Ice Age Evolution

I have made a big life-changing, evolutionary decision: I am leaving my job with public health. It was not an easy one. It isn’t because I don’t love my job greatly; because I do. In fact, I feel like the queen of the jungle, leaving her subjects. It’s not easy to let go.

My reasons for leaving have nothing to do with the job itself, but have everything to do with my own personal life situation which requires me to migrate from one county to another in Southern California, in order to follow my primal instincts to be closer to family. It is an ice age era, and in order for my family to survive I need to migrate. I have decided long ago that I never want to live with any regrets in life. And taking care of my family is number one priority, as it should be perhaps for all of us mammals. After all, that’s what life is really about – protecting your own, isn’t it?

But I still cannot help but think about how much I will miss my patients whom I’ve been taking care of for the past three years. My experience in public health has been truly irreplaceable, and probably one of the best in my mammalian career. One that I will never forget.

For this reason, I thought it may be a good idea to take this opportunity to reflect on my previous three years here in the public health territory, and chronicle the reasons why I am so grateful that I chose a career in public health:

Survival of the Fittest. You’ll never lose your skills. It’s an ideal job to move into, especially straight out of residency. Why? Because I was able to practice every facet of family medicine – from taking care of numerous children, practicing low-risk prenatal care, serving very sick patients with chronic disease, performing minor surgeries, and everything else in between. You will be taking care of patients with diminished access to care, and you are truly “it” for many of them. In other systems, you may be able to refer out for many conditions; in public health referring out is not often so easy. Therefore, you learn to really tease out those wonderful skills you learned in residency, and develop them even further. You will become a better diagnostician, with less reliability on tests and technology. In public health, you are the epitome of the family physician; there are no specialists in the territory. It’s just you. That’s it.

My Encounters with Rare Species in Danger of Extinction: What I have seen in my public health clinic, I have never came across prior in my life as a physician. I never know what will appear behind that exam room door: an ill patient knocking on death’s door with no prior medical care or health insurance, full-blown syphilis in pregnancy, large breast lump the size of a grapefruit that you can literally spot across the room, patients seizing in the lobby, end-stage rheumatoid arthritis in a patient without prior care, numerous involuntary psychiatric hospitalizations, child-abuse cases you would cringe at the mere thought of, and infectious diseases I’ve had the unfortunate job of diagnosing. All those rare cases we read about in the books but never really see in reality, well I actually got to see some of them. Every day was an interesting one. You just don’t get to see such cases in other settings very often.

I Am the Queen of Jungle. You may be working as the only physician, or with a select few others or mid-levels. No one will be telling you how to practice. You are your own boss on a day-to-day basis. You are typically at the top of the hierarchy in your clinic. The staff will be coming to you for guidance because you are the decision-maker. You rule the kingdom. But the truly best part: you won’t have to worry about the financial details of running your own practice.

My Subjects Worship the Lioness Ground I Walk on: This is perhaps the best reason to join public health. These humble patients are generally so very grateful for the care you provide them, and thank you on a daily basis. Some end up waiting for the providers for up to two or even three hours, and they do not get angry or complain. They are just grateful to be seen. They may not have health insurance, and they cannot afford to be seen anywhere else. You are often all they have in this big jungle of a world. You’ll love these patients, and they will love you back.

Community medicine is one of the most rewarding experiences in my life. I know that I will never have this experience anywhere else. And I have truly become a better physician because of it.

But, like in any ice age era, we all need to thaw out, migrate and evolve sometime I suppose. 

Now, if it were only as easy and affordable to settle into a new home in Southern California as it was in those days...