Over breakfast in the St. Lukes cafeteria, Dr. Colson relates that he chose family medicine "because I wanted to treat the whole person and the whole family."

Dr. Colson is on one of several 4-week family medicine rotations, acting as chief resident of the Family Medicine Service for the month. "That means Im checking all new admissions of Mercy Family Practice patients," he explains. "This service follows other residents patients. So well check in on them and might make suggestions for therapy changes. You never know what will happen."

Compared to his OB rotation the week before, when he delivered three babies in one night, Dr. Colson predicts this day may be boring. To the casual observer it is anything but.

After checking in with a patient at St. Lukes, its off to Mercy Medical Center. We run up to fourth floor to check on a patient who is being discharged, then dash back downstairs to spend much of the morning in rounds with faculty.

This is perhaps the most valuable component of the program. Gathered around the conference table are Charles Zelnick, MD, Russ Brown, PhD, Holli Kautzman, PharmD, first-year resident Dr. Cindy Squires and medical student Taylor Sawyer from the School of Ostheopathic Medicine in Des Moines.

Unlike television portrayals of residents being grilled by intimidating senior staff and faculty, this seems an exceptionally supportive environment. Residents are gently guided and encouraged to think on their feet. But, "I dont know" is an acceptable answer to the questions asked here, especially in the first year.

Discussion ensues about a number of patients under the care of the family practice service, among them a woman Dr. Squires intends to put on hormone therapy. "Which medication and what dosage?" asks Dr. Zelnick. Drs. Squires and Colson each give an opinion, then Dr. Kautzman weighs in. As the faculty doctor of pharmacy, she is an invaluable resource.

Psychologist Russ Brown is on hand today because Dr. Squires has asked for advice on an entanglement with a patients family members. The ensuing exchange speaks to the question "how involved in the family should the doctor become?" Dr. Brown spends half an hour offering basic conflict management techniques.

Dr. Zelnick offers, "We cant treat patients in a vacuum." Realizing the residents frustration he adds, "It just takes a lot of practice."

As the meeting breaks up, Dr. Squires and Dr. Colson discuss her need for sleep since shed been on call the night before. With a four-year-old and a three-month old, she confesses, "Theres not enough of me to go around." But the residency program appears exceedingly family friendly. Dr. Colson says, "Im one of only four residents who dont have children. That would have been unheard of 30 years ago."

During rounds Dr. Colson has been paged no fewer than five times about various patients, the last of which will occupy his thoughts the rest of the day. An 81-year-old woman from Amana is headed for the Mercy Trauma Center.

When she arrives, Dr. Colson performs a physical exam and takes down her history. Explaining that she may have pancreatitis and a blocked bile duct, he draws a picture to help her understand.

Though he is due at the office of Dr. Brian Lindo in less than 20 minutes, Dr. Colson listens with compassion to the patients story of losing her daughter in a car accident a few years ago. He asks about her husband and grandchildren. Treating the whole patient seems to come naturally to him

As we walk away, Dr. Colson confides his concern about the patients condition. "I have a bad feeling," he says. "She might have pancreatic cancer. I hope Im wrong." After a quick call to Dr. Zelnick, he checks in with a radiologist to see whether an ultrasound or CT scan would be most appropriate. The verdict is an ultrasound.

We speed off to Dr. Lindos office where Dr. Colson has the opportunity to remove a sebaceous cyst and perform a skin biopsy.

An hour later, back at Mercy, Dr. Colson walks into an ultrasound room where his patient from Amana has just learned from Dr. Zelnick that she has a large gallstone. But thats not the whole story. Radiologist William Scheible steps in to give an opinion about a suspicious area on the scan. "Its in the right place to be a lymph node." A CT scan is ordered to gain more information.

On the way to the 4^th floor, Dr. Colson says, "This is looking less and less positive." He finds her lab report and notes an enzyme level that rules out pancreatitis and does nothing to ease his suspicions of cancer. "I hate when those feelings are right," he says. He speculates about the timing of the CT scan. It will be getting late in the day to ask for a consultation from a gastroenterologist.