Still flowering

I recently received some anonymous feedback wishing for me to "create better boundaries" in my scope to focus more on my "areas of passion". I found this both shocking and saddening and have been reflecting a lot on this perspective. Is the era of the full-spectrum family medicine physician ending? 

I find it disappointing that some folks feel we need to "specialize" in something within Family Medicine. The truth is, having great breadth to my practice as a "comprehensivist" is my passion and I am specializing - in primary care for all ages. To have a day that can involve a well child check, OB visit, joint injection, counseling a patient struggling with depression, and a heartfelt discussion on end-of-life wishes, all while teaching a couple medical students the tools of my trade - that's pure joy for me. Sure, it's exhausting as heck and I need time to replenish myself when I get home, but I'm getting a lot better at filling my cup back up so I can keep pouring for others. 

I'm a fairly open book about the human issues I deal with - from working full-time while parenting two young children, to navigating a neurodivergent household, to struggling with self-compassion and taking rest, to healing from childhood trauma, to embracing a queer identity that many folks don't understand or acknowledge. I own this authentic approach because I know I'm not the only person living an imperfect life and trying to find my way through. I trust that vulnerability builds connection. But it does also risk the fact that others will make judgments based on what they see. I accept it and have no regrets.

Maybe this person also saw me juggling a shocking list of commitments in medical education and scholarly work as an academic physician - this year alone, I'm president of the San Diego Academy of Family Physicians and busily coordinating our annual conference, completing the Sanford Compassionate Communication Academy Fellowship, serving as Well-Being Educator for the American Academy of Family Physicians and Wellness Director for UCSD's Department of Family Medicine, disseminating important findings from wellness work through scholarly channels, mentoring students and residents in their own research endeavors, developing a new FM clerkship and compassion curriculum for the School of Medicine, envisioning care workflows to better meet the needs of gender-diverse patients, and not to mention all the teaching at the med school and with our residency program. 

Believe me, my resident/student evaluations often come in late and sometimes chart notes stack up (especially if I have to stay home with a sick kid), and I always manage to submit work *right* under the deadline. But the important stuff - like being fully present with my patients in the exam room, helping my learners continue to grow in their clinical identities through teaching and actionable feedback, supporting my colleagues who are going through tough times, and spending quality time with my family -- the human stuff, I think I'm doing OK.

I have been transfixed by my son's pumpkin plant that's been growing in our home. It's easy to get distracted by some of the wilting leaves and not notice the ever-lengthening vine that is starting to flower. But that's life, isn't it? Sometimes things have to wilt a little in the juggling game of life, but if we stay true to what matters, we can still find ourselves flowering. It's a delicate balance and I'm constantly fighting a momentum towards overwork and overcommitment, but I can say with certainty that this busy woman is focusing on her passions. And there's much more to come.

Breathe, and notice

I recently attended a “roll and release” class at a yoga studio, using massage balls to release tension. I was so pumped to work out some of the kinks in my body, but little did I know that some life philosophy was coming my way. As I settled in on my mat and tried to maneuver awkwardly over one of the spheres, the instructor encouraged us to go slow, breathe, and notice. 

Go slow. 

Breathe. 

Notice.

Those simple but wise words started turning over in my head and have become a mantra for me this past week. 

Sometimes when we are going through hard things, we are so focused on feeling better and getting away from discomfort that we don’t take the time to understand what is truly going on. Maybe it’s because we fear what we might find… but the fear and avoidance often turns out to be much worse than meeting our pain with curiosity. There’s a famous saying, 

Suffering = pain x resistance.

I really don’t want to avoid my pain- more and more as the years go on, I realize the wisdom and power that has emerged in times of pain when I just.. opened to it. More on that later.

So during the class, I really made a point to compassionately seek out my trigger points and meet them gently with a little pressure and patience. With time, there was release and I found myself feeling more open, nurtured and grateful. 

By meeting our pain points with an open-hearted tenderness, we  can achieve greater understanding through this focused introspection. And maybe, just maybe, we can also prevent the deep scars of avoidance that inevitably emerge when we turn away from it.

The power of primary care, mentorship, and wellness

It is truly an honor to assume the role of President of the San Diego Academy of Family Physicians this year. This is my acceptance speech from the Installation of Officers event.

It is an exciting time to be stepping into the SDAFP presidency role, with new opportunities as we enter a period of new normals. As we find ourselves armed with more resources to continue forward in the fight against COVID, we also might find ourselves feeling more empowered to connect with others and restore a sense of community that was strained these last 3 years. I’m hoping that SDAFP will begin to host more social events again for those looking to reconnect or meet with other family docs in San Diego. I hope we can come together more often and build up old and new bonds with awesome FM colleagues across the county. 

Now, I take this privilege of representing all of you very seriously and am very open to hearing ideas from folks on where we want to use our momentum this year. From my point of view, I have three main areas I’m hoping to focus on: increasing awareness of the power of FM, strengthening the primary care pipeline through mentorship, and increasing focus on physician wellness.

It is one of my passions to spread the magic of Family Medicine to current and future physicians and the general public- anyone who has seen my posts on social media knows that I unabashedly post on the regular about my #FamilyDocJoys. I think in general we are all too humble about the incredible feats we pull off in our lives as clinicians, educators, scholars, advocates, and so much more. It is such a joy to publicly brag about all my favorite people in our specialty who are moving mountains, and I encourage you all to join me in this collective uplifting of colleagues and the beauty of the work we do. Don’t be shy! What we do is awesome and we need to talk about it more!

Another area ripe with potential is building a stronger pipeline into our specialty - and I’d argue that effective mentorship is crucial to help achieve that goal. I’ve been communicating with the rising FMIG leaders at UCSD SOM and it just further reinforced to me that if we can create some powerful links with students earlier in their education, we have the capacity to connect more amazing future docs into FM. Whether it’s speaking on a panel for National Primary Care Week, or simply getting a cup of coffee with a couple students, putting a face to the work we do can be so powerful. The risk of primary care erasure is palpable across the country and while we need to advocate for strong primary care education in med schools (something that we are actively working on at UCSD), we are all capable of making an impact on the individual level with every student we meet.

Lastly, I’d like to make a few comments about another passion of mine- physician wellness. I have served as Wellness Director for UCSD’s Department of Family Medicine for the last four years, and have seen the power of institutional investment in primary care and its impact on physician wellness. I was also fortunate to be a part of the AAFP’s Leading Physician Well-being program, which has provided additional insight that I hope to share with our members. I hope I can inspire colleagues to employ innovative strategies to support their wellness during an especially challenging time in health care. I have felt the potential for individual and systems approaches to revolutionize our care delivery, our working relationships, and our quality of life. This openness to seeing and practicing things differently is so crucial as we continue the movement to improve physician wellness in our specialty and in our lives.

Whether it’s leveraging social media to raise awareness, writing resolutions or lobbying on issues impacting our work, mentoring students and residents, or advocating for what we need to thrive as family doctors, we have a tremendous capacity to make an impact and shape the future of our specialty. I know I don’t need to overstate this because you all get it, as enlightened and empowered folks doing the good work both in the exam room and out. So I encourage you to continue using your primary care power - inspire others to explore leadership and advocacy and amplify the important work we do. And I am so excited to be on this journey with you.