GRADUATING CLASS 2022
Stephanie LaFave, MD
Undergraduate: Tulane University
Graduate: Tulane University School of Medicine
Medical School: Louisiana State University Health Sciences Center in Shreveport SOM
Hometown: Asheville, NC
Personal: Growing up in the mountains and after an 11 year run in Louisiana, coming
to the Shenandoah Valley feels like home. I am also very excited to be
practicing Family Medicine in this community where we can see interesting
pathology and stretch our scope of practice to fit the needs of our patients.
I grew up playing golf and continued on scholarship at Tulane but afterward
picked up rugby and hope to squeeze in time for both here, but will definitely
be able to continue my foodie ways and enjoy the delicious cuisine in
the area. Also my husband, Joe, and I have 7 furchildren (dogs) and 1
feather child (Andy the cockatiel) who also enjoy the mountain air, our
yard and sitting on the back porch.
Delmar Martin, MD
Undergraduate: National Autonomous University of Nicaragua
Medical School: National Autonomous University of Nicaragua
Hometown: Denver, Pennsylvania
Personal: I was born in Haiti, raised in central Pennsylvania, and lived most of
my adult life in Nicaragua. This is where I completed medical school and
became a licensed physician, while working with a church planting mission.
The many experiences along the way have broadened my horizons and given
me a desire to serve my fellow man. The broad-spectrum training, the strong
support and drive for excellence that is evident among the faculty, and
of course, the beautiful setting are a few of the many aspects that drew
me to SVFRP. I am honored to be a part of the team and serve the local
community. During time off, I enjoy playing piano and guitar. I also take
pleasure in getting away to the hills to camp and hike. As time allows,
I also like playing volleyball, softball, and racquetball. My greatest
highlight is time shared with my family - my beautiful wife and son.
Carl Rudebusch, MD
Undergraduate: College of William and Mary
Medical School: Medical College of Virginia
Hometown: Springfield, Virginia
Personal: Let’s go Nats!
Julie Shuster, MD
Undergraduate: Georgetown University
Medical School: St. George's University
Hometown: McLean, VA
Personal: I was born and raised in and around Washington DC, majoring in Biology
of Global Health at Georgetown. I then went way down south to Grenada
for basic sciences and north to New Jersey for clinicals. Now I am very
excited to be back home in Virginia! I love family medicine for the continuity
of care, the relationship with patients, and treating the whole person.
I have particular interest in women's health and end of life care.
Outside of medicine, I love the food network (and attempting to cook),
hiking, visiting vineyards, and music.
Jerry Skuthan, DO
Undergraduate: University of Central Florida (2017 National Champions)
Medical School: Edward Via College of Osteopathic Medicine - Auburn Campus
Hometown: Orlando, Florida
Personal: Hey fam! My name is Jerry and I'm a transplant from the Sunshine State.
I'm looking forward to experiencing seasons for once, although that
may change after winter. I love hiking, kayaking, and watching college
sports. I love that through family medicine I can treat patients throughout
their lives and be a part of their family as well. I am excited to learn
and grow throughout my time here in the Shenandoah Valley.
GRADUATING CLASS 2021
Andrew French, DO
Undergraduate: The College of William & Mary in Virginia
Medical School: University of Pikeville Kentucky College of Osteopathic Medicine
Hometown: Farmville, VA
Personal: I chose family medicine for two main reasons: continuity of care and spectrum
of practice. Being able to care for patients over the entire span of their
lives, from the labor and delivery unit to the nursing home, is a privilege
no other specialty gets to enjoy. And the broad scope of our training
is unmatched as well - every specialty from dermatology to sports medicine
and every setting from the ER to the primary care clinic.
There are a lot of great family medicine residencies out there. Front
Royal has several special features that made it my top choice: The mental
health in primary care opportunities; the practice management curriculum;
the OMT training. By the end of my time here, I expect to be well-prepared
to practice family medicine in a rural area.
