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The Road Not Taken

By Caroline Knox, M.D. , MD 09
July 2009

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When people asked me what sort of doctor I wanted to become, I answered by listing the various subpopulations I had an interest in working with: geriatrics, palliative care, adolescent medicine and women’s health. As I became more familiar with the health concerns of adults with chronic diseases, I thought I might go into internal medicine or pediatrics. Looking back now, it’s easy to recognize that all of those groups add up to the patient panel of a family physician, but since I knew very little about it, family medicine was not even on my radar.

As a volunteer at the Vanderbilt student-run Shade Tree Family Clinic, I learned first-hand about the dire need for primary care in an urban, under-served area. This experience was very important for my personal path to a career choice.

I had helped cared for an elderly, frail patient who was having trouble controlling her diabetes, despite being on an ideal regimen. I had met her entire family. I knew she had great-grandchildren living with her, but I had never thought about what their home was like. As “one of our most loyal” Shade Tree Clinic patients, she had won the Thanksgiving basket and we planned to deliver it to her home. After five minutes of waiting outside her apartment, our arms laden with groceries, we started to worry. This patient was such a frail woman, I wondered how she had enough strength to get down these stairs and around the corner to our clinic each month. Finally, a granddaughter came to the door with a toddler in her arms. Our patient was just behind her, beaming like I had never seen before. Inside the kitchen, there was hardly any room to stand, much less set down groceries. The room was dark and musty with mold and stale cigarettes. It was five days before Thanksgiving, and there was barely any food in the house. I offered to put the turkey in the refrigerator, and a grandson opened it to reveal rows of empty shelves and a single jar of mayonnaise. The expectations we had for our patient in the clinic did not take these circumstances into account. This patient’s “difficult case” had been demystified in a way that hundreds of dollars of laboratory tests never could.

Then, during my fourth year, I spent a month with family physicians working for Indian Health Services on the Navajo reservation. At that point I knew primary care family medicine was where I could find both personal and professional fulfillment.

Many of my classmates entered medical school already attracted to a particular subspecialty. With so many talented specialists on campus to foster those interests, I can see why many of my peers are still gearing their careers toward a specialty.

Primary care appeals to me for many reasons. I want to emphasize disease prevention and health maintenance before illnesses spiral out of control. I see the health of the individual inseparable from the health of their relationships and social and physical environments, and I want to consider my patients’ health within these contexts. I want to be a part of a community and develop meaningful relationships with families spanning generations. Maintaining health is complicated for every individual, and I want to provide a “home base” for my patients.

Note: Caroline attended Vanderbilt University School of Medicine on a Dean’s Scholarship. She is pursuing her family medicine residency at a community hospital in western Colorado.



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The Road Not Taken

New physician Caroline Knox discusses her reasons for choosing a career in family medicine when most of her peers have opted to specialize.

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