MAFP Physician of the Year
Speech,
Jennie Orr, April 16th, 2009
Good evening, ladies and gentlemen!
It is indeed humbling to stand up here representing many of you, Minnesota’s
family doctors.
First, I let me say I am very
aware that this could have just as easily have been just about any one
of you. Each and every one of us has the privilege of walking
with our patients through both difficult and joyous times in their lives.
Every year about 50 or 60 of us have someone who takes notice of the
Academy’s request for nominations and support letters and takes the
time to write what has made their experience memorable. For every letter
that makes to the MAFP office in St. Louis Park, there are countless
encounters where one of us has made a difference in someone’s life.
Just Sunday someone came up
to me after one of the Easter services at church and said the infamous,
“You probably don’t remember me, …” (you are right, lady, I
don’t. Somehow you look different in street clothes and makeup) “…
but,” and went on to recount some casual statement I made when admitting
her from the ER some time ago that stuck with her. We do make a difference.
We have the privilege, and responsibility,
of interacting with our fellow
human beings at their most vulnerable. Sometimes on the fourteenth
or sixteenth hour on call it isn’t as easy to muster the grace to
couch our communications in the most kind and respectful words, but
to THAT patient or family, it is critically important. But you know
that, - and do it, - all the time. I suspect I am preaching to the choir.
The second thing I need to
say is that good care is a team effort and to acknowledge some of my
team:
Above all, my God and my faith
community that have upheld me by the Holy Spirit and in prayer over
and over and over again. Along the way, from meeting a professor who
knew both the colleges I was planning to apply to and told me - quite
correctly for me -
to go to the state school halfway
across the country and NOT the church college much closer to home, to
getting accepted into the “just right for me” primary care focused,
non-competitive medical school I attended three days before I was going
to take that job offer as a programmer/analyst in Seattle, to newsletters
and E-mails from people who just HAPPEN to need a Cursillo team member
or short term C-section provider right when I’ve just HAPPENED to
be thinking I hadn’t done anything in missions lately, to successfully
doing several emergency procedures overseas I’d never done before,
the Holy Spirit has been with me and guided me in ways my personal capabilities
could never account for.
In human terms, the first to
acknowledge is my mother, Ione Orr, who taught me from day one to love
the Lord and give back time, talent and treasure from the bounty with
which I have been blessed. I think my first volunteer experience
must have been rocking babies, working with her in the church nursery
at age about 5 or 6, so her example took hold early! She also
moved to town shortly before our long term housekeeper moved on to something
fulltime with benefits. She was a Godsend during the phase when our
teens were “too old” for a baby sitter but never too old for a ride
from Grandma or a chance to go out for dinner with her when Dan and
I were both gone for the evening.
Thanks, Mom! You still inspire
me with your faith and dedication to others.
Second, my husband, Dan Thomas,
who shares with me core values of faith, family and frugal living.
He naively agreed before we got married to share “equally” in homemaking
and child raising responsibilities. He grew up with a stay at home mom
and had no CLUE what he was
getting into. Dan, - here’s to all the meals you’ve made,
hours of housework you’ve
done and months you single parented while I was over seas.
Bless you for hanging in there!
Third, my two favorite young
adults in all the world, Lori and Joel Thomas, my kids.
They put up with many late
meals, and all the other inconveniences of a physician parent’s unpredictable
hours. It was with mixed emotions, mostly pride in the busy and meaningful
lives that they have created for themselves, that I received the news
that they were both “too busy” to come home for tonight’s event.
I take it as a confirmation that we have done our job of giving them
both roots and wings and that they’ve fledged.
Bless them!
Moving on to the clinic, thanks
to the managers and lead physicians that have allowed me to work so-called
“ part-time” so I could do some of the volunteer and teaching things
I’ve done the last 11+ years. I am very grateful for your understanding
and flexibility.
Next, my early colleagues who
mentored me, especially Tom Schwinghammer and Gary Moody, who I did
most of my early C-sections with, and my current colleagues who take
the phone calls and see my patients when I am not available. I could
never take the time off without the wonderful backup.
Also critically important are
all the support staff that make the clinic run smoothly and take care
of both the patients and us providers
- Kathy, who juggles the call
schedules,
Tammy, who solves computer
and staffing problems with equal grace,
Jessie my current nurse, who
is a whiz at managing diabetic tracking (50% “in control” for March
- yes, nagging phone calls and repeat blood pressures after 5 minute
rest matter!) as well as juggling patients who need to get in
to a packed and running behind schedule -
and can still smile at the end of the day!
