March 30, 2016

People : Diversity

New Haven, Connecticut. Fall 2009

I really love my job, and I think that that can come to a surprise to people who know what primary care is like. Primary care is demanding on the mind, spirit and body. On a full day I have 24 patients on my schedule, each with a 15 minute slot, and I'm required to write a note about each visit.  Because it's primary care, patients come to you with multiple concerns and several chronic illnesses. In between and during visits, you get messages from patients, pharmacies, nurses and forms from patients, pharmacies, and insurance companies. At each point in time whomever you are interacting with expects your full attention and is unaware of all the other demands on you, and it's a constant practice of mindfulness in the midst of chaos and lists of tasks.

It can be draining but I am generally happy during the day at work and when I come home. I've thought about the elements that contribute, and it essentially comes down to diversity.

A diverse place: My clinic is located in a larger center for people with disabilities. The center was built with this population in mind, so its space is carefully and thoughtfully designed. Being in a place that is thoughtful and open to people with differences is nice. It is also nice to visibly see differences and be reminded of people who lead lives very different from mine, sharing a space.

Diverse colleagues: It was important to me in residency to be around people with similar values and motivations and goals, both daily and beyond. It's different being in the community versus being in an academic center. We're working together in a place with a similar mission, but we have more individual differences in terms of how we work and what our goals are. This can pose barriers and conflicts at times, but I actually like this, as I think that we bring different perspectives and I feel like I have something unique to contribute.
New Haven, Connecticut. Fall 2009

Variety in my work: I'm very grateful to be able to practice different kinds of care within primary care. On Monday afternoons I treat patients with Hepatitis C with new drugs that cure them, a rare experience in the world of chronic illness.  On Tuesday afternoons, I help run a cooking class for our patients, figuring out how to eat well on a budget. On some Wednesday afternoons, I get to lead a workshop on Advance Care Directives and help patients consider and document their goals of care to ensure they get the kind of health treatment that fits their individual priorities.  On Thursday mornings, I see patients who attend our acupuncture clinic designed to offer detox for substance use. A lot of these patients have been out of medical care for years, but come to acupuncture regularly. I've accumulated a small panel of patients who come every week or every few weeks, which makes it really easy to get to know them and help care for them.  On Wednesday mornings, I precept our nurse practitioner residents. One of the nurse practitioners at our site has started a program to help train recently graduated nurse practitioners, who are otherwise start jobs as primary care providers immediately after schooling. I get to help them talk through the patients they see and teach them what I've learned from residency.  And all in between, I get to see my own patients.

New Haven, Connecticut. Fall 2009

Diversity in my patients: While the above are things I've learned over time are valuable and important to me, this was the one thing I always knew I wanted. I absolutely love our patient population, with the mix of complex medical and psychosocial issues. The fact that we are based in a center for disabilities and are an integrated mental health center means that we see diversity not just in race and income, but in development, social background, psychology, and overall access to opportunity and advantage. Anyone fortunate to work in the healthcare field has been lucky to have more education and exposure than many others, and we can forget how different our opportunities have been. In this setting there are always patients who can pose draining interactions, but when I take a step back I find myself attached to every one, even when my patience is tested and failed. It is so fun to meet people with such different personalities and quirks and backgrounds, some characteristics so extreme that I know I would never come across in a job other than this one. Growing up I fell in love with fiction because of the people and worlds you can meet, and in this job I love the spectrum of characters and lives you glimpse, and sometimes enter.


  1. So interesting to read about your daily work and the variety! Makes me think, and maybe even appreciate more, the variety in my work. Also great to see you blogging again and i'm looking forward to your future posts!

  2. I'm glad you've found ways to vary your work so that you stay happy in it and it also seems like the best way to care for your patients. Thanks for reading since this all began, before we had any idea what medicine was like!


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