I was asked to contribute to a popular column on MedpageToday.com titled 10 Questions. Succinct and tight answers were what I was going for, but each of these questions deserves an entire column by itself. Here are my responses:
1. What’s the biggest barrier to practicing medicine today?
The seemingly interminable documentation required for administrative and medicolegal reasons. To do this well, it is immensely detailed and time-consuming. We spend far more time typing and staring at the computer screen than sitting down with the patient. It feels like we are taking care of a chart rather than a living, breathing human being.
2. What is your most vivid memory involving a patient who could not afford to pay for healthcare (or meds or tests, etc.) and how did you respond?
I’ve seen many patients present to the ED with advanced disease which were not diagnosed earlier because the patient – for good or for bad reasons – was uninsured. Just today, a 50 year old uninsured male presented in renal failure and CHF with associated malignant hypertension who had not seen a doctor for many years because he couldn’t afford medical insurance. From the Emergency Medicine point of view, that usually means admitting them for the emergent care they need, and letting them figure out the insurance issue later. The tough situations are when the problems are not of emergent nature and we must discharge them with resources from social services and hope or pray things work out for them.
3. What do you most often wish you could say to patients, but don’t?
I wish I can be unreservedly honest and direct without undue concern over the patient complaining to administration. I want to be able to care for the patients the way my many years of training and experience have taught me to. I wish I can just tell the prescription drug addicts to stop coming to the ER for their fix, and they aren’t fooling anyone. I want to say to the diabetic that the soda and twinkles are the problem, not their “brittle diabetes.” I wish I can just tell them it’s not only tonight’s party that got them in trouble; it’s the years of alcohol-filled nights, and that they are deluding themselves. But, I would also to tell them that despite that, we can help them if they would just be honest with us and with themselves.
4. If you could change or eliminate something about the healthcare system, what would it be?
The very misguided focus on “patient satisfaction.” Physicians have been pressured to be medically “PC” by administrators who are, for the most part, non-physicians and concerned about the bottom-line. The unspoken threat is there that if your group is not performing well in terms of “patient satisfaction,” they can find another group to cover their ED (or, another hospitalist group to staff the hospital.) This is akin to a business corporation indirectly practicing medicine without a license. That is to say the way physicians diagnose and treat patients can be subtly influenced by concern over backlash by administration. This is wrong. We need to redirect our focus on the patient’s well-being and not solely on the patient’s emotional satisfaction.
5. What is the most important piece of advice for med students or doctors just starting out today?
Integrity above all: personal integrity, intellectual integrity, and financial integrity. At its core, medicine is a highly noble profession and as such, we physicians must try our best to be authentic, honest and have high integrity and moral character. We must strive to be this way for the good of our patients.
6. What is your “elevator” pitch to persuade someone to pursue a career in medicine?
Unlike what Dr. Daniela Drake feels, I feel that being a doctor is a deeply satisfying and meaningful career. We truly make a difference in this world. All the years of hard work and sacrifice has given me the ability to help those in need and those who are hurting or helpless. We can make people better and alleviate suffering. We give them hope. And, sometimes we save a life.
7. What is the most rewarding aspect of being a doctor?
Being a physician gives me a profound sense of purpose and meaning which is broader and (arguably) further reaching than my other roles as wife and mother. It is also financially rewarding and allows my family and I to live a comfortable life as well as donate cheerfully to worthy causes.
8. What is the most memorable research published since you became a physician and why?
Probably the advent of thrombolytics (“clot buster”) in a STEMI (heart attack) and then emergent PTCA (angioplasty and stenting.) When I first got out of residency, my hospital was involved in the the GUSTO II trials (thrombolysis for heart attacks) and we had the highest enrollment in the entire state due to the high percentage of retirees in our community. Since then, however, thrombolytics has gone by the wayside for the most part, and emergent PTCA has become the standard of care and it truly has been revolutionary and life-saving. I’ve seen thrombolytics and PTCA save lives and myocardium (heart muscle) time and time again.
9. Do you have a favorite medical-themed book, movie or TV show?
The first years of ER were awesome and realistic (for the most part.) But then it became a soap opera. Haven’t watched any medical-themed shows since. However, I have read a lot. One of my favorite books is Dr. Meg Meeker’s Strong Fathers, Strong Daughters. Insightful and powerful, written from the perspective of an experienced pediatrician. I also loved Quiet: The Power of Introverts in a World That Can’t Stop Talking by Susan Cain. It is a well-researched book exploring the differences between introverts and extroverts. But, hands down, my absolutely favorite science book of all time is The Hidden Face of God by Gerald L.Schroeder, PhD. It is very dense reading, but well worth the time invested. It is meticulous in its scientific integrity and reasoning. For physicians, the chapters exploring the brain and nervous system are are astounding. This book is truly a tour de force.
10. What is your advice to other physicians on how to avoid burnout?
Balance your professional life, your personal life and your spiritual life. Intentionally devote time to each of these areas. There will be periods of time in your life when out of necessity one area will occupy your time and energy. But, you absolutely must purposefully bring those neglected areas back so you are in a state of equilibrium. As physicians, our focus is always on caring for those in need or suffering. But, we cannot forget to care for ourselves: if our well is empty, we cannot provide the thirsty with water.