Jennifer Frank MD

I am having a moment of existential crisis. One of my patients asked me about my kids recently. I recited their ages and a funny anecdote before he asked me, “So, are any of them going into medicine?”. “No,” I replied. Truth is, I have a budding mathematician, engineer, teacher and professor, but no potential physicians. This is perplexing to me as both I and my husband are physicians and both come from families populated with nurses and physicians. I assumed at least one child, if not all four, would pursue a medical career.

There are articles out there about how many physicians would discourage their offspring from charting the same course they did given the hours, the debt, the current state of health care, and the demands of the job. I’ve never been one of them. I love being a doctor even though I don’t love every aspect of being a doctor. Medicine is a wonderful combination of applying science to ever-changing situations. Almost every day in clinic, I am simultaneously intellectually and emotionally challenged. I have such a unique and privileged view into people’s lives and enjoy partnering with them through some of the most difficult moments they face as well as the joyful times. So, I wonder, why has my enthusiasm for what I do not caught on with my kids?

In my better moments, I pat myself on the back for this. Clearly, I am teaching my children to develop their own interests and passions. What a great mom I am! However, I can’t really claim that as I do struggle to keep my opinions at bay when talking to them about their futures. In other moments, I consider what they see of Dr. Mom from their vantage point. Maybe, I spend too much time complaining about the aggravations of medicine or am away from home too many hours, and they don’t wish to live with those same burdens. The dedication I try to show my patients may inadvertently reflect back on my family as a lack of dedication to them.

I wonder about their perception of the notion of a career rather than a calling. It is certainly the case that younger generations of physicians have a different view of things like work-life balance which impact how they practice. The abuses I suffered, somewhat willingly, were born because of my belief that this was the price of admission for the calling of medicine. Newer generations may be smarter than I in questioning what degree of sacrifice is actually necessary for our profession. My high school age children completed a school exercise in which they had to research possible careers and their desired lifestyle and then crunch the numbers. This required them to identify the average salary and then calculate the cost of living for where they’d like to live. I don’t remember those kind of pragmatic exercises as I was growing up and wondering what I wanted to be someday.

Truth is, I only decided I wanted to be a doctor when I was 17. Prior to that, I had my heart set on attending the Air Force Academy and becoming the first female fighter pilot. In a psychology class, we learned about the research being done on premature neonates and how much human touch improved their physiologic function, and I was fascinated. I can still remember that moment when it clicked for me and all of the things I loved to learn about and could see myself doing came together into a career path from which I’ve never deviated. The wonder I felt in that psychology class is replicated regularly as I learn something new about an individual patient or about the human body as a whole. If my own children find that combination of wonder and purpose, I will be a proud mama whether that is in medicine or in another field.

, MD is a family physician and chief medical officer in northeastern Wisconsin. She continues to find medicine to be the most rewarding profession imaginable, second only to motherhood. She's married to a fellow physician and has four children. Her family reminds her of what is most important and inspires her study and pursuit of work-life balance.

Articles

After a patient asked, one physician wonders why her children aren’t going into medicine.

Career or calling: Should my children be physicians?

What started as a dull ache Saturday morning blossomed into moderately severe pain that kept me up through the night. I modified my activities on Sunday and used ice, NSAIDs, and tried to rest and stretch.

When I awoke Monday morning, I felt better briefly before the cycle of pain started all over again. I loaded up on more NSAIDs and packed an ice pack and a heating pad in my bag before heading to work. Mid-way through my morning I realized that I was in too much discomfort to give my patients the attention they deserve, and I went home early.

I’m so fortunate that my episode of back pain is an anomaly as I know many people live with daily pain and bravely function through work and home activities. For me, this was the first episode of back pain I’ve had in the last two decades, and I was amazed by how much it stopped me. When we have a sickness, injury or emergency, it tends to crystallize what is most important and order our priorities quickly – even those we have difficulty juggling on a daily basis.

The pain literally prevented me from doing my normal activities, and I spent much of Monday afternoon in the one position that caused the least pain alternating between staring at the ceiling and watching The Good Wife. I wasn’t even able to work on patient charts because it hurt too much to sit. Guess what? Life went on without me. My patients were able to reschedule their appointments with me or one of my partners. My husband gamely covered the evening’s parent-teacher conferences and fed the kids. I didn’t get anything on my to-do list done, and it was okay.

Medicine teaches you through many small experiences to ignore your own physical limitations – whether that is an illness or the basic biological needs for sleep and food. This gradual conditioning can give you the false conviction that you are indispensable and that you cannot afford to take time off for sickness yourself. This is false, as any physician learns who has had a baby, had surgery, ruptured their Achilles tendon, or developed a severe case of influenza. During these episodes, we are reminded how fragile we are and how easily the things that seem essential can fall away.

It is good for doctors to be patients and to wrestle with the things our patients do – pain, limitations, frustration, loss, and perspective. When these moments catch us, as they inevitably do, we can fight against our physical vulnerability – often making things worse – or we can accept what our own patients already realize. We have limits, and we are not in control. While humbling, these experiences can teach us important lessons.

It is good for doctors to be patients and to wrestle with the things our patients do.

