Envisioning a Future in Primary Care: Reflections from Two HMS Students — by Juliana Morris & Janine Knudsen
On the morning of October 28th, 2010, the Harvard Medical School community opened their e-mail to some exciting news: the announcement of the new Center for Primary Care. As two first-year medical students interested in primary care practice, we were particularly thrilled to hear the news, as it signals a renewed exuberance about primary care both at Harvard and across the nation. No other field in medicine offers both the flexibility to work with a variety of patient populations, while also providing opportunities to engage in cutting edge research and advocacy.
While we both plan to pursue careers in primary care, each of us has chosen the field for our own unique reasons. Here, we describe these reasons in more depth, by sharing our stories of our paths to medicine, and discussing our goals for the future.
Juliana: Inspiration through Community
My own interest was sparked through my experiences doing community-based work with immigrant communities in the US and abroad. When I graduated college, I wasn’t sure that I would go into medicine, but my work with the homeless and in community health centers in my college town of Poughkeepsie, New York, convinced me that I wanted to do something to address social injustice. I had worked closely with immigrant youth at Poughkeepsie High School and, after hearing their stories, grew particularly concerned about the experiences of poverty, violence, and marginalization that face low-income immigrants, both in this country and during their journey to the US.
This interest led me to pursue a fellowship opportunity in southern Mexico, where I worked as a volunteer and medical anthropologist for a year in migrant shelter. There, I was immersed in the community I was serving on a daily basis, helping meet the residents’ immediate needs along with deeper medical and social issues. The shelter served a diverse group of migrants, many of whom had complex chronic health issues or were suffering from the aftermath of trauma. For example, I remember tending the gardens with a man named Don Rodrigo, hearing about his past experiences working as a farmer in Honduras before his economic troubles forced him to migrate. After hearing his stories, I encouraged him to take his diabetes medications in order to reduce the swelling in his feet. I remember driving with Christina to the offices of the migration authorities to submit her application for asylum and hearing her disclose that she had been raped by thieves while crossing the border into Mexico.
Working in the shelter, I learned first-hand about the dangers migrants were facing on their journey to the US and saw clearly how these impacted their physical and mental health. Through listening to migrants’ stories and carrying out background research, I came to understand how underlying social, economic, and political factors were leading to the injustice I was seeing on a daily basis. The experience was very defining – not only did it solidify my desire to work for social justice, but it also made me certain that I wanted to become a physician working in the field of primary care. To me, being able to establish longitudinal relationships with my patients, provide holistic care, and become part of the community I am serving are all central components to my desire to become a physician. At the same time, I want to be a leader in calling for social justice for the communities where I work, basing that advocacy on the deeper understanding about my patients’ lives that I’ll gain as a family physician. Primary care, and family medicine in particular, is the career path that will provide me the flexibility and capacity to pursue these integrated goals.
Janine: A Bridge to Population Health
I moved to Seattle in the nineties, during the growth of the Gates Foundation, World Vision, and other NGOs that were doing innovative global development work. I was fascinated by their efforts and the disparities they sought to address. Why was it that so many children grew up in poverty and malnutrition, without adequate access to education? How did this affect their health and well-being?
I was eager to learn more about these issues and how I might contribute to efforts to alleviate them. When a high school trip to India brought me to the Nishta Health Clinic nestled in the foothills of the Himalayas, I knew I had found the answer: Medicine. In the time that I spent there, I witnessed how Dr. Nath-Wiser, the clinic’s physician and director, balanced a patient population that included Indian farmers, Tibetan refugees, and Nepali migrants. One patient, a pregnant woman bed-ridden due to calcium deficiency, particularly stuck with me. As we sat by her bedside, Dr. Nath-Wiser learned how precious of a commodity milk was in this patient’s community, and used her knowledge of the local diet to prescribe an unusual, but effective, remedy including calcium-rich egg shells. Recognizing that many patients such as this one were coming to her clinic, she went on to develop a maternal nutrition program for the surrounding communities.
But Dr. Nath-Wiser’s innovation in the face of her patients’ financial and social constraints did not stop there. She went on to add on a women’s health class, a youth program, and a literacy initiative to address the needs she saw in her communities, with great success.
Inspired by Dr. Nath-Wiser’s work, I headed off to study public health in college, where I continued to explore innovative, population-wide solutions such as these. In nearly every case, the essential role of the primary care physician stood out. PCPs were tapped into the pulse of the community, its history, and its health determinants. They could interface with health departments, advocacy groups, and researchers to develop far-reaching programs for everything from disease control to health outreach. They also appeared perfectly situated to provide preventative care, a feature that I’ve learned to value as a public health student.
In my career in medicine and public health, I hope to address the major diseases of our time at the population level. Progress in confronting disease in the United States, from diabetes to lung cancer, will come from addressing issues through population-based approaches. I know that as a primary care physician, I will be able to incorporate this perspective in my work.
Building a Foundation for Leadership in Primary Care Practice
Through our own unique approaches, we have developed a shared goal of becoming leaders in medicine, as well as excellent primary care providers. In choosing which medical school to attend, we were both drawn to Harvard because of news that the school had commissioned a Primary Care Advisory Group (PCAG), an indication of its growing commitment to primary care. Since coming to HMS, we’ve witnessed important achievements like the launch of the Center for Primary Care. However, there is still much more that can be done to fully implement the PCAG recommendations and ensure that primary care is integrated into our medical school experience and our curriculum.
We look forward to participating in the transformation of primary care at Harvard in the coming years. With more primary care-related tools under our belt, we’ll be all the more prepared to dive into our communities and work to address the health issues that inspired us to enter medicine and continue to motivate us to serve others through primary care practice.