Lessons for New Doctors…..
What I Wish I Knew When I Graduated From Med School
The son of a close friend and colleague graduated from medical school this week. I have known him since he was about ten years old. Seeing the video of him walking on stage and receiving his degree left me with tears in my eyes because I know him so well and I know all of the sacrifices he, and his family, have made to help him succeed.
This gave me pause to think of what advice I would want to give him, now that I have been in practice for over 30 years. Or maybe better said, what advice would I want my twenty-seven-year-old self to know if I could sit down and talk with “him”.
To wit, here is what I would want him to know.
1- Listen. After more than thirty years in practice, I have come to realize that all patients really want is someone who will listen to them and then in return, speak to them in a way they can understand. As my Mom told me, “talk to your patients like you are talking to me- no big words.”
2- Never stop learning. Never. Whatever you need to do, make learning a part of your daily life. Read, and listen to audiobooks or podcasts. But learn about your profession -every day.
3- Never say “never” or “always “ in medicine. ( Exception is rule number 2 above that starts with “ never”!) Just about anything is possible when it comes to the unpredictability of the science of medicine ….and patients.
4- If a patient tells you that this feels like the same thing they had the last time, believe them. Your ears should perk up and you should pay close attention to what they say.
5- Stay humble. Always have enough self-doubt to consider that you don’t have all the answers or perhaps you are wrong. You will never know everything in medicine. There is no shame in second opinions or referrals when you need help… or admit to the patient that you just don’t know. But, you will do everything you can to find out.
6- Good doctors know what the guidelines say about a condition; great doctors know when to apply them and when to ignore them.
7- Hypochondriacs get sick too. You can’t automatically assume that the patient you have seen 10 times before for chest pain is not really having a heart attack today. That bias will eventually get you into trouble.
8- Some patients are just not nice people. There are a whole host of personality disorders out there in your patient population. Know that you will have conflicts with some people because of that, but never let their toxicity seep into your spirit. You don’t get paid extra for taking care of people like this.
You are not the “Jackass Whisperer.”
Set boundaries with them, warn them if they step out of line, and discharge them from your practice if the behavior continues. ( If someone out there is reading this and you have been “fired” from multiple medical practices, you may need to take a good look in the mirror.)
9- Always defend your staff. Of course, first get both sides of the story when it comes to a complaint, and where necessary coach your team on how they could handle the next situation better. BUT, never let a patient be abusive to your staff. There are legitimate ways to voice a complaint, but verbally abusing staff is not one of them. Address the complaint, but in no uncertain terms let the patient know that in the future abusiveness is not an acceptable avenue of complaint.
10. Do house calls on occasion….and don’t charge for it. Over the course of my practice I have made house calls to patients who are shut-ins, and almost always for my home hospice patients. I don’t charge for these visits. I do it to remind me of what I got into medicine for in the first place- to help others.
These visits are what I call “moments of grace”- I always feel that I get more out of them than patients do because I feel that they encapsulate the essence of medicine in all of its goodness. While at their homes, I learn more about my patients than I have at all of the office visits we have had in the past. And I know that they will always remember that someone touched their lives in a positive way when they needed it most.
11- MD means Medical Doctor, not Magical Doctor. Never get confused about your abilities. Your white jacket is not a cape, your stethoscope is not a magic wand.
12- Patients will never get better until they care more about themselves than we care about them. This was a gift from a colleague of mine. I think it holds true; year after year I have the same conversations with patients about their health and prevention, and the conversations are, many times, exactly the same.
13- You can’t cure everyone.
But you can help everyone, and always strive to do so.
14- Patients are allowed to have more than one thing wrong with them.
Their symptoms may be all over the place, and Google may have told them that they have Transcarpathian Porcelanosis, but there may be several different explanations for the multitude of symptoms. Not everything can be wrapped up in one box with a bow on top.
15- Being a doctor is what you do, not who you are.
In other words, never forget that you have other responsibilities to fulfill, mainly to your family. In this regard, I will relate a profound lesson taught to me by my family doctor.
He was the doctor to my entire family- grandparents on both sides, aunts, uncles and cousins as well as my parents and my brothers. His office was located on the first floor of an apartment building three buildings down from where I lived in Astoria, New York.
My Mom was a school crossing guard and would see him while returning from her post after lunch and he was returning from hospital rounds. He of course knew me well and would inquire about how I was doing from time to time.
On one such occasion, he asked about me and my Mom told him I was about to start my residency. He asked her to have me stop by the office when I was home; he wanted to talk to me.
When I came home, my Mom dutifully relayed the message and I went to the office. His wife ran the show, and I told her that he wanted to see me to talk to me about something. The office was, as always, packed with patients. And she, as was her way, was completely calm and told me she would bring me back once he was done with the patient he had with him now.
When she escorted me back, he warmly shook my hand and offered me a seat, in his heavy German accent. He was an Austrian Jew who escaped the Nazi regime and spent many years in Shanghai as a refugee before coming to America.
His office was a time capsule- as I sat there in 1987 nothing had changed since I was going there in the early 1960s. Every picture and every book was in the exact same place.
He congratulated me on finishing medical school and then said he had a question for me. He pointed to the dated pictures on his desk of two young women in their 20s or so.
“ Do you know who those women are?”
I looked at him incredulously; everyone knew who they were.
“Yes, they are your daughters.”
“ Yes, they are. You know who they are, but I do not. And that is why I called you here today.”
He went on to explain that he let the profession of medicine consume his life; his wife often said he didn’t know how to boil water. And by letting medicine take up every minute of his days, he had lost out on the beautiful moments of his children growing up to become adults.
And he lamented it, deeply.
He told me he did not want me to make the same mistakes he did and asked me to promise that I would always make time for my family…no matter what.
I left that meeting profoundly touched by his kindness and caring for me to take time out of his busy day to speak with me, but I was also profoundly saddened by what he said…” you know them, but I do not.”
I can honestly say that I kept my promise to him- I never missed a school event, holiday, sports tournament, dance recital, or anything else when it came to my family. I would make hospital rounds very early on the weekends so I could be home to be with my family and spend time with them. I did homework with my kids more often than not.
I am so deeply thankful for that bit of advice from my family doctor. In that one bit of caring for me, he epitomized what a doctor should be.
Medicine is a wonderful profession, full of awe, raw emotion, passion, triumph, and tragedy. We have the unique ability to alleviate suffering and lessen the burden on others.
Every doctor should remember the words of our Hippocratic Oath -
“…. in whatsoever house I enter, there I will go for the good of the sick..”
Disclaimer- the words and opinions expressed are the author’s own and not those of his employer.