Learning from the reminder that physicians are patients too

As we approach Thanksgiving, I find myself trying to focus less on the chaos of the season and more on the many blessings in my life. So, this week, I wanted to share my gratitude for the balance I continually try to achieve at home and at work.

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As we approach Thanksgiving, I find myself trying to focus less on the chaos of medical practice and more on the many blessings in my life.

14 things one physician is thankful for  

features contributions from members of the medical community. The expressed opinions are that of the writers and do not necessarily reflect the opinion of 

One aspect of practicing family medicine that I find challenging is maintaining confidentiality when I take care of multiple members of the same family. Some of them will come in together for back-to-back visits, happily sharing all information with each other. Others purposely arrange appointments on different days. In other cases, they ask me to design a situation in which they are not seen together without letting their family member (usually a spouse) know that they do not want to be seen conjointly.

I treat patient information with the utmost respect and confidentiality. I am cautious in what I share, even whether I’ve seen their family member for a visit recently. However, I am often privy to information from one family member that impacts another. This requires me to tread carefully as I cannot ignore important information relevant to one patient’s health but also cannot disclose a confidence that violates HIPAA for another.

Recently, I was seeing both a husband and wife on the same afternoon. They were each in a separate room, so I conducted each visit independently. The wife shared concerns with me about how her husband was using one of his medications. She said that unless she managed it, he would take too much. “But you can’t tell him I told you,” she admonished, “or he might get angry that I said anything.” This scenario is almost always shared out of concern and caring, although sometimes one family member will seek to undermine the care of a patient for their own reasons.

I tried to consider how to address my patient without indicating that his wife told me anything. I considered recent visits and the conversations we’d had around medication management. Seizing on a previous conversation about cutting back on medication, I gently inquired about his openness to continue to re-evaluate medications. Fortunately, he was agreeable, and I was able to adjust his medication dosing to a safer level.

For all the complexity of managing patients in family relationships, I find the additional context to be very helpful in evaluating and treating my patients. Family members will often clarify a winding narrative or correct a history. A wife may accompany her husband to make sure he doesn’t minimize concerning symptoms. A husband may tearfully offer that his wife is very forgetful, and he’s worried about dementia.

Even with potential difficulties and contradictions that come with caring for multiple members of the same family, I wouldn’t want to limit these insights and reports. Our patients are complex. How they see themselves or experience their own health and disease is of primary importance, but the additional perspective of loved ones who see them with greater frequency, objectivity and clarity rounds out their psychosocial and medical status. That helps me improve the quality and depth of care I can provide.

, MD is a family physician and chief medical officer in northeastern Wisconsin. She continues to find medicine to be the most rewarding profession imaginable, second only to motherhood. She's married to a fellow physician and has four children. Her family reminds her of what is most important and inspires her study and pursuit of work-life balance. 

Seeing patients and their relatives creates additional HIPAA considerations but ultimately improves patient care.

The delicacies of treating family members

I am known to be pretty easygoing with nursing staff. I don't yell, pitch a fit, or belittle clinical staff. My responses are generally mild, even when I am annoyed, frustrated, or incredulous. This may be causing problems. I wonder if I was more assertive about the things going on with my patients that I disagree with, I'd have an easier time of it.

This week, I've had two orders entered in my name that I disagree with. The first was a nursing evaluation for a patient who fell at her long term care facility. She had physical therapy ordered, but the facility requested a nursing evaluation. I used to just go ahead and sign these, assuming that the request was based on sound clinical judgment. In the last year, as I've started to question orders, I realize how often requests are reactive rather than thoughtful. No one can really tell me what the nursing evaluation is supposed to accomplish for my patient. Since he was seen in the emergency department, my office, and a specialist's office, I don't know what additional information the nurse will obtain, even if she is the absolute best nurse. No one else seems to know why the nursing evaluation is needed, either.

This morning, I was informed that a urine culture was ordered on one of my patients under my name through a message sent only as an FYI. The lab staff decided she needed a culture based on an abnormal urinalysis. However, the staff member apparently did not review any of the last several years' worth of urinalysis results for this patient, all basically the same. Am I supposed to sign the order or refuse?

I welcome clinical input from everyone who works in our clinic. Regardless of the level of education or training, each staff member has an important contribution to make, even if it is the front-desk staff raising the alarm about a patient who just doesn't look right. However, the doctor's ordering pen should not be available for wide circulation. The reason that physicians and advanced practice clinicians have the authority to write orders when others do not is because of the level of education and training that makes them qualified to interpret clinical information in the right context. This certainly does not mean that nursing and other clinical staff do not have adequate knowledge or experience. Indeed, I think very seriously before I countermand a nurse's recommendation. However, just as my nursing and clinical staff deserve respect for the roles they play in the patient's care, so do I.

The best possible scenario for a physician or advanced practice clinician is to have a clinical staff member give us an "SBAR" briefing - the clinical situation, patient's background, their assessment and recommendation. It is infrequent that I would disagree with a recommendation and usually only do so when I have additional knowledge that did not factor into the nursing assessment and recommendation. Yet, there should still be a conversation - out of respect for both the physician and advanced practice clinician and for the nurse's role.

Has anyone else experienced a similar situation? If so, how do you handle it? Tell me in the comments section below.

As a physician, I depend on my clinical team to take care of the busy work. But I have a problem when staff make medical decisions without my input.