I, Intern: It Takes a Village

The support of a medical team is invaluable to patients -- and also to one primary care intern.


New doctors started their new jobs earlier this year.



Each week, we follow a different intern's story.


Internship can be notoriously isolating, says Jessica Hoy, MD. "You're working so hard, you're taking care of really sick patients, and there's not a ton of time to digest and reflect."

But the primary care intern is part of a system that recognizes and tries to deal with the problem, and she thinks it's working.

Experiments in Teamwork

Hoy is building her primary care clinic practice. She sees patients at Brigham and Women's Advanced Primary Care Associates, South Huntington, in Boston's Jamaica Plain neighborhood, which is set up as a team-based medical home with a large number of medically complicated patients. The 4-year-old program, which Hoy described as "Brigham's showcase practice," includes physicians, nurses, medical assistants, social work services, nutrition services, and a pharmacist onsite.

"It's considered to be the experimental practice," she said. "You can do new things, there's a lower threshold to institute new ideas. There's a lot of people who are working on cutting-edge projects in primary care."

Perhaps, most importantly, it helps Hoy feel like part of a team.

She particularly appreciates what is called a "warm hand-off" to another caregiver during a patient's appointment.

For example, if Hoy is seeing a patient with a behavioral health issue, "I'll literally go and get the social worker. And I'll say, 'Patient, this is the social worker. She is part of our team, she's available to talk to, she's able to care for some of your concerns, and I want to connect you to her.' Then I leave the room and go see my next patient."

Another patient came to his appointment with a box of medications. Beforehand, Hoy and a pharmacist had discussed possible pain regimens for him.

When the patient arrived, "I said to him, 'Great. I'm going to go get the pharmacist, and she's going to go through these with you and make recommendations to us about what's working.'"

After the pharmacist left the room, a nurse coordinator entered to talk about additional aspects of care.

"I think these are examples of very connected and in-tune team care," Hoy said.

The Quarterback

Hoy found that her team extended outside clinic walls when dealing with a patient with a complicated cardiac history.

"He was very sick," she said. "He'd been through the wringer. He'd been through more than any normal person would be able to survive, both emotionally and physically."

Hoy emailed her patient's cardiac surgeon with basic questions about a medication regimen.

The surgeon emailed her back almost immediately. In addition to answering her questions, he added a touching sentiment: "It's so wonderful that he now has someone to coordinate his care. Please feel free to be in touch with me any time you have questions. I am attached to this patient as well."

It was a reminder of the forest to Hoy, whose daily job involves a lot of trees. "As an intern, I feel like I'm moving care forward, and it's not a united feeling," she said.

"But I see I'm not alone in caring for this patient. There are people who are really pulling for him. I find that to be so powerful."

The surgeon's email also reminded Hoy how much she loved primary care at its best.

"One of the things that attracts me to primary care is the concept of being someone's quarterback," she said.

"A quarterback is someone who organizes everyone, calls the plays, knows everyone, has the bird's eye view, but who is also in the thick of it," she added.

"So that's what I think about when I talk to these attending surgeons, who aren't interns like me -- that they're helping me run a tight team that can provide really good care."

Hoy recalled her patient asking her, "Am I going to get through this?"

Although she didn't have a direct answer, "I told him this isn't his battle alone."

Previous installments of I, Intern:

I, Intern: When the Student Becomes the Teacher

I, Intern: New Questions, New Mistakes

I, Intern: Consults and Conversations


I, Intern: Common Problems, Elusive Answers

I, Intern: Starting With the Sickest

I, Intern: Wielding Scalpels and Fielding Pages