As a kid, Anna Chollet wanted to become a veterinarian. But after working on a pig farm she decided she'd rather treat people because they have more to share.
"With humans you get to take in the desires of your patients and the goals of their lives," she said.
One of 12 medical school graduates to this summer join the Santa Rosa Family Medicine Residency Program at Sutter Medical Center, Chollet said her chosen field also continues a family focus on social issues.
"There was no one really medical in my family," said the 27-year-old from St. Louis. "But with a mother who is an environmentalist and a grandmother who is a Methodist minister, you grow up thinking of things larger than yourself."
Chollet and other new doctors also have to think of such large things as the future of health care and what it will be once politicians, insurance companies, drug firms, the voters and whoever's in the White House get through reforming it.
Yet, a sample of future family physicians suggests that if their idealism holds and they can balance student debt against a non-glamorous, relatively underpaid specialty, they'll make a people-centered difference.
Family medicine, said Chollet, "is not the glory job. Not like the ultimate specialists and being the respected surgeon," but she prefers its close connection with patients.
"A family doctor tries to understand the whole self. You get to know your patient as a person, not a specimen. It's not just what pill can I give this person."
It's the same for Noreen Singh, who grew up in Fremont, went to Yale Medical School and was drawn to the residency program because of its "strong focus on prevention, holistic care and wellness.
"Illness doesn't just stand alone. It's often a product of a person's environment," said Singh, 27. "Even in a limited time there's always the opportunity to connect with your patients and hear the story that is the underlying framework for their ailments."
For example, she said that some of her patients at the Vista Family Health Center, which partners with the residency program, are Cambodians who include survivors of the Khmer Rouge genocide.
"They come in saying they feel dizzy or have a headache or chest pains. If I just approach their treatment from a purely medical standpoint, it's not enough," she said. "In going deeper, I might find that they are re-experiencing the triggers that take them back to the awful things they lived through."
To further her own understanding of that culture, Singh has joined a Cambodian women's group that meets regularly at the health center.
"Family doctors have to be comfortable with ambiguity," said Amy Marietta, a first-year resident from Illinois. "Sometimes we don't know why a person is sick. It may have to do with external forces at play and we have to be comfortable with that. We have to be good at collecting information."
Marietta, age 33, majored in Spanish and Latin American studies in college and worked on affordable housing in Chile.
After that she considered becoming a nurse like her mother but said, "I thought about how complex health care is in this country and maybe I'd want to start a clinic. And I also want to inform and change health policy. Family-medicine training is a good path for that."
Inequity in health care is a big issue for residents whose patients include those with no insurance, little insurance and those on Medicare and Medicaid.
Berkeley native Aaron Greenblatt, a second-year family resident, served two years in the Peace Corps in Mali in Western Africa and said, "I got a glimpse into people's lives, people who are very different from my own culture."
His parents were both teachers and his family always had good health care.
"I saw the same pediatrician until I turned 20," he said.
Just as Greenblatt was starting medical school, his closest friend in Mali died.
"Because of lack of access to health care," he said. "It was a visceral reminder of just how important access to care is and how absolutely unjust it can be."
He intends to practice in a rural area and says the program gives him wide experience with a variety of patients.
"We are essentially the only residents, the only specialty working in Sutter Hospital where we get most of our training," he said. "We are not competing with internal medicine or obstetrics residents. It inspires you to be self-sufficient and resourceful."
Third-year resident David Stromberg grew up in an upper-middle-class family in Albuquerque. One summer he worked with a landscaping crew of mostly immigrant workers and discovered "the disparities in opportunities that people have as well as the health disparities."
New Mexico, he said, "is still definitely a land of impoverished people who are not getting health care," and it is where he hopes to eventually practice. But he regularly sees the same need in Sonoma County.
He tells about a woman who lost her job and with it, her group insurance. Right before that she had a checkup that showed a suspicious Pap smear, the routine screening for cervical cancer.
"But then when she lost her access to care there was no one to push her to follow up," he said.
She ended up in the hospital with metastatic cervical cancer and died after multiple costly surgeries.
"She died of cervical cancer, which is preventable," he said. "And it's treatable, if caught early enough. It's why we do Pap smears. This didn't need to happen."
"We're working with a broken health system," said Singh, adding that she sees her role as "half physician and half advocate. We spend our time trying to get our patients the care they need with limited insurance options.
"What's unfortunate is that the people making decisions about health care have no idea what it's like to have a patient who is really sick and can't get health care."
Stromberg said he thinks family medicine, with its focus on prevention, is "on the brink of becoming much more important in our society and making people healthier in our community."
But he's not personally going to go it alone, the old-fashioned way, in private practice.
"I don't have a desire to run my own business, especially in the context of our fragmented insurance system," he said. "To be honest, I don't want to have anything to do with it."
(Susan Swartz is a freelance writer and author based in Sonoma County. Contact her at susan@juicytomatoes.com)
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