Then there’s Bonnie, whose
cheerful and efficient “I can do that” as the Peach station float
makes everybody’s day go smoother
and Liza who schedules our
outside referrals
and all the RN’s on triage
and schedulers
and coders
and housekeepers
and the list goes on.
They are all a part of the
team and the patients wouldn’t care the care experience they need
and want without ALL of them.
Last and most of all, what
gets me up and off to work every morning are the patients.
It has been my privilege to
walk with some of them for over a quarter of a century.
The woman I still see who brought
in all three of her kids - on different days - for well child checks
my first week in town. The woman that had breast cancer around
the time my mom did 17 years ago, who still asks how Mom is when she
comes to see me. The twenty-somethings that I delivered and still see
as adults. The aphasic man who swore at me - with a smile - every time
I saw him for 12 years because those were the only words he could reliably
produce. I may not LIKE all the patients, - a few with personality
disorders come to mind - but more or less in my own all too human and
imperfect way, I’ve tried to love them all with the agape love first
shown to me by God through my family, friends and faith community.
No one has told me exactly
why the MAFP chose me for this award. Like I said at the beginning,
most of us have some patients who like us a lot. They wouldn’t keep
coming back if they didn’t. I suspect when they checked references
on the finalists, most of our peers and administrators are willing to
say nice things about each of us, so I doubt if the references were
what drove their decision. I assume it came down to the volunteer and
teaching things I’ve done and maybe some of the enthusiasm I do have
for Family Medicine.
Why do I volunteer and encourage
all of you to consider ways that you might do so as well?
First, faith. I don’t recall
that we had to pick a theme verse 40 some years ago when I was confirmed,
but if I had to now, I think mine would be - Micah 6:8. “What do I
(God) require of you but to do justice, love kindness and walk humbly
with your God.”
I am so blessed, - with
health, for the most part, medical skills and a wonderful support system.
If I didn’t use them to give God thanks and glory, I would be an ingrate.
Which I’m not.
Second, need. Our safety net
in the US is broken and many people lack health insurance and access
to care. The St Mary’s Free Clinics were I, and many others,
volunteer provides needed services to those that are unemployed or under
employed or otherwise ineligible for benefits. I can’t
think of the last time I heard of an obstetrical death in Minnesota,
although I know there are one or two a year, but world wide, more years
of useful life are lost by women to obstetrical complications than almost
anything else.
Training of mid-levels and
lay midwives in recognition of complications and basic emergency skills
and provision of back up services for complications SAVES LIVES.
The need doesn’t get much
more obvious than that.
Third, opportunity. You could
call it coincidence, although I don’t.
Kallie Macken, the director
of the United Family Practice residency, just HAPPENED to run one of
the first ALSO courses outside Wisconsin AND she asked my partner, Leslie
Atwood, to help with it AND they recruited me to help the next time
around. Now Lesley is the national chairperson emeritus and I’m an
International Advisory Faculty member.
Coincidence?
I don’t think so.
When I was frustrated with
our disastrous detour to “just counting the number of visits” during
the move from charge based production to RVU’s, a former colleague’s
newsletter from Bangladesh just HAPPENED to mention an need for someone
to teach C-sections to the staff at their new OB hospital, and, by the
way, culturally it really needs to be a female. I’m female.
I do C-sections. Mom is in town now and can help with the kids.
It wasn’t “why me?” But
more “why NOT me?”
Don’t get me wrong, I don’t
take every opportunity that comes my way. I passed on three months
in Kabul two years ago. Last year I turned down a chance to spend six
days traveling to teach ALSO for five days in a Nepali city where the
latest blog entry I could find was several months old and said, “I
haven’t heard too much anti-aircraft fire from the rebels in the hills
LATELY.” But I AM headed to Katmandu next Saturday to
teach ALSO again. Three days travel for seven days teaching and a couple
of days to visit the orphanage we support an hour away, THAT I can handle.
And last, the intangible rewards
of doing what one is meant to do.
I wouldn’t be good at fixing
cars. half the time I can’t even change the wiper blades.
