Physicians in the Constellation of Care

“I am only one, but I am one. I cannot do everything, but I can do something. And because I cannot do everything, I will not refuse to do the something that I can do.”  Edward Everett Hale

“A year from now you may wish you had started today.” Karen Lamb

Constellation of Care: In a chronic and progressive disorder like Parkinson’s, you will have many different types of people involved in helping you manage the rest of your life, including: family, partners, spouses, friends, pharmacists, PA’s, nurses, speech pathologists and physical /occupational therapists.  In my opinion, two crucial parts of your constellation of care are the Neurologist and Internal Medicine (or Family Medicine) physicians. These physicians may not know one another, but your individual interactions with them supports a key three-way interface (depicted below).

Sauron_doctor.3Physicians in the Constellation of Care: In my case, my Internist helped me navigate the various things that were occurring over the past few years (described in an earlier posting).  I am not a physician but I am also no dummy.  When I was referred to Neurology for a consult, I had done enough ‘internet-sleuthing’ and had listened carefully to my Internist about what could be going on with my movement dysfunction. The first visit with my Neurologist was simply amazing. He listened, he was supportive, and he gave me the ‘good news/bad news’ speech.  Next, he presented to me various treatment options/strategies, and in a very reassuring tone, he said he’d be here for me long-term. Paramount to my interactions with both my Internist and Neurologist were their willingness to listen and communicate effectively. For me, it was also key to accurately portray what my symptoms were, and to carefully listen and engage them each in honest dialogue (asking great/good/mediocre questions but asking questions nonetheless). Getting a diagnosis of Parkinson’s (while it could be worse), well, it really sucks big-time. You have to process this information, get a game-plan, and decide how best to unite these Physicians for your health and care.

Your Neurologist is helping you manage your Parkinson’s and he/she is coordinating all of the ancillary care givers, and there are a bunch of them.  Your Internal Medicine (or Family Medicine) physician is managing the rest of your health care.  Their paths to caring for you are neither parallel nor diagonal to one another; with you as the interface, it is a complementary relationship.  My Neurologist expertly manages my life with Parkinson’s and always has cogent replies to even my wildest questions about the latest trends in Parkinson’s research and therapy.  My Internist oversees the rest of my health as I age, all the while staying attuned to what is going on with my Parkinson’s.  Ultimately, I’m lucky to have such wonderful Physicians to help me navigate my health issues.

Teaching Medical Students, Our Future Physicians: The two Physicians described above achieved a lot before, during and after their medical school education. Besides all of the exams (MCAT, USMLE Step 1-3, and NBME Shelf exams), material to be learned (basic science and clinical medicine), medical students also learn how to become physicians. Along the path to becoming a physician, medical schools teach the basic sciences (areas including biochemistry, physiology, molecular biology, immunology, anatomy, genetics and so forth) and then we merge it with the clinical sciences (fields such as hematology, neurology, cardiology, urinary, respiratory and so on). Sir William Osler said: “The practice of medicine is an art, not a trade; a calling, not a business; a calling in which your heart will be exercised equally with your head…The practice of medicine is an art, based on science.”

Besides being a research scientist, a very important part of my career has been teaching. Since joining the School of Medicine faculty, I have taught over 6,000 students (27 years of medical students x ~160 students/year = 4,320; 23 years of graduate students x ~20 students/year = 460; and 19 years of ~75 undergraduates/year = 1425). When you teach you learn a lot about yourself and you gain perspective on science, education and those you are teaching. What I have learned is that I am a decent educator, and I know how to bridge knowledge to students. I invest the time to do my best, and the rewards are providing a suitable template for students to learn and appreciate the material, not just memorize facts, but joining together biology, biochemistry/molecular biology, pathology, and the basic science principles of the topic. My teaching of medical students is somewhat analogous to when you learned the alphabet as you began to fully understand the meaning of your words and sentences.  Thus, I teach some of the basic principles of science (the ‘alphabet’) that bolster the clinical aspects of medicine (the ‘words and sentences’).  Sir William Osler also said: “The hardest conviction to get into the mind of a beginner is that the education upon which he is engaged is not a college course, not a medical course, but a life course, for which the work of a few years under teachers is but a preparation…Education is a life-long process.”

Chuck Stone, former Professor of Journalism, once told me (many years ago): “You may have seen that wonderful television commercial in which a group of kids are discussing what they want to be when they grow up. One says, a doctor, the other says a teacher. When the others suggest being a doctor is superior, the little kid ripostes with a quick, but slightly uncertain ponder, but who teaches the doctors?” Professor Stone was reminding me that I am that teacher of future physicians. It is an honor to contribute to the education of medical students.

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