Put fun back in your practice

Here are seven ways to make your professional life more satisfying and enjoyable.

By Richard E. Waltman, MD

True, medicine isn't as much fun as it used to be. But I still love what I do. So while forces beyond my control make my professional life more difficult, I've taken some measures to bring back the fun.

Here are seven suggestions I'd like to share with you. They won't resolve all the problems we face. But they may make your work more pleasant, and remind you of what a great job we still have.

1. Send notes to your patients. One of the real pleasures of following patients over the years is getting to know them well, and establishing a good physician-patient relationship. A brief letter at the right time can make that connection even stronger. I keep a pile of cards on my desk, and when the right occasion arrives, I write a note.

When Frieda Barnett (not her real name) told me that her 76th birthday was coming up, I sent her a birthday greeting. It turned out to be the only one she got. When I read that Bob Marshall's grandson had scored 15 points in a local basketball game, I sent a note congratulating the proud grandfather. Sometimes I'll send a card just to tell a patient I enjoyed seeing her, and that I'm glad she's doing well. My patients enjoy these notes, and always thank me for them.

A public relations firm might tell me this is a good way to market my practice, but that's not why I do it, and I don't need the extra business. Frankly, I do it because it gives me pleasure.

I also send thank-you notes when someone is unusually kind, cooperative, and helpful. When a patient from an adult home came into the office looking much better, I wrote to the home's owner and thanked her for providing such good care. When a colleague did a particularly fine job on a consult, I thanked her for her good work. These notes take only a few minutes each. Sometimes I get a nice note in return; sometimes I don't. But I know it gives some deserving people pleasure to get them.

2. Improve your knowledge base. We all have areas in medicine that we don't know enough about. Just recently, for example, I was slow to diagnose a torn Achilles' tendon, and I did less well than I should have with two patients with peripheral vascular disease. So I focused on those topics over the next few months.

I got pertinent articles from the hospital librarian and read them carefully. If I feel I've made enough progress in a few months, I'll move on to another topic on which I don't feel very solid.

I also keep up on general clinical literature. About three months ago, I bought a new textbook on internal medicine, and began reading it for 10 minutes every morning as soon as I get to the office. If I have time during the day, I read a bit more. Not only have I learned a few things, but I feel good about what I'm doing. In two months, I'll be finished, and ready for a new book—maybe one on dermatology or psychiatry.

These efforts keep me learning, and make me feel more competent about my ability to provide good care.

3. Buy something new for your office. We all spend a lot of time in our offices, but we rarely do much to brighten them up. How many of you are still using the same pen and pencil set you had on the first day of practice? Or maybe you still have the same pictures hanging on your walls, or you're sitting on the same well-worn chair.

I try to buy something new from time to time, just for the sake of novelty. My most recent purchase was a reproduction of an old radio. It wasn't expensive, and it works well. Many of my patients enjoy seeing and hearing it, and tell me it reminds them of one they had, or their parents had.

4. Do something in the community. Once a month, I speak to local fourth and fifth graders about the dangers of smoking. Since I don't see children in my mostly geriatric practice, I'm still struggling to find the best ways to persuade these young people about the risks of smoking. But each month I enjoy the talks more. In fact, they've become one of my most challenging and rewarding professional activities.

5. Get rid of an unpleasant task. A few months ago, I found myself so busy that I realized I needed to give something up. When I tried to decide what was my least rewarding professional activity, I concluded it was my membership on a particular medical committee.

I always came out of those meetings feeling irritable, frustrated, and wishing I had done something else for the previous hour. So when my name came up for re-election, I declined. I stay active on other committees where I feel more productive, but leaving this one has already given me a sense of freedom.

Do you have a similarly unrewarding duty? Or maybe you have a nursing home where you see only one patient? Perhaps you can trade that patient to a colleague for another one in a facility where you have several patients.

Is there one specialist who never gets back to you or who undermines your care? Why not find someone else for your referrals? Or perhaps there's some annoying paperwork your office manager could do for you. I'm sure there's something you can give up or delegate that will make your days happier.

6.Try to succeed with a difficult patient. You know who I'm talking about: the patients who make you groan when you see their names on your schedule. Either their complaints make no sense, or what we do for them never seems to help. I recently sought advice on this matter from a psychiatrist, who suggested a new approach to such patients. After hearing their concerns, I now say, "I really don't think I can help you with that problem. But what can we do today that will make things better for you?"

This technique really works with some of my difficult patients. After chasing odd symptoms with him for six months without results, I asked Zach what would make him feel better. He told me that his father had died of cancer at an early age "because he never complained, and never went to the doctor." So Zach had apparently decided that if he came in to see me every time he had a pain or a "funny feeling," he might avoid the same fate. We then had a great talk about preventive health, and we established a regular visit schedule. The last time I saw Zach, he said he was doing so well that he probably wouldn't be seeing me so often "for the other stuff."

7. Give yourself some credit. Most of us do a pretty good job: We work long hours, and we care about our patients. Yet we're probably more critical of our own work than we should be. And if we're not, the media, insurance companies, government agencies, and malpractice attorneys are always looking over our shoulders.

Sometimes we deserve a compliment.

About a month ago, I saw Fred Tolliver for abdominal pain. I identified an early bowel obstruction, arranged for timely surgery, and carried him through a very difficult post-operative course with multiple complications. One night, on my way out of the office after a visit with Fred, I looked at myself in the mirror.

"Hey, pal," I said. "You did a good job with that one."

The author, a family physician in Tacoma, WA, is a Contributing Editor to this magazine.

 

Richard Waltman. Put fun back in your practice. Medical Economics 2002;7:95.