But cross cultural stuff doesn’t
seem to be hard for me. I enjoy ethnic food, I love meeting new
people with a passion for something we share, like OB care or missions,
and yet a different point of
view from another culture. I come home tired, yes, but reenergized
by the knowledge I’ve done something that made a difference and with
new experiences and friendships to treasure.
Enough of that.
Why do I think NOW is a great
time to be in Family Medicine?
Number 1: Our patients need
us. The population is aging. Treatments are now helping people live
longer with more chronic health conditions and complex medical regimens.
Coordination of care has never
been more important. I see lots of talk about Medical Homes. That’s
what we’ve been doing all along. Now it is starting to get some
long deserved recognition. Whether we will get more support or financial
reward for doing it, I leave to the political and business types to
hammer out.
Number 2: Taking care of families
and people over their life spans is fun. I’ve always liked OB but
I still can’t feature not taking care of the baby just because the
cord got cut.
Really knowing whole family
gives a lot of insight into the 60% of medicine that is really more
psychosocial than not. From “little peds” to geriatics and ophthalmology
to orthopedics leads to never a dull moment. We can take care of 90%
of what our patients present with and yet have the resources to consult
with on difficult cases in all areas.
I find that the best of both
worlds.
Number 3: We live in exciting
times in medicine. Genomics, robotic surgery, even the computerized
medical records that we love to hate for their flaws and growing pains.
I spent the first year on the EMR swearing I should have stayed in software
after all and written something a CLINICIAN can use. But now I appreciate
it so much when I can see my referred inpatient’s notes as soon as
they are written and can pull up history and lab results on phone calls
at night or have the medical history of one of my partner’s patient’s
literally handed to me on a printout when I go in to do an admission.
No more wondering when I go to dictate at night “now which antibiotic
did I give THAT child for their ear infection?” Now I have documentation
for all those visits that were really 99214’s but I down coded because
I wasn’t sure I remembered to document all the details.
Lastly, and I think most encouragingly:
While their numbers may be down nationwide, I’m able to tell you with
confidence that we have some wonderful, homegrown young doctors going
into Family Medicine in Minnesota. For instance, the class of 2012 for
the United Family Medicine residency is all from the U of M Twin Cities
and U of M Duluth. Their biographies are impressive. Their passion for
medicine and cross cultural experience makes me doubt that I would have
been even considered had I been applying for their class with my experience
as a new grad. Their collogues I have precepted in RPAP and the residency
over the last 10+ years are smart, caring and enthusiastic. They have
way more wisdom than I had at their stage. Mentoring them is a blast.
Try it, you’ll like it!
In closing, how can we survive,
- and yes, thrive, - in these difficult times?
First, cultivate an attitude
of gratitude and a long term view. I try to think about the patients
I’ve helped live a little healthier over years instead of the number
charts I still have to close this week. My 403b has lost 40% or more,
just like yours, but I haven’t sold anything. I have a job I love
that provides more than enough for now and this, too, will pass, like
the recessions before it.
Next separate wants from needs
and simplify our lives. When I was growing up “Reduce, reuse, recycle”
wasn’t an ecological slogan, it was a way to get by on a teacher’s
salary.
“Stuff” takes time and
money to take care of, leading to more stress, to say nothing of its
carbon footprint on our increasingly beleaguered planet. Having spent
our lives following “give 10 (or more), save 10 (or more) and live
on less than the rest,” has left Dan and I debt free so that I can
still work part time and be able to volunteer even with Dan’s unexpected
early retirement and the recent economic down tern.
Then, follow your passions
and work from your strengths. I am a teacher and a clinician, not an
administrator or politician. I’ve taught ALSO around the world but
I’ve never been on the hospital executive committee or responded to
pleas to apply for the lead physician job at the clinic. I don’t
herd cats. I’ve corrected papers at math tournaments but never
coached youth sports. If it involves a ball, I guarantee I’m lousy
at it. Find your own passion and follow it. No one is good at everything,
Thank goodness other people are good at the things I’m not.
Lastly, play it forward. I
believe that I, and all of us, have been “Blessed to be a blessing.”
(Genesis 12:2-3) As St Francis said long ago: “Preach the Gospel
at all times and when necessary, use words.” Since I have only
15 minutes with you, I’ve used more words than usual. God loves
you and so do I. Spread the message in your own unique way.
Blessings on your journey,
where ever near or far it takes you.
MAPF Family Physician of the
Year Speech Page of 5
Jennie Orr, April 16, 2009