My professional interests include: rural medicine, osteopathic medicine,
natural family planning, private practice, and obstetrics. In my time
off, I enjoy seeing the latest Marvel or Star Wars movie with my wife,
visiting Dinosaur Land with my kids, and learning new things outside of medicine.
Nauras Hwig, MD
Undergraduate: Old Dominion University (ODU)
Medical School: VCU/MCV SOM
Hometown: Vienna, Austria
Personal: Love anything and everything sports
Nelson McKay, MD
Undergraduate: Ashford University, Clinton IA
Medical School: Ross University School of Medicine
Hometown: Port Byron, IL
Personal: I was born and raised in rural Illinois. I majored in biology at Ashford
University in Clinton Iowa. After graduating undergrad I began medical
school at Ross University where I spent my clinical years in London, New
Jersey, Chicago, Miami, and Atlanta. I moved to Virginia with my girlfriend,
Danise Vroman, and our husky-lab mix Evey. My hobbies include traveling,
hiking, caving, and music. I plan to work internationally once I finish
Elena Messina, MD
Undergraduate: University of Florida
Medical School: University of Virginia School of Medicine
Hometown: Moscow, Russia
Personal: Shenandoah Valley was quite a change from growing up in Moscow, studying
in Florida, Seattle and France, and working for Lehman Brothers in New
York City, but I fell in love at first sight. I feel honored to serve
the local community and to learn from wonderful faculty, staff and fellow
residents. I enjoy outdoor activities, vinyasa yoga, ice skating and exploring
new places with my husband and son. I chose Shenandoah Valley residency
program for full-spectrum, hands-on training to practice Family Medicine
in any setting, whether following my husband around the world in his career
as a military officer or fulfilling my dream of becoming an "old
fashioned country doc" in rural Virginia.
Camelia Soliman, MD
Undergraduate: University of California San Diego
Medical School: University of Virginia School of Medicine
Hometown: Torrance, CA
Personal: Hey everyone, my name is Camelia. I'm originally from a little known
placed called southern California. While I miss my family and friends
(and the beach!), I must say that I absolutely love Virginia! I love the
seasons, all the green landscaping, and the people here. I'm slowly
working on trying to get everyone I know from home to come live out here
-- we'll see how that goes! I chose family medicine so that I'd
be able to be a resource for patients who want to understand their health,
and who needed a listening ear. I'm very privileged to be in a profession
that works to serve others, and I hope that I grow in my capabilities
of serving you all.
GRADUATING CLASS 2020
David Clark, DO
Undergraduate: Brigham Young University
Medical School: University of New England College of Osteopathic Medicine
Hometown: Keene, NH
Personal: I have a passion for all aspects of medicine and love the continuity of
care found in family medicine. I am happily married with a son and my
family is the most important thing in this world to me. Together we enjoy
traveling, running, hiking, camping, skiing, Frisbee, mountain biking
and most anything outdoors. I plan to practice the full scope of family
medicine in a rural area after residency.
Tyler Felton, MD
Undergraduate: University of Wyoming
Medical School: Ross University School of Medicine
Hometown: Cheyenne, WY
Personal: Born and raised in rural Colorado and Wyoming, living and working in a
rural setting is what I can envision in my future. Having first-hand knowledge
of the need for general practice physicians and the passion for all types
of patients made Family Medicine the best choice for me. I enjoy being
with my son/wife, climbing, bicycling, kayaking, disc golf, tennis, and
watching the Denver Broncos win.
Emily Kluball, MD
Undergraduate: University of Richmond
Medical School: Virginia Commonwealth University
Hometown: Richmond, VA
Personal: I have enjoyed gardening, cooking, and baking since I was young. I also
crochet and scrapbook. I enjoy music in general but especially playing
piano, flute and singing. I was a volunteer EMT for 7 years. I love traveling
with my husband, exploring and especially trying new restaurants and cuisine!
