I've been a Family Physician for almost a year, and something struck me as odd yesterday. I'm on my ER rotation, and a patient mentioned to me "Dr. CardiologistName saved my life." It was weird for me to hear that, because I think I had forgotten that doctors "save lives." Interventional Cardiologists, Trauma Surgeons, Emergency Physicians, they do it all the time.

Undeniably, there's opportunities for Family Physicians to directly save lives in a dramatic way, but I don't think that's why I'm in it. I had clinic yesterday afternoon. Outpatient medicine is different than the inpatient stuff in good and bad ways. One of the key differences is that the doctor doesn't usually do anything directly. It got me thinking, "Did I save any lives today?"

A 4-month-old came in for a well-child check. I ordered the standard immunizations to be given. I didn't give the shots (the nurse did). I didn't manufacture the vaccines. I'm not really sure of an unvaccinated kid's chances of dying of measles, mumps, rubella, hepatitis b, or pneumoccocus. But I think the chances of having complications from one of those diseases would be significant. I don't know if I saved his life, but getting a kid to their shots makes me feel satisfied nonetheless.

I saw a lady in her 60's who's doing better than she was last time I saw her. Her hypertension's under control, she's lost 60 pounds since October. She's walking more. I gave her a pap smear, a breast exam, and ordered a mammogram. Those last three things save lives in an abstract statistical kind of way. But what's really saving her life isn't my doing. She's better at taking her pills. She's been doing well with her diet, and she's walking more. I prescribed the pills, but I don't feed them to her. The patient and her family is taking her health seriously, and that's what's most important.

Anyway, I think what primary care should be about, is empowerment of the patient. A primary doctor should give the patients the tools to save their own lives. A place to get their shots and pap smears, to get the preventative health care and prescriptions that are right for them. Sure, intubating someone that's not breathing is rewarding, but I hope I can save some lives in more subtle ways too.

It kind of reminded me of one time on a late night on my medical school trauma rotation. I was sleep-deprived and yawned in the middle of a big open-abdomen motor-vehicle-accident case. The surgeon joked "I know this stuff is boring, but just pretend you're treating hypertension."