This specialty provides a wide range of care for all ages

Host Amber Smith: Upstate Medical University in Syracuse, New York invites you to be "The Informed Patient" with the podcast that features experts from Central New York's only academic medical center. I'm your host, Amber Smith. Many specialties in medicine are tied to a particular organ or disease, but doctors of family medicine are specialists who are qualified to treat a range of illnesses and provide comprehensive care to people from birth into the senior years. Today I'm talking about family medicine with Dr. Sana Zekri. He's a doctor of family medicine at Upstate. Welcome to "The Informed Patient," Dr. Zekri.

Sana Zekri, MD: Thanks for having me. I love talking about family medicine.

Host Amber Smith: Well, let's start by talking about the education of a family medicine doctor. Medical school is typically four years, right?

Sana Zekri, MD: That's right.

Host Amber Smith: How soon do people know that they want to practice family medicine?

Sana Zekri, MD: Some people know before they go into medical school that they want to be a family medicine doctor. Others, it takes them time to figure it out. They need to get exposure to all the types of medicine and decide which one is the right type for them. In general, you have to choose your specialty in your fourth of because that's when we apply for our specialty trainings, called residency.

Host Amber Smith: Why did you choose this specialty?

Sana Zekri, MD: Well, I went into family medicine because somewhere along the line in medical school, I started to feel that there was a double standard between men and women. It seemed like men were able to go to a single doctor for their primary care needs, but women were more likely to be told that they needed to see both a primary care doctor and a gynecologist for their woman organs. And that seemed kind of ridiculous to me. Half the population is women, and they were frequently being told that they needed to see a separate doctor for their basic needs. And that was what really drew me to family medicine instead of other specialties. I wanted to be able to provide basic care to everybody, at every point in their life.

And I also really love delivering babies and taking care of the children after the baby was delivered. And that's a unique thing to family medicine. We take care of pregnant women, and then we take care of the whole family afterwards. That's just really special to me, to see families growing under your care, watching the development of these children to have their own personalities. It's magic.

Host Amber Smith: So tell me about your family medicine residency. What, what was that like? How long does it typically last?

Sana Zekri, MD: So, typical family medicine residencies are three years. Some family medicine programs are four years. And if you do a fourth year, you usually get extra specialization in some particular field of family medicine. I did a four-year program. I did three years of general family medicine and then one year of family medicine with obstetrics, where I did more training in what I would call medium risk obstetrics. That's pregnancy care.

Host Amber Smith: Since we're speaking about primary care, is a GP, or a general practitioner, is that the same thing as a family medicine doctor?

Sana Zekri, MD: That's a really good question. So a general practitioner is an older type of doctor. They're actually pretty rare now. These were doctors who only did one year of training after medical school, and then they started to practice. Family medicine as a specialty was actually created because there were concerns that general practitioners didn't have enough experience in primary care prevention and care for broad populations to be really effective. So general practitioners still exist, but they're much less common than they were in the later half of the 20th century.

Host Amber Smith: I understand family medicine -- you do some pediatrics, and you do some obstetrics and gynecology as part of family medicine -- what is the difference between family medicine and internal medicine?

Sana Zekri, MD: The biggest difference between family medicine and, really, all the other primary care specialties is the emphasis on the full life spectrum care. Internal medicine tends to take care of only adults, and they may be less likely to do standard screenings for women. Pediatrics only takes care of children. And obstetrics and gynecology only takes care of women in both pregnancy and after pregnancy. But family medicine has the capacity to do all of it.

Host Amber Smith: Can you tell me about the range of things you might do on a given day?

Sana Zekri, MD: On an average day, I might go to labor and delivery to do a c-section, and then I might help with a newborn resuscitation on another baby. And then I have my clinic session where I take care of newborns, children, pregnant people, and older adults in various states of health. And the reason that I can do this is because I did extra training, called a fellowship, to get extra competency in something called maternal child health. So in my fellowship, I gained the competency to take care of some moderate to high risk pregnancies and to do uncomplicated cesarean sections. And I also got more experience in care of newborns and comprehensive family planning.

Host Amber Smith: With medicine being so complicated these days, how can a family medicine doctor maintain confidence in the care of babies, teens, adults, seniors. How do you stay current with everything that's going on with everyone?

Sana Zekri, MD: Yeah. All fields of medicine are constantly expanding. And physicians are constantly learning. This is even more important for family medicine because of the scope of patients we take care of. This is made easier for us through curated articles and podcasts that bring together the most consistent and evidence-based data to help inform us of changes in practice as they come up.

But mostly it comes down to learning new guidelines and learning and taking large sets of data and putting them together to know what to do for the patient that's in front of you. There's a lot of changes that happen in medicine on almost, it seems, a day-to-day or week-to-week basis, but not all of those changes matter in the long term. Sometimes you have to wait for all of the information to come together to render a good opinion for what you need to do for all of your patients.