Joseph Schwartz, MD
Undergraduate: University of Notre Dame
Medical School: New York Medical College
Hometown: Arlington, VA
Personal: Growing up in the shadow of the Washington Monument, I love this area
and call it home. This is where I learned family values and American history,
scouted the Blue Ridge and Shenandoah with Troop 111, climbed Great Falls,
sailed the Potomac, worked on Capitol Hill, studied Public Health in Richmond,
met the best of friends and married my wife. While we loved college at
Notre Dame and enjoyed NYC during medical school, nothing would match
the camaraderie of six years as a Navy flight surgeon that took us from
Florida to Washington, and Italy to Japan. I am very proud to be a Virginian,
an Eagle Scout, a Naval Officer and a Blue Angel, and now, a family physician
in training. It's good to be back and we're glad to be here!
Michael Weingart, MD
Undergraduate: Reed College
Medical School: American University of Caribbean
Hometown: Johnson City, TN
Personal: I was born in southern California but raised in eastern Tennessee and
central Kansas. I chose to pursue Family Medicine for the opportunity
to practice full spectrum medicine and to contribute to smaller communities.
Outside of healthcare I enjoy cooking, hiking, kayaking, and goofing off
on the computer.
GRADUATING CLASS 2019
Brad Birth, DO
Undergraduate: Christopher Newport University
Medical School: Edward Via Virginia School of Osteopathic Medicine
Hometown: Sterling, VA
Personal: I was born and raised in Sterling, Va. Prior to medical school I spent
2 years in a physical therapy clinic as an Office Manager/ PT aide. It
was then that I discovered Osteopathy and decided that was the path I
wanted to take. I attended medical school at the Edward Via College of
Osteopathic Medicine (VCOM) Virginia Campus. I did an audition rotation
here at Shenandoah Family Medicine Residency while in my last year of
medical school and felt it was a good fit for me and my family. I enjoy
spending time with my wife Kristen and energetic black lab Bruce Wayne,
as well as friends and family. Recreationally, I like to play games on
the computer, go to the movies, or a sports bars to watch Hockey/UFC.
I am excited to find my place in the world and in medicine here at this
Garrett Kent, MD
Undergraduate: Clemson University
Medical School: Medical College of South Carolina College of Medicine
Hometown: Ashville, North Carolina
Personal: I am from a large family in rural South Carolina. I enjoy spending time
with my family, sports, weightlifting, and outdoors. I chose Family Medicine
because as a physician you are best suited to help any age person in any
aspect of their lives from the medical to the social. I plan to work as
family physician somewhere rural and I have interest in underserved/international
medicine and medical device inventions.
Daniel Mendez, DO
Undergraduate: Elizabeth City State University
Medical School: Edward Via Virginia School of Osteopathic Medicine
Hometown: Riverside, California
Personal: I was born and raised in Southern California. I chose SVFP Residency for
the opportunity of broad training that includes hands-on procedural experience,
breadth of experiences with patients and illness, and care for complex
hospitalized patients. I have particular interests in Primary Care/Sports
Medicine, Osteopathic Manipulative Medicine, and International Medicine.
My personal interests include traveling, sports, outdoor activities, and
spending time with my loved ones.
Michael Ryder, DO
Undergraduate: Brigham Young University
Medical School: University of North Texas Fort Worth College of Osteopathic Medicine
Hometown: Midland, Michigan
Personal: I am interested in competitive trail running, skiing, surfing, skateboarding,
rock climbing , sketching and painting, learning foreign languages, hiking,
backpacking and camping and mountain biking.
Sunmi Yang, MD
Undergraduate: Williams College
Medical School: University of Queensland School of Medicine
Hometown: Seoul, Korea / Madison, WI
Personal: I love to explore the world, whether it be through traveling, reading,
meeting new people, or trying interesting things. In medical school I
discovered that I loved all of the specialties too much to give up on
any of them, so I chose rural family medicine to get the most solid foundation
of training on which to build my future, full-spectrum practice. I also
hope to be involved in overseas work with organizations like MSF or PIH
someday, and am confident that I will graduate from the Shenandoah Valley
Residency with the skills and knowledge to face any challenge. In the
meantime, I look forward to spending the next three years in this beautiful
place, surrounded by the incredibly supportive staff and faculty, and
my amazing fellow residents.
