Pub. 4 2020 Issue 1

I would discover my specialty by finding co-workers whom I wholeheartedly respect, liking what I do 90% of the time, and identifying which set of practice guidelines I would readily curl up at night with to read. I happily checked all three when I picked primary care via family medicine. Residency and Living in Utah I never imagined that Utah would now be my home, but I could not be happier to be here. I wanted an academic program and to stay in the Western states, so I found myself interviewing at the University of Utah. I fell in love with Utah on my interview day. It was a bluebird day after the first snow of the season. The mountains were shimmering, and the air was fresh. The faculty members I met on my inter - view day were infectious; they were clearly passionate about resident education and delivering effective primary care. I really connected with the fact that the leadership team was mostly women. It wasn’t until that interview that I realized how much I wanted a program with gender diversity in its leadership. Now I look back and have no doubt that the women mentors in my program have been a huge part of my success in residency. They’ve inspired me and shown me what is possible as a young female physician. Although I came here for the program, I think the location is really important, too. When medical students ask my advice about picking a residency, I always say the following: you will work six days a week for much of your training, so pick a place where on that one day off, you can do what rejuve - nates you. For me, that is being in proximity to nature. There have been so many memories from residency, but when I think about what has brought me the most joy, it is from experiencing what it feels like to have a continuity panel of patients. Finally, by the end of the intern year, there were a handful of patients that I knew really well. And now, I don’t have a clinic session that isn’t full of returning patients. The patient-provider relationship creates a new level of ac - countability and motivation for quality patient care. This kind of relationship was the reason I went into primary care, and it’s so nice to finally experience it. One of the more challenging aspects of family medicine residency is the constant setting changes, from inpatient to outpatient, from pediatrics to labor and delivery to inten - sive care. This change can be wearing, but it lends to one of the most treasured strengths of family medicine residents, which is adaptability and comfort with uncertainty. Every - thing in life is about attitude, and residency is no different. Last year we tragically lost one of our co-residents, and when I find myself struggling with the pace or expectations of residency, I think of how lucky I am to be here, and I try to honor her by living my best life and doing my best job. It was refreshing to see how robust the LGBTQ commu - nity is in Salt Lake City. Working with this community in the clinic, particularly through transgender care and HIV pre-exposure prophylaxis (PrEP), has been one of the most rewarding parts of residency. There wasn’t much training in medical school about transgender health or sexual health outside of what has traditionally been termed “women’s health.” The University of Utah clinics here have been a leader in delivering gender-affirming primary care, and I could not be more proud to be a part of this. As I move into geriatrics, I am really interested in staying connected with and caring for the aging LGBTQ community. Geriatric Fellowship During my residency, I realized how passionate I became when working with older patients. It was almost as simple as which patient visits I looked forward to the most. There was no particular moment in which I identified my passion for caring for older adults. Instead, I gradually gravitated toward this population. With my older patients, I found myself poring over their illness histories, looking for the disease culprits, and wondering how their comorbidities may have contributed to their aging organs or vice versa. The medical complexity was motivating. The awareness of and proximity to death for older people lends itself to shared decision making and discussions of goals of care. This awareness has allowed me to be more present for my older patients and provide the type of human-paced “slow medicine” I wish to practice. I think there is often an illusion that simply because we (fam - ily or internal medicine residents) care for older patients that we are being thoughtful about, or are getting the teaching for how we might care differently for these patients. Older adults face unique medical, psychiatric and social chal - lenges. One of the fundamental roadblocks for delivering better care to older adults is the paucity of research in this age group. This lack has led to the unfortunate reality of simply extrapolating data about medication safety and disease states from studies conducted in younger people. Other unique conditions of older people include the onset of cognitive disorders, polypharmacy from amassing medi - cations, concerns of independence versus patient safety, and opportunities for palliative and hospice care interven - tions. Yet, given all of this, I would be amiss not to recog - nize one of the biggest misperceptions of geriatrics: that geriatrics is a homogenous population. There is incredible heterogeneity with age; one 80-year-old patient may be frail and a wheelchair user, while the next one is healthy and independent. Recognizing this is one of the attributes of geriatric-trained providers. Once I realized I wanted to practice geriatric medicine, I knew immediately that I wanted to do a fellowship. That was an easy decision for me as I want to be a clinician-educator and stay in an academic environment after training. How - ever, I do not think one needs to do a fellowship to be skilled in the care of older adults. Of course, medical schools and residency programs could do a better job and bolster their time and expertise in geriatric curriculums, but with motiva - tion and the right tools, there is a lot of learning one can do on one’s own. For example, this is the perfect time to improve the care of your older patients. As the novel coronavirus (COVID-19) is challenging our health care system, primary care providers are in a unique position to be doing proactive planning with our oldest and most vulnerable patients before acute illness Resident Spotlight | Continued on page 18 17 |