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She was only 18 years old, but had been through trauma that most women will never understand. During a recent international elective in La Paz, Bolivia, I had the opportunity to visit Raquel in her home.

I walk the hallways of the United Nations’ Palais des Nations in Geneva, Switzerland, and I am overcome by a sense of awe as I think of the historic significance of the place, the many global political decisions debated in its chambers and actions that have changed the course of the lives of entire populations.

As the end of residency draws near, I have been reflecting on the experiences and lessons I have learned over the past three years that I will carry throughout my career as a family physician. I expected residency to be challenging; I was expecting the long hours, the steep learning curve, and added responsibility of being the primary provider for patients.

Patient A is before me. He is in his late 80s, sharp as a tack and a delightful conversationalist. He lives in elderly housing and has just been discharged from the rehab center. He didn’t expect to be in my office “so soon” after returning home.

”Push! Push! You can do it! You’re so close! Breathe deep! Only one more push!“ Cheering and laughter erupt as the last ping-pong ball shoots out of the balloon, bouncing across the room. This is a CenteringPregnancy® prenatal care group session at the Duke Family Medicine Center, and today we are learning about labor strategies by ”birthing” a ping-pong ball out of an inflated balloon.

It is not often you get a chance to learn a new skill when you are in the "midlife" of your career. However, that is exactly what I have been allowed to do recently, and it is one of the reasons I enjoy working at an academic medical institution so much.

I had the honor of participating in the N.C. Academy of Family Physicians’ 10th annual Family Medicine Day recently. Students from across three states gathered to learn skills critical to family medicine, and were given the opportunity to meet with representatives of family medicine residency programs from North Carolina, South Carolina and Virginia.

One of the more enjoyable parts of my job is working on practice-wide interventions to improve the health of our patients. Reimbursement for health care services is moving more toward quality and value-based payments and away from payment for the clinic visit and this is forcing us to think more broadly of how we can affect the health of our patients outside of the clinic visit.

In the Hippocratic Oath, we vow to do no harm. This concept helped lead me to a career in family medicine because I was concerned by what can become lost in translation as we intensify the medical care we administer to patients.

Residency training at Duke Family Medicine is in full swing. Busy lives, achieving knowledge, competencies and skills and new Family Medicine Milestones are reached each day. Every week, I look at where the residents are spending each day.