GRADUATING CLASS 2018
Regina Carpenter, MD has joined a private practice in Georgia.
David Estrada, MD has joined Valley Hospitalists in Winchester.
Michael McLaren, MD is e doing an ER Fellowship in California.
Daniel Moore, MD will be doing Urgent Care in Richmond while working towards opening a
Direct Primary Care office.
Sam Waltos, DO will be doing Locum Tenens work.
GRADUATING CLASS 2017
Alison Collins, DO is practicing at a Family Practice center outside of Tyler, TX.
Gabriel Edmondson, DO is doing outpatient Family Medicine in Bassett, VA. at a Community Health
Center (Bassett Family Practice, which is a part of Martinsville-Henry
County Coalition for Health and Wellness).
Akolea Ioane, MD is practicing at Straub Medical Center Urgent Access Department in Honolulu,
HI which caters to immigrants and the city poor.
Stephanie Marzola, MD is practicing in Lakeland, FL.
Kirsten Wiitala, MD is practicing Urgent Care in west Los Angeles, CA.
GRADUATING CLASS 2016
Jessica Jackson, DO has joined Valley Hospitalists in Winchester.
Benjamin Kaplan-Singer, MD is practicing in a solo holistic practice based in Virginia.
David Leng, MD has joined Kaiser Permanente in Ashburn, VA.
Kyle Song, DO has joined a practice in the Bealeton, VA area.
Candace Wise, DO has joined the faculty of Lewis-Gale Hospital-Montgomery in Blacksburg, VA
GRADUATING CLASS 2015
Patrick Antonio, DO is practicing in the Maryland suburbs of DC.
Sayeh Daee, MD is practicing as a Hospitalist in the Phoenix, AZ area.
Andrew Otto, MD is an Emergency physician in California.
Eva Prince, MD is practicing in Fredericksburg, VA.
Caitlyn Santer, DO returned to the Parkersburg, WV area and practicing in Ohio.
Jordan Tran, MD is practicing at an Urgent Care in Winchester, VA.
GRADUATING CLASS 2014
Danielle DuBrey, DO has found her dream job on the east coast practicing family medicine with
Ellis Johns, MD has joined the faculty at Front Royal Family Practice
Holly Pierce, MD is working in Virginia Beach, VA.
Laura Wolfe, MD is working in Cherokee, NC.
GRADUATING CLASS 2013
Leigh Atcheson Vaughan, DO is practicing in North Carolina.
Anna Eirich, MD is practicing at Selma Family Medicine in Winchester, VA.
JoAnna Salmon Kaufman, MD is practicing in Bluffton, OH.
Melinda (Lindy) Valichnac Feely, MD is practicing in Safford, AZ.
Kristos Vaughan, DO is practicing in North Carolina.
GRADUATING CLASS 2012
Edward Fleming, MD is practicing in Clinton, NJ.
Julie Howard, MD is practicing in Wisconsin in a full-spectrum family practice, including
OB at a rural critical access hospital.
Amanda Michael, DO opened a solo practice in Berkeley Springs, WV.
Rebecca Rehmann, DO is practicing in Centreville, VA.
Michael Usberghi, DO is practicing at a hospital in Ocala, FL as a hospitalist.
Morgan VanDerHorst, MD is practicing at a Family Health Center in Newport News, VA
GRADUATING CLASS 2011
Sachin R. Nagrani, MD is a physiciain with Heal.com (house calls).
Megan L. Williams, DO is practicing at Amherst Family Practice in Winchester, VA.
Chi G. Young, MD has joined a family practice clinic in Northern Virginia.
GRADUATING CLASS 2010
Matthew Fagan, DO is working for Kaiser Permanente in San Francisco, CA.
Jacqueline Judd Flack, DO has joined Selma Family Medicine in Winchester, VA.
Abdurahman Hassan, MD is practicing in Northern Virginia.
