1) Perseverance
It drives me insane when people equate becoming a physician with intelligence. While the road to MD/DO degrees involves countless and never-ending tests and the accumulation of volumes of knowledge, this does not endow upon our profession the characteristic of intelligence. On the contrary, the road takes immense perseverance - it is challenging to sit and study for test after test, year after after. As long as an individual has this characteristic, they can become a physician. It does not take the epic intellect that people often believe is a pre-requisite for entering the profession.
It takes perseverance to wake up daily at 4:30 AM, get in to work by 6:30 AM for 12-16 hours of work a day. Every minute of these working hours is completely filled by talking to patients and families, calling consultants, rounding, writing notes, placing orders, admitting new patients, discharging others, and teaching students, all the while being interrupted incessantly every few minutes for another task that demands instant attention. Notice that most of these activities do not involve the intellectual exercises of diagnostic reasoning and treatment planning. None of this even involves the regurgitation of memorized facts. Some of the best doctors I know perform these activities without any complaining or whining - they effectively perform the day-to-day routines that comprise patient care.
2) Patience
It takes forever to go through medical training - 4 years of undergraduate, 4+ years of medical school, 3-7 years of residency and 1-3 years of fellowship. This means that most of us do not have our first salaried jobs (research jobs do not count) until our late 20s at the earliest. This involves many significant opportunity costs, including skewed personal finances, strained social lives, and the wholehearted consumption of all free time to the pursuit of professional goals.
Though I have no regrets and am immensely thankful for the opportunity to care for patients, I sometimes wonder: if I had chosen one of my other passions:
- Where would I be living? (Home in NYC, obviously)
- How many countries would I have been to? (Probably > 40)
- Where would I be working? How much would I be making? How positive would my net worth be? (anything is better than the current abyss of red ink/negative yardage)
- Would I be an actor? A hip hop choreographer? A singer? A consultant? A trader? (probably an actor/singer/dancer)
- How many more significant family events would I have been able to attend?
Though I have no regrets and am immensely thankful for the opportunity to care for patients, I sometimes wonder: if I had chosen one of my other passions:
- Where would I be living? (Home in NYC, obviously)
- How many countries would I have been to? (Probably > 40)
- Where would I be working? How much would I be making? How positive would my net worth be? (anything is better than the current abyss of red ink/negative yardage)
- Would I be an actor? A hip hop choreographer? A singer? A consultant? A trader? (probably an actor/singer/dancer)
- How many more significant family events would I have been able to attend?
3) Teamwork
Medicine has always been a team game. With the recent changes to duty hours and the dramatic increase in the number of handoffs and cross coverage, this has become truer than ever. Being a good team member is critical in providing effective patient care and making a stressful work environment more enjoyable. What does this entail? It involves the skills of being a leader, follower, facilitator, and teacher; good team members play all of these roles simultaneously - I have been fortunate to be a part of many such teams during my career. Studies have shown the importance of teamwork within High Reliability Organizations (HROs) in high-risk work environments where errors can have huge consequences but occur infrequently; this is the ideal that we should seek in the provision of healthcare.
The best doctors remember that the most important team member is the patient. Patients are the most important determinants of the ultimate outcomes. This means that we do our part to enable patients to take ownership of their care by providing appropriate education and ensuring we convey the importance of follow up and compliance.
4) Humility
While it takes perseverance and patience to become a doctor, I believe the most important trait in a practicing physician is humility. We practice an art that is filled with uncertainty. No two patients are similar; no matter how many studies are done, each patient will have idiosyncrasies that deviate from the patients studied in the cardinal trials. Furthermore, we often work with incomplete information; a differential diagnosis is an amalgamation of competing probabilities that vary with the unique characteristics of each patient, how they tell their story, and the accumulated experience of the physician.
