I discovered at a very young age that the quiet times, often right before bedtime, were the best times for problem solving, creative thinking and planning. I would spend a couple of hours after school doing homework and there would be that one geometry or trigonometry problem that would allude solving. But, lights out and alone, the answer magically appeared. At that age it was easy to wait until morning and write it down before breakfast, eat, board the bus and wait for the next challenge. Anyone who actually remembers the start of the space age knows that a bedside notepad or smartphone is a handy tool for memory today, but the process remains the same.
My current “aha” time is during the commute to work. I realized that this morning as I was doing my mental checklist and contemplated the day. What is on my checklist today? Then it hits me: It is recommendation season. One of the more honorable tasks of being a faculty member is the privilege of providing an account of the accomplishments and potential of future house staff or physicians from a personal point of view. While I can’t recall the number of letters I have produced, I do remember the inspirational students who made it easy.
I remember one applicant essay in particular, from over 15 years ago. The essay was by a student who found the pathway to Family Medicine through his experience with great mentors and who knew his passion for people and his desire to make a difference was a sure formula for our specialty. The timeframe was during the “gatekeeper” model of primary care, a model that was received by patients more as a locked gate than an open door. The essay centered on the family doctor as a lighthouse keeper. The keeper is a guide through smooth seas with hidden dangers as well as a provider of a beacon through troubled waters.
Today I also have more appreciation for the captain of the ship who may choose to follow the beacon, try to ride the storm at sea, or change course and return to safer shores. The captain needs her own set of skills and knowledge. She needs to know the signal pattern of the lighthouse. She needs to know how to read the winds, judge the clouds and how to track the weather. She needs the proper nautical maps and know how to read them. She needs an understanding of her vessel and the competence of the crew. She needs to know that the consequences of her decision may be a safe port or a deep dive. She needs the support of the lighthouse keeper who knows the risks of the passage and to know he is monitoring the changing seas. Her experience should provide information to help negotiate a dark night and high waters. A wise captain takes advantage of all these components, and she knows that she cannot do it alone. She needs a crew that shares her values, shares the work load and understands the navigation plan. She also needs to know which crew member is the best choice for a given task, and she needs to be able to seek and deliver feedback within an atmosphere of trust. She must remember that the captain is a member of the crew.
We are about to embark upon a voyage, another new era in healthcare. We need to find young leaders who will become the lighthouse keepers, the captains, the crew members.. I am looking for those virtues as I write my recommendations, and I see those virtues in our students and residents. You never know when one of your crew members will end up being the American Academy of Family Physicians Family Doctor of the Year. Congratulations to Maureen Murphy. I am happy to have met her when she started her voyage in Family Medicine. Best wishes to her.
And about that commute…
I am truly blessed to see the morning skies heading into Durham from my home in Efland. It is particularly beautiful on the days when the clouds frame a brilliant sun. Reds, yellows, oranges, purples and pinks shout out and make me optimistic for a good day. That glorious view helps me connect with the spiritual journey we travel every day in our privileged world. That is the time I reflect. It is the time that I create, problem solve and plan. Rather than at night before bed, it is now the morning that provides inspiration and the quiet time to reflect.