Jordan Hill, DO is practicing in Broadway, VA.
Tamara Spriggs, MD has joined the faculty at Front Royal Family Practice
Molly Cage, MD is working in the Richmond, VA area.
GRADUATING CLASS 2009
Micah Crouse, MD is working in Emergency Medicine at Warren Memorial Hospital in Front
David Flack, DO has joined Selma Family Practice in Winchester, VA. He also teaches Internal
Medicine rounds with the intern classes and is the Osteopathic Director
of Medical Education and the residency Designated Institutional Officer (DIO).
Larisa Martin, MD has joined a private practice in the Seattle, WA area.
Daniel Pham, MD has founded a private practice in Oklahoma.
Ramashilpa Sudireddy, MD is practicing rural Family Practice with OB and C-Sections in Columbus, TX.
GRADUATING CLASS 2008
Chaitanya Alli, MD is practicing in the Houston, TX area.
Monina Daguio, MD is practices in downtown Seattle, WA.
Martin Kosciuk, MD is practicing Emergency Medicine in a trauma center in Jonesboro, AR.
Charles Middelhof, MD founded Valley Family and Procedural Medicine in Stephens City, VA.
Kimberley Wyrick, DO has joined Rockingham Family Physicians, Harrisonburg, VA
GRADUATING CLASS 2007
Christopher Craig, DO is practicing at Stephens City Family Practice with Joel Grant, MD (Class
of 2004) in Stephens City, VA.
Samer Hawari, MD is practicing at Selma Family Medicine in Winchester, VA.
Namrata Joshi, MD is practicing at The Permanente Medical Group in Santa Clara, CA.
Rajith Rajan, MD practiced Stafford, VA until his death in 2013.
Jocelyn Serrano, MD is practicing at Inova Family Medicine in Ashburn, VA.
GRADUATING CLASS 2006
Holly Abernethy, MD is practicing at High Desert Family Medicine in Farmington, NM.
Charles Cho, DO is practicing at The Family Health Center in Woodbridge, VA.
Anne DeLanoy, MD is practicing at Shenandoah Community Health in Martinsburg, WV.
Omar Khan, MD completed a Neurology residency at Dartmouth and completed a Clinical
Neurophysiology and Epilepsy Fellowship at the National Institutes of
Health in Bethesda, MD. He is an Assistant Clinical Director NINDS, Medical
Education, a Fellowship Director NINDS & NIH-Site Director MGNN Residency
Program, and a Staff Clinician: Neurology, EEG and Epilepsy at NIH in
GRADUATING CLASS 2005
Alexander Akhavan, MD is a hospitalist in Las Vegas, NV.
Cynthia Flores, DO practiced in Gainesville, VA until her death in 2010.
Shannan Green, MD is currently a staff physician for Virginia Commonwealth University.
Jason Hackett, MD has joined a private practice in Gainesville, VA.
Minh Nguyen, DO is practicing in Washington state.
GRADUATING CLASS 2004
Robert Saunders, MD practiced in Leesburg, VA until his death in 2019.
Joel Grant, MD started a solo practice in Stephens City, VA that has now expanded to
include Christopher Craig, DO (Class of 2007). Dr. Grant now regularly
precepts at the Family Practice Center.
Gina Adair, MD is practicing in Tracy, CA.
Iris Sadowsky, DO started a solo practice in Gilbert, AZ.
Nancy Pandhi, MD is practicing in Madison, WI and is also on the faculty at the University
Brian West, MD is practices Emergency Medicine in WV, is a physician in the WV Army National
Guard and has had several tours in overseas combat areas.
GRADUATING CLASS 2003
Jason Bhan, M.D. is currently in New York City. He founded Osmosis.com.
Pamela Heath, D.O. is practicing in a Community Health Center in Danville, VA.
Dreama Rucker, M.D. practiced in Frenchburg, TN until her death in 2016.
GRADUATING CLASS 2002
Christine M. Aiello, M.D. is practicing at Berryville Medical Associates in Berryville, VA.