Finally, human beings are fallible and physicians are no different. Dr. Atul Gawande beautifully articulates this in his book "Complications". Medical decision-making is heavily influenced by internal and external factors, such as fatigue, misleading cues in a patient's history, the diagnosis associated with the patient seen immediately prior to a given patient, and how pressed a physician is for time. A physician's memory is similarly affected by these factors. This is what makes medicine challenging. Given these factors, I do not want the perfect physician to be my doctor; I want one who acknowledges the uncertainties in clinical practice and as well as his/her own limits and potential for fallibility. I want the doctor that does not rely on imperfect memory and chooses to look things up when doubts arise.
Fallibility is influenced by intrinsic as well as extrinsic factors - inexperience is the most common internal factor in young trainees. Inexperience can be rectified, but the extrinsic factors that we cannot control are more frightening. This is especially true for surgical fields: operative success and complication rates provide excellent statistics on the track record and experience of a given surgeon. However, how can we predict whether the next case is unsuccessful or is complicated by adverse outcomes? If/when I need surgery, I plan to seek what I feel are the most important factors in surgical outcomes: experience and confidence in the face of the routine as well as the unexpected.
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Given the uncertainty that often shrouds our work, I believe there is no room in medicine for arrogance, for that would imply greater control over the unknowns that is realistically possible. I hope that I will be able to practice throughout my career with unending perseverance, patience, teamwork, and humility.
Medicine has always been a team game. With the recent changes to duty hours and the dramatic increase in the number of handoffs and cross coverage, this has become truer than ever. Being a good team member is critical in providing effective patient care and making a stressful work environment more enjoyable. What does this entail? It involves the skills of being a leader, follower, facilitator, and teacher; good team members play all of these roles simultaneously - I have been fortunate to be a part of many such teams during my career. Studies have shown the importance of teamwork within High Reliability Organizations (HROs) in high-risk work environments where errors can have huge consequences but occur infrequently; this is the ideal that we should seek in the provision of healthcare.
The best doctors remember that the most important team member is the patient. Patients are the most important determinants of the ultimate outcomes. This means that we do our part to enable patients to take ownership of their care by providing appropriate education and ensuring we convey the importance of follow up and compliance.
4) Humility
While it takes perseverance and patience to become a doctor, I believe the most important trait in a practicing physician is humility. We practice an art that is filled with uncertainty. No two patients are similar; no matter how many studies are done, each patient will have idiosyncrasies that deviate from the patients studied in the cardinal trials. Furthermore, we often work with incomplete information; a differential diagnosis is an amalgamation of competing probabilities that vary with the unique characteristics of each patient, how they tell their story, and the accumulated experience of the physician.
Finally, human beings are fallible and physicians are no different. Dr. Atul Gawande beautifully articulates this in his book "Complications". Medical decision-making is heavily influenced by internal and external factors, such as fatigue, misleading cues in a patient's history, the diagnosis associated with the patient seen immediately prior to a given patient, and how pressed a physician is for time. A physician's memory is similarly affected by these factors. This is what makes medicine challenging. Given these factors, I do not want the perfect physician to be my doctor; I want one who acknowledges the uncertainties in clinical practice and as well as his/her own limits and potential for fallibility. I want the doctor that does not rely on imperfect memory and chooses to look things up when doubts arise.
Fallibility is influenced by intrinsic as well as extrinsic factors - inexperience is the most common internal factor in young trainees. Inexperience can be rectified, but the extrinsic factors that we cannot control are more frightening. This is especially true for surgical fields: operative success and complication rates provide excellent statistics on the track record and experience of a given surgeon. However, how can we predict whether the next case is unsuccessful or is complicated by adverse outcomes? If/when I need surgery, I plan to seek what I feel are the most important factors in surgical outcomes: experience and confidence in the face of the routine as well as the unexpected.
---
Given the uncertainty that often shrouds our work, I believe there is no room in medicine for arrogance, for that would imply greater control over the unknowns that is realistically possible. I hope that I will be able to practice throughout my career with unending perseverance, patience, teamwork, and humility.
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