Title:Reflections on medicine with Ayaz Virji (C’96, M’00)

In 2014, this family medicine doctor took a leap of faith, leaving a big practice in Pennsylvania and moving with his wife and children to Dawson, Minnesota, population 1500, to practice rural medicine. They felt welcomed, but were disheartened after the 2016 presidential election when nearly half the town voted for a proponent of anti-Muslim rhetoric. At the urging of a local Lutheran pastor, Virji added public speaking to his repertoire, and began the “Love Thy Neighbor” series to promote religious understanding and interfaith dialogue. His book about the experience comes out in 2019.

I’m Indian ethnically, born in Kenya. I grew up in Florida, with very little diversity.

When I was a kid my OB/GYN uncle would take us to the hospital doctors’ lounge for free ice cream and I thought, “I want in on this!”

I am Muslim and went to mosques in my childhood. I never understood Islam until I learned it from the Jesuits at Georgetown.

Family medicine’s biopsychosocial model—care beyond the physical entity that takes into consideration the economical, biological, spiritual, and emotional—resonated with my approach to life.

In medical school our attendings impressed on us that we are stewards of knowledge—we don’t own it. The person who gives us the honor of learning from them as students, or practicing on them, or cutting them up in gross anatomy, does it for the benefit of humankind.

As a resident I saw my first pediatric case of diabetes and it broke my heart. I saw that lifestyle changes were important but our profession had not emphasized them yet.

Since coming to Dawson I’ve helped residents lose 3500 pounds. They’re healthier, and need less medication.

In big health systems, care becomes fragmented to accommodate volume, and primary care is almost a triage scenario where patients come mostly for referrals to specialists or for imaging.

In rural medicine we work at the height of our training. In Dawson we have a clinic, a hospital, an ER, a nursing home— I do it all. I do my own intubations. Specialists come just once or twice a month.

If someone has abdominal pain, I get the scan and lab results. If there is appendicitis I admit that patient, call the surgeon, follow the patient in the hospital, and see the patient when they come out. I know their values. They know and trust me.

The hours are long. This is the hardest I’ve ever had to work in my life.

Good primary care is a solution to our current health care crises around affordability and sustainability. We have tremendous potential to reduce costs and improve care.

We’re idealistic when we go into medicine: “I don’t need money, I’m just going to live on a farm and take care of people.” Then you have a family and bills and you have to balance those ideals, but I make time to work at free clinics. I learned this from family physician Dr. Robert Cutillo at Georgetown. Finding the balance to serve humanity, beyond just making a profession, makes life meaningful and gives us peace.

What I love most about my work is the patients. I need them as much as they need me. I feel such a sense of satisfaction taking care of them, when they smile, lose weight, lower their blood pressure, come off medications.

Keeping up with the latest in medicine is a moral act.

Physical activity has been designed out of our environment. I invented BodyTogs, anatomically designed wearable weights. When you wear them all day, they equate to a two-mile run in terms of calorie burn.

In medicine, the science alone is challenging, but we can also get lost in the complexity of the administration of health care. As clinicians we can find ways to solve those problems. We shouldn’t lose hope.

I’ve had doctors tell me they can’t continue in the system or they wish they’d never become a doctor. It’s sad to hear, and the despair is infectiously disheartening. They’re forgetting what this is about in the first place: the doctor and the patient. That’s sacred.