Tony Fiore, D.O. is practicing at Multispecialty Health Group in Fredericksburg, VA.
Daniel Freed, M.D. became the only practicing physician in the very underserved Highland
County, VA. He is working for Bedford Hospitalists in Bedford, VA.
Rebecca Layman, M.D. joined Dr. Jennifer (Dwyer) Pope (Class of 2001) at Shenandoah Valley Family
Medicine in Strasburg, VA.
Nimsha Thaver, D.O. is practicing in Pennsylvania.
GRADUATING CLASS 2001
Sam Armitage, M.D. founded Pelican Family Medicine in Wilmington, NC.
Jennifer Dwyer Pope, MD founded Shenandoah Valley Family Medicine in Strasburg, VA. Past graduate
Rebecca Layman, MD (Class of 2002) has since joined the practice.
Michael T. Lin, M.D. is practicing at Fauquier Family Practice in Warrenton, VA. Upon completing
a Virginia Commonwealth University Faculty Development Fellowship Program
in 2001-02, Dr. Linnow regularly precepts in the Family Practice Center.
Douglas Thrasher, MD is practicing in Omak, WA.
"A DAY IN THE LIFE"
I look at my alarm clock. It’s 5:30 a.m. I’m up, but the sun’s
not. Yawn! It’s time to get out of bed and start my day as a 3rd
year resident. By about 6:30, I arrive at Warren Memorial Hospital. It
may look small on the outside, but don’t let that fool you. On the
inside, things are always plenty busy! I arrive on the second floor and
print out our Family Medicine inpatient list. There’s a variety
of patients as always. There’s a pregnant patient in labor (better
visit her first!). There’s a newborn male who needs a circumcision.
An ICU patient on a ventilator just had an ABG performed and the settings
on the machine need to be changed. Of course the 2nd floor is full of
interesting folks. Pancreatitis, chest pain, atrial fibrillation, pulmonary
emboli, hip fractures, and pneumonia are just a few of the disease processes
that we deal with on a typical day. I’m so glad I’m not alone!
My second year is here and we’re ready to divide up the patients
and begin our day. It’s 8:00 a.m. and our attending arrives. We
all sit down and update him/her about our patients and devise our treatment
plans. Beep! Beep! Beep! There goes my pager. It’s the ER and they
have a patient for me to evaluate. I go downstairs and find a 90ish female
who is unresponsive, a tearful family by her side. I perform an H&P
and write orders for her admission. It’s about 11:00 a.m. now and
it’s time for teaching rounds. Today, the Clinical Pharmacist on
our staff presents a case for discussion. On other days, our attending
asks us to present a case and teach the other residents and students about
a particular disease process. Wow, I look at my watch, its 12:30. Time
flies when you’re having fun! I grab a quick bite to eat and finish
some discharge paperwork on the floor. During the rest of the day, there
are a few more trips to the ER. Beep! Beep! Beep! The nurse on the on
the phone tells me that the elderly lady that I admitted earlier in the
morning isn’t doing well. I rush up the steps and make my way into
her room. Around her bed, her family gathers. I join them. Her prognosis
is not favorable. A few minutes pass, and I pronounce her: 4:00 p.m. It’s
a sad moment for us all. As I walk out of the room, a nurse tells me that
they need me downstairs in Labor and Delivery. Remember that pregnant
patient in labor? I run to the Women’s Care Center. I gown up and
get myself ready to deliver a baby. I position myself at the end of the
bed and take in the scene. Here again is a family joined around a bed
for an entirely different reason: to welcome a child into the world. One,
two, three… We start pushing. Soon after we start, I deliver a
beautiful baby girl. Everyone is smiling, especially me! As I walk up
the stairs to sign out to the on call resident, I pause and think how
privileged I am as a family medicine physician to participate in the circle
of life. It’s 5:00 and it’s time to go home. A few hours later,
it’s time to go to bed. I set my alarm and think of what the next
day will bring. I fall asleep happily thinking of tomorrow.
