October 2019 Member of the Month
Member of the Month:
Fiona Prabhu, MD
Academic family physician finds variety and joy in practice
By Kate Alfano
Fiona Prabhu, MD, is a family physician in Lubbock, Texas, and faculty with the Texas Tech School of Medicine. She attended and graduated from Texas A&M University College of Medicine in 1995, completed her residency at TTUHSC and joined the faculty there upon graduation. She splits her time between teaching first- and second-year medical students and family medicine residents, and serving as co-medical director of the TTUHSC free clinic — a role she has held since the clinic’s opening 10 years ago.
Why did you choose to become a physician?
It’s the same standard answer everyone gives in their medical school interview. I wanted to combine my love for science with wanting to take care of people, and that hasn’t really changed.
Who or what influenced your teaching career?
When I was doing residency training, we taught medical students on a regular basis. First the students shadowed with us; we would have to listen to them take a history and observe them doing a physical exam, then listen to them present what they thought was going on. I enjoyed those different aspects of teaching. The program needed faculty when I was getting ready to graduate and our faculty encouraged me to stay. I did a three-week rotation at the Faculty Development Center when it was located in Waco, Texas, and went through the academic medicine fellowship when I was a first-year faculty. There’s enough variety that it keeps me interested in the teaching aspect, and I have also developed a continuity of care practice.
What do you like most about family medicine?
I enjoy the long-term experiences with my patients and just being able to share different parts of their lives, being there with them. When I was doing obstetrics, I followed my patients throughout their pregnancy, delivered their babies and got to see the babies grow up. Then on the other side, when I got to take care of different generations of the same family, I’d be there at the end of life. Those are the very unique experiences that you don’t get in any other profession. It’s that unique relationship with people and the chance to serve them in a very different manner than you would in any other field. It does require a certain amount of, you could say, sacrifice but it doesn’t feel as much like a sacrifice when you enjoy it.
What gives you the most joy in your day-to-day professional life?
My patients. Basically I realized when I was having a really bad day, my patients put me in a better mood because I focus on them and their lives and after that half-day in clinic I feel a lot better. I stop thinking about my troubles and because I’ve known many of them for a long time, we get to joke around. They put me in a better mood.
Does anything surprise you about the medical students you encounter?
I don’t know if today’s students surprise me. You’ll hear a lot of people out in practice who haven’t watched the changes in medical education grumble about generational differences but I think the current generation has chosen to go to medical school for the same reason as their predecessors: for the chance to help people.
There has been a little bit of a trend, at least in our school, of accepting a lot of people who are not just straight out of college but those who have had other life experiences. One of our recent graduates had a 20-year career as a pharmaceutical rep. Others have been teachers or administrative personnel without a straight career path and they’re in their mid-to-late 30s when they start. Another recent graduate is a mother to seven children of varying ages. TTUHSC is known for taking people who haven’t taken a traditional route to medicine and I think it tends to encourage people from other walks of life to continue to apply to our school. It adds to the mixture of background experiences to the whole class.
Do you have advice for medical students?
Yes — for the first years, they come in with a lot of enthusiasm and the first course they’re introduced to is anatomy, which really challenges them. The basic sciences can consume them entirely and they lose sight of why they came. They’re getting used to the volume of information that they’re going to have to learn for every test. They can get discouraged pretty quickly. I tell them: If you were smart enough to get into medical school and you’re smart enough to pass your tests, then let that be enough. Don’t beat yourself up because you didn’t get the A. We encourage them to volunteer at the free clinic, because that’s a reminder of why they wanted to become a doctor in the first place.
Second years are all wound up by the spring semester because they’re all worried about passing the first Step of the licensing exam. So many of them go into a little cave and study for several weeks at a time. Then once they take their Step exam, they re-emerge from the depths. I tell them to remember that you can study intensely but you need breaks. And you’re actually better for it if you take breaks and connect with people around you.
The third year of medical school is almost like an ongoing job audition in some ways. A certain amount of it requires the knowledge base that you’ve gotten in the first two years and a lot of it is how well you interact with the people you’re working with: Being a team player and supporting residents who are your teachers. Until this point they have rarely encountered a resident doctor who is only a few years ahead of them and then when they get to third year and beyond, the residents do the majority of their teaching. In some ways there is a shock to the students’ system. They haven’t pictured that they’ll be right there in two years and sometimes there is an issue of respect. It’s not important what your grades were in the first two years or what your Step score was but how well you work in a team setting, how eager you are to take that first patient. My advice is be the first to volunteer for any new experiences because the way you get those extra procedures is to show that you’re willing to do the work. It’s a totally different culture than what they’ve been used to.
