Academics has been my love for a long time. I started teaching at the university level 13 years ago, and I knew that it was a great fit for me. I love college student, I love teaching, and my profession is medicine. I’ve always called myself “half pastor, half professor.” It’s not that I don’t like practice — I do. But my issue with practice has always been the unnatural pace.
As annoying as it is for patients to have to wait to see a medical provider, it’s so much worse being a provider. In a typical appointment, I have to:
- Review the patient’s chart, all their past diseases and treatments, allergies, family history, etc.
- Interview the patient, letting them talk for at least 2 minutes, uninterrupted
- Negotiate a plan for the visit, based on their needs, and what I need to cover
- Finish interview
- Do physical exam
- Put all the symptoms together with the exam and make a diagnosis
- Determine patient’s need for treatment or testing
- Determine what needs to be done for health maintenance (routine bloodwork, testing, etc.)
- Order testing and write prescriptions, calculating dosages and checking for drug interactions
- Educate the patient on what they have, what needs to be done, and any side effects, expectations, etc.
- Document all of the above
- Code the visit for payment, assigning numbers which quantify the visit
Sometimes I’ve gotten 12 minutes a patient. Sometimes I’ve gotten 20. It’s really hard to do a good job while being efficient, personable, thorough, yet unhurried. It’s nearly impossible to truly look a patient in the eye and be present. And if one patient is running late, it sets the whole schedule back. It’s really hard to make up time when I barely have enough time to begin with. If a patient needs to be admitted to the hospital, then there is no hope of staying on schedule. All the while, you know that in spite of doing the right thing, all of your patients are going to be angry for the rest of the day, and long after they are home, you’ll be working on charting, call backs, hospital rounds, prescription refills faxed in from the pharmacy that have to be found in charts, and on and on.
I felt like patient care was getting reduced to clock-watching and a panic-driven pace.
When we moved to North Carolina, I applied for a license to continue to practice medicine here and discovered something unusual about PA practice in North Carolina. If you are not actively practicing for 2 years, your license goes under review and you are required to apply for re-entry into practice. The process is not clearly defined, but the only PA I knew of who had gone through it had to shadow a physician for 6 months before being granted a clear license to practice. That means no income for 6 months. Because I stopped practicing when I became Program Director, my two years is up in the next few months.
So I had a decision to make: stay in academics and lose my license to practice in the next few months, or go back into clinical practice.
In September, I got a call from the practice that is the gold standard of physician home-visit practices in the nation.They see adult and geriatric patients in their homes and in assisted living facilities. There is no time crunch to see patients, as patients are seen within a window of time, as they wait in their own homes making dinner, reading a book, or watching their favorite TV show without being exposed to other sick people. I would see the same number of patients in a week that I have previously seen in a day. I’d work out of my home, but I’d have lab and radiology staff, and an online support team. I’d carry my “office” with me in a rolling doctor’s bag with everything from vaccinations to suture kits. The schedule would be flexible. It reminded me of John Wesley and how when he made pastoral calls, he and his fellow ministers would care for a person’s physical health as well. I think it’s the way Jesus would practice medicine too — going where the needs are, seeing people in their own homes, taking time to look a patient in the eye and listen.
At the same time as deciding whether or not to move to Ghana, I had to decide whether to stay in academics and lose my license to practice, which would make it very difficult to get a license back, here or anywhere else, including Africa.
Or I could leave academics and go back into clinical practice, which would help prepare me for the mission field by refreshing my skills, and allow me to maintain my license, while practicing in what I feel is a God-honoring way.
After praying about it and consulting with mentors, I am transitioning back into clinical practice. I will still continue to do some guest lectures in the PA Program here, but my focus is going back to clinical practice. I have already started seeing patients one day a week, and I absolutely adore my patients. They remind me so much of the people at Mercury Courts that I worked with and loved for 6 years in Nashville. I love the fact that I have enough time with each patient to appreciate who they are. And I get to live out the gospel through medicine among the geriatric population in preparation for living out the gospel through medicine in Africa.
We had no idea when we moved to North Carolina that God would have so many changes in store for us. The things we thought we loved and depended on are rapidly changing. Jobs, our house, our friends, our financial security — the things we have had any dependence on — are fading in importance compared to the ultimate goal of following where God is leading us.
“But whatever were gains to me I now consider loss for the sake of Christ. What is more, I consider everything a loss because of the surpassing worth of knowing Christ Jesus my Lord, for whose sake I have lost all things. I consider them garbage, that I may gain Christ and be found in him, not having a righteousness of my own that comes from the law, but that which is through faith in Christ—the righteousness that comes from God on the basis of faith. I want to know Christ—yes, to know the power of his resurrection and participation in his sufferings, becoming like him in his death, and so, somehow, attaining to the resurrection from the dead.
Not that I have already obtained all this, or have already arrived at my goal, but I press on to take hold of that for which Christ Jesus took hold of me. Brothers and sisters, I do not consider myself yet to have taken hold of it. But one thing I do: Forgetting what is behind and straining toward what is ahead, I press on toward the goal to win the prize for which God has called me heavenward in Christ Jesus.” Philippians 3:7-14, NIV