"2008 Graduation Speech" Dr. Thomas Ball
Thank you Frank, and Tony, and all of our esteemed colleagues. And thank
you graduates for allowing me this one last shot at giving you useful advice.
Naturally I would like to distill all that you have been learning and crystallize
it into one fine gem. That is not going to happen. I have, however, spent
some time thinking about what I think it takes to be a great family physician.
To start, one needs to keep in mind the grand scale of our enterprise.
We deal with the human being in all of its extraordinary complexity. I
know of no other profession that asks one to analyze and interpret the
workings and malfunctions of something more complex. And in family medicine
we are allowed no shortcuts. We cannot narrow our focus to a single organ
or system, in fact we cannot narrow even to a single individual. There
is really nothing, from the biochemical to the psychodynamic to the socioeconomic
that we can leave out. And the stakes are high. We make decisions daily,
usually after a 15 to 20 min interaction, that may impact a persons well
being for life. How do we make that happen? What does it take to practice
First, it takes Knowledge. You have to know a lot of stuff. Even in this
age of electronic information, I still believe that means reading. You
have to read, and you have to read some more, and you have to keep reading.
The information in the palm pilot and on the computer is great, but to
make the initial connections that point you in the right direction, you
have to have data right up front.
I like to think of Martin Kosciuk when I think of the knowledge base of
family medicine. Martin is obviously a smart guy, and he came to us with
a lot of experience and knowledge from his medical training and his work
as an anesthesiologist. However it was also evident, early on, that there
were some gaps. For one thing, anesthesiologists do not worry much about
treating psychological factors that affect a person’s health. Rarely
is depression diagnosed in the operating room.
Fortunately, Martin’s passion to know seemed to ignite during his
residency training. Over three years his presentations evolved from “I
don’t know, I think he is just depressed”, to “well
as you know among the DSM IV criteria for depression he meets” this
and this and this. Martin’s expanding level of knowledge and detail
is not limited to psychiatry, it is all over our field. The phrase “As
you know”, coming from him, began to frighten me, because often
I was not so sure I did know. Martin you may not be aware, but more than
once, when I knew you had admitted a patient overnight, I found myself
at 7:45 checking out Dynamed or a review article to make sure I did recall
what you were about to tell me you assumed I knew. This is how one builds
the knowledge base necessary to practice family medicine.
The science of medicine is a beautiful thing in its own right. Our job,
however, is to apply it. That involves really knowing the patient. Before
we can snap together a medical puzzle, we have to have the pieces laid
out before us. Our craft is one of digging out the information that allows
us to explain a person’s condition. And this is hard work It is
a craft that requires dedication, often many hours dedicated to eliciting
the information we need about one patient.
Dedication to her craft is the reason Kim Wyrick can so often be found
working after hours. She is there searching patient records, tracking
down radiology reports, calling patients, and pulling together information.
Kim is dedicated to her craft, and dedicated to her patients. She is willing
to go the extra mile or spend the extra hour to make sure her work is done.
Over the years I have often been asked to review cases where things have
gone badly for a patient. There are many reasons problems occur, but I
have found that most commonly those problems stem not from lack of knowledge,
but from not doing the work. When we cut corners we make mistakes. When
I am fatigued, overwhelmed, straining to keep up with what seems like
an ever increasing load, I can think of Kim, and her dedication and willingness
to do the job, even if it requires sacrificing her own time. I do not
counsel anyone to give up their personal life or drive themselves to exhaustion,
but I believe a family physician must take a measure of what our craft
requires and dedicate him or herself the getting the job done.
I’ve spoken about a knowledge base, and about dedication, but of
course knowledge are guided by reason. My palm pilot can read and store
more information in a 5 minute hot sync that I can in a month. There are
surveys and electronic means for assessing patient’s symptoms as
well. But artificial intelligence schemes have performed poorly as diagnosticians,
much less healers.
