as the family and community that surrounds that individual. I’ve come a long way since my first visit to the nursing home. I still find them to be incredibly lonely places, but I am also hopeful that one day I will be in a position to better alleviate suffering in places like these.