Host Amber Smith: At what point might you send a patient with a heart ailment to a cardiologist, or a patient with diabetes to an endocrinologist? Do you use other specialists to help?

Sana Zekri, MD: Absolutely. And a natural question might be, why do other specialties exist, if family medicine does everything? These other specialties must have something that family medicine doesn't. And that is true. Family medicine is very good at doing preventive care and managing common problems. We're very good at identifying when something is wrong and doing the first steps to fix it, and sometimes we need to get experts in other specialties involved if we don't feel comfortable addressing it all on our own.

So, for example, I would feel very comfortable taking care of most patients who have type 2 diabetes and most patients who have high blood pressure and high cholesterol, and maybe even heart failure and asthma and COPD (Chronic Obstructive Pulmonary Disease.) And that's what most people have problems with. But if it gets to be beyond my realm of expertise, if a patient doesn't respond to the common therapies. If a patient is progressing in their disease, despite my best efforts, at that point, I'm bringing in a specialist to help me with the most cutting edge information and with the things that I may not know, the things that are relevant to just their specialty.

Host Amber Smith: This is Upstate's "The Informed Patient" podcast. I'm your host, Amber Smith. I'm talking with doctor of family medicine, Sana Zekri. He's an assistant professor at Upstate, and we're talking about the role of family medicine in America's healthcare system.

Now, depending on what insurance coverage a person has, they may have to choose a doctor from a list of practices within a particular network. What could a patient do to determine if they're going to like a doctor's philosophy or style of practice?

Sana Zekri, MD: Well, personally, I want patients to feel like we are on a team for their health and that they're active members of the team. And I want them to know that we both have the same objective, which is keeping them as healthy as possible.

Most commonly, I hear from patients that they want to feel heard and they don't want to be talked down to, and I think it's important to know that. Just because your doctor is nice or easy to talk to doesn't mean that they're practicing evidence-based medicine, but still, it's hard to want to listen to someone who you don't feel gives you the respect you deserve as a person.

I don't think there's anything wrong with going to a doctor's office and giving the doctor a few appointments to see if their style fits what you're comfortable with. And don't be afraid to voice your concerns with your doctor. If you're afraid to do so or if you feel dismissed, maybe you need to consider a change in doctors.

Remember that a doctor's job is to give you their best medical advice, and they should package it in a way that's understandable to you. You may not agree with their medical advice, and that's okay. . You should choose what you do and don't do with your body. But remember, they're still trying to give you their best medical advice and trying to keep you healthy.

Host Amber Smith: So, do family medicine doctors want patients to see them as someone who will be taking care of them their whole life?

Sana Zekri, MD: Absolutely. Family medicine doctors are kind of a part of the family. We want our patients to come to us at different phases in their lives and to bring other members of their family to be a part of that practice. We want to see families grow and unfortunately, we will also see members of families die. It's part of this amazing care that we can provide, that we can see people from the very beginning until the very end and be one of the constants there.

Host Amber Smith: How often do you find an issue, a medical issue, in a patient that you also end up treating in their family members? Because a lot of diseases run in families, right?

Sana Zekri, MD: I would say it's important to keep track of a person's family history. I don't particularly see it that often, that there's something in one family member that I proactively find in another family member. But in the situations where I do find it, I'm usually very glad that I'm taking care of more than one member of their family because it's easy to explain everything.

Host Amber Smith: How would you advise someone to prepare for their first visit with a new family doctor that they're going to see?

Sana Zekri, MD: It's important to know your family history, to know about what has happened in your family, what illnesses people in your family have had. If you have a family history of cancer, it's important to know what type of cancer and at what age your family members were diagnosed with those problems. It's also important to know what other problems you've had from childhood or in adulthood, what surgeries you've had. Having that information is really, really meaningful and helpful.

It's also really important to be open and honest with your doctor, and you have to be comfortable being open and honest with your doctor. Remember, your doctor's not there to judge you. Your doctor wants you to feel safe talking to them. If you have a condition that's sensitive or something that's a health problem that's sensitive, your doctor wants to know about that so that they can help prevent any problems from coming up from those health conditions.

Host Amber Smith: Well, Dr. Zekri, thank you for making time to tell us about family medicine. I appreciate it.

Sana Zekri, MD: Thank you for having me.

Host Amber Smith: My guest has been doctor of family medicine, Sana Zekri. "The Informed Patient" is a podcast covering health, science and medicine, brought to you by Upstate Medical University in Syracuse, New York, and produced by Jim Howe. Find our archive of previous episodes at Upstate.edu/informed. This is your host, Amber Smith, thanking you for listening.