How do you envision medical education changing in the next decade or more? And how has it changed since you were in school?
One of the things that’s different from when I was in school is the amount of lecture time. We had to literally sit in the lecture hall from 8 a.m. to 5 p.m. with a one-hour lunch break. It was lecture misery. Very dry and one subject at a time with little integration. Now research says you shouldn’t put a student in a chair for eight hours a day Monday through Friday. You need to give them breaks. Students can only manage about 20 hours of lecture a week. Then they need other activities where there is small-group interaction and other ways to integrate the materials. The other difference with medical education today is there are a lot better electronic tools so if you need a different approach, you have a different way of absorbing that information.
I know there are a lot of books out there about the robot replacing the doctor in the future [laughs]. That’s not going to be the case because there’s something about the actual doctor-patient relationship that is healing in and of itself. You can’t get that from a robot. With that said, I think current students will have better-quality technology and electronic resources to help them learn to take care of people better and enrich that actual fundamental doctor-patient relationship.
What do you enjoy to do outside of medicine?
I like cooking, traveling, reading, watching movies and going to plays. Lubbock has grown a lot since I got here in 1995. They even have local community theater, and some of our physician faculty participate. It’s fun to see them perform. With Texas Tech being here, there are lots of arts appreciation events in Lubbock. I like to attend many of those because that just feeds another part of my personality.
What’s the coolest place you’ve traveled and why?
My friends and I recently returned from a northern European cruise and the coolest part of that trip was going to St. Petersburg in Russia to see the Winter Palace and the Hermitage. The architecture and art was amazing to see.
But my favorite place in the world is a small town in Canada called Niagara on the Lake, north of Niagara Falls. I am an American citizen who grew up in Canada. Their downtown is built in 19th-century style and you can get high tea at the Prince of Wales Hotel. They host the Shaw Festival April to November, which shows plays from the era of George Bernard Shaw along with at least one or two Shaw plays per year plus musicals and new, experimental performances. It's an area of Canada surrounded by wineries and orchards. It’s beautiful. You can stay at a bed and breakfast, get tickets to plays, and ride bikes around to the wineries.
Is there anything else our members should know about you?
That I appreciate the opportunities that family medicine has given me, academics as well as clinical practice. I like when different opportunities come up. I didn’t do a geriatric fellowship but when I finished my residency I became a medical director of a nursing home for six years.
My most recent interests have evolved and I’m actually taking care of patients who are transgender, which is a very different thing in very conservative west Texas. You don’t advertise it as a huge clinic offering; it’s more of word of mouth. I was originally asked if I would be willing to do the treatment in Lubbock by one of the representatives of Parents and Friends of Lesbians and Gays (PFLAG). I said I’m willing if the patients are willing to put up with my learning curve. I’m fortunate to have a great resource in my best friend from med school who, despite ranking all programs opposite of me, ended up in my residency program and eventually on the TTUHSC faculty. She worked at the student health clinic for 16 years doing transgender medicine and overseeing transition and maintenance in the college population. I draw from her expertise plus all the papers I’ve had to start reading to learn.
The best part of family medicine is you can segue your interests. My friend decided to return to our regular department for a broader variety of patients in terms of age groups, as well as continue to do transgender medicine. We try to teach it to our medical students so they’re more comfortable knowing what’s involved in taking care of that patient population and feel less uncomfortable about having that discussion about what to do.
Working in an academic setting you have a better opportunity to take care of more vulnerable and marginalized populations. It lets you give back without feeling like you’re giving away all your income. You have a lot of people in private practice who want to be there for marginalized population and want to be involved but they can’t give away that bottom line. That’s a difficult struggle for them but it’s easier for me in our current academic setting. I appreciate that our department chair, Dr. Cook, gives me the opportunity to let me be involved.
TAFP’s Member of the Month program highlights Texas family physicians in TAFP News Now and on the TAFP website. We feature a biography and a Q&A with a different TAFP member each month and his or her unique approach to family medicine. If you know an outstanding family physician colleague who you think should be featured as a Member of the Month or if you’d like to tell your own story, nominate yourself or your colleague by contacting TAFP by email at firstname.lastname@example.org or by phone at (512) 329-8666. View past Members of the Month here.