So this is family medicine

 I always knew family medicine meant "cradle to grave care". It means seeing newborn babes at 10:45 and palliative care in an end stage dementia patient at 11:20. It means a day's patient list might include a blood pressure assessment, someone just discharged after a heart attack, someone suffering from severe depression seeking help, and a routine pregnancy visit. I have gone from an appointment that made me want to scream in frustration to another equally complicated but much different patient that takes every ounce of patience and gentleness I can muster. Of course, a variety of factors contribute to how the patient presents and my reactions to them, but not a single patient should receive subpar care or less emotionally nuanced support because I had a difficult encounter before them. Every patient deserves my reset and refresh in between. 

But some days it is really really hard. Just so hard. 

One day I received an urgent imaging result back. Metastatic cancer in a pediatric patient. Followed a few minutes later by an urgent call from the ER physician who also received the results. We conferred and I spent the rest of the morning and lunch calling up specialists, arranging appointments, transportations and, not the least of which, disclosing this terrible information to the patient and their family. Telling them the results of the imaging. Explain what metastatic means. Discuss the uncertainty of the prognosis. Encourage hope at least enough to go for urgent assessments by specialists. Console the family. Explain why it took so longer to get this diagnosis. Explain my own limitations and the need for other imaging and specialists before we can have a more specific answer. 

After several hours of this, to go and see someone who is acutely distressed about a single acne lesion was jarring. I wanted to just cancel clinic after this diagnosis to nurse my own shaken mental state, but I was needed and I wasn't SO badly disturbed that my medical skills would be affected. After seeing the next patient, I really wanted to brush them off. A comedone to a metastatic cancer? Come on. 

That is family medicine, however. And we can't go around comparing diagnoses. You can't compare suffering. 

So I held it together and examined the lesion and explained the treatments and empathized that yes, it does suck to have acne. By the way, it turns out the acne was only the leading question and once the patient was comfortable with me and reassured I would provide affirmative care, disclosed their more significant concerns. (That's family medicine, too. Sometimes complaints are only tips of the iceberg.)