Medical reasoning is a complex art beyond the ability of machines. It involves
synthesizing, weighing, organizing a knowledge base and meshing that with
the information we gather from a patient. It is really an art we know
little about and I cannot begin to describe or explain. But like Supreme
Court justice Potter Stewart’s comments on pornography, “I
may not know how to define it, but I know it when I see it”. Seldom
do I see medical reasoning more evident than when Chaitanya Alli presents
Her presentations are particularly special to me, because I remember her
first presentation as a subintern over 3 years ago. Then, there was a
small torrent of data and findings and ideas. She was obviously very nervous.
The patient actually did not seem to have an overly complex problem, but
by the time she finally seemed calm enough to stop adding in information,
I was not sure what was going on. That was then. Now, it is a pleasure
to listen as Chaitanya lays out a case. She is organized, succinct, and
decisive. A phrase she uses that always catches my ear is “and coming
to the physical exam”, or laboratory data, or whatever is coming
next. I presume this may be a bit of Queens English as opposed to our
American speak, but I smile a bit inside each time I hear say “and
coming to”, because I know that soon we will be coming to a very
logical conclusion, consistent with the presenting facts and supported
by best evidence.
Now, when I find myself wandering as I present a case to a consultant or
colleague, I like to hear Chaitanya’s voice in my head and ask myself
if I am coming to the next logical step or not.
An immense knowledge base, dedication to the craft of gathering information,
brilliant medical reasoning. These are all key facets of a good family
physician. But we know these things are not nearly enough. For we have
not spoken of the heart. Ours is a caring profession. The art of caring
is the heart of medicine.
I remember talking with Mimi Daguio about a patient with multiple medical
problems including chronic pain. I said something to the effect of “you
know Mimi, we could do that test, but realistically, we are not going
to be able to do anything for her”. Mimi’s face took on a
pained expression, “Oh Dr. Ball, she just needs to know we are trying”,
she told me. We knew the data, we had done our homework, we had reasoned
things through clearly; but I had missed something. We did not order the
test, but I believe Mimi was able to give that patient some of what she
Sometimes our brains are not enough. Sometimes we have to work from our
hearts. Simple caring and compassion are often the most important steps
in healing. A one of my mentors phrased it years ago, “Patients
care about how much you know, what they really want is to know how much
you care.” I hope that Mimi’s face will always be there in
my memory, and in the memory of all of you, to remind us that when we
sit with or take the hand of a patient seeking our counsel, we do little
unless we let them know that we care for them.
There is something more involving heart and family medicine I struggle
to define, but would like to bring up. Last fall I had the unique opportunity
to travel with Charles Middlehof to Honduras. It was an enlightening experience.
Charles seemed to fill the experience with energy. There was a young woman
with heart failure living in a simple village miles from the nearest road.
Charles’ efforts on her behalf were a marvel to behold. He arranged
everything; a burro for transportation of the patient, contacts in the
city, an echocardiogram by a board certified cardiologist. The wit, resourcefulness,
and energy he brought to the task were remarkable. I believe this resourcefulness,
and particularly the joy with which Charles employed it, exemplified the
spirit of family medicine.
Our job is hard work, and you graduates are in it for the long haul. I
could not do it were it not for the many rewards it offers. I don’t
mean monetary rewards, I don’t think people work this hard and dedicate
themselves this long if there is not joy in what they do. There is a special
joi de vive, a spark that must be present to keep me going. I believe
the spirit of family medicine brings us the joy and the spark we seek.
I appreciate Charles reminding me of that.
I began seriously training to be a family physician about 25 years ago.
I have amassed a body of knowledge. I have been dedicated to my craft.
I have honed medical reasoning skills. I have shared a bit of my heart.
And I have loved the spiritual side of my job and the life it has brought
me. I think I can speak for all the faculty when I say to you Martin,
Kim, Chaitanya, Mimi and Charles, that we have tried to share our knowledge,
our commitment, our reasoning, our care and our spirit with you. I think
you are well aware of that. What I want you know today, is that I myself
am also a better family physician now than I was three years ago. Some
of that is because of what I have learned from each of you. So I thank
you, and I wish the blessing of similar continued growth on each of you.