Still a privilege to be a doctor

March 21, 2008

Though not immune to the hassles and hardships of practice, this physician tells why he experiences the joy of medicine. 2007 DOCTORS' WRITING CONTEST - HONORABLE MENTION

Twenty years ago, when I was barely out of medical school, I attended a conference and found myself seated at a table with far more experienced physicians. As usual when seasoned doctors converge, the complaining-about managed care, malpractice, unfair reimbursement, lack of respect-quickly began.

I kept quiet, until an older doctor turned to me and asked what I thought.

What I wanted to say was: "What a great job we have! We help people, we make a difference, and we make a fine living." Not wanting to sound like a Pollyanna, I simply replied, "I think the positive aspects of being a doctor outweigh everything else." But even this response brought stares of disdain.

Much more than mundane

Since then, I've remembered that phrase. It's become an approach that's helped me throughout my professional career.

As a doctor, I've experienced life's extremes. I've felt life enter the world in my hands as a child was born, and felt life leave the world under my hands while performing CPR on a patient who didn't make it. But, like most doctors, my day-to-day routines are not so dramatic. In my pediatric practice, most of my time is spent on mundane problems-kids' colds, worried parents, ear infections, strep throat. Same old, same old.

But wait. Everyday routines can hide everyday wonders.

Ashley's in Room 3, with a positive rapid strep. It doesn't get more commonplace than that. Then, with a sense of wonder, I remember: A century ago, rheumatic fever complications from strep were the No. 1 cause of death in school-age children. Now, we hardly see rheumatic fever in this country; a few generations ago, Ashley may have been one of the victims. As I write out yet another prescription for amoxicillin, I think maybe I just saved a life.

Bobby's in Room 6. Routine immunizations, which I've already given 20 times today. Then, a quick thought: During the first half of the 20th century, polio killed tens of thousands of people in the US alone, and crippled tens of thousands more. Since the development of polio vaccines like the one I'm about to administer, polio has been eradicated from this country and is close to elimination in the rest of the world.

When I pause and really think about what our profession has accomplished, the sense of wonder rushes in. Since the mid-1800s, life expectancy in much of the world has doubled. It's as if modern medicine and public health have given each of us a second lifetime. Who among us doesn't have a relative who was saved by modern science-heart bypass surgery, perhaps, breast cancer treatment, or a C-section? My role may be small, but it still feels good to be a part of such a positive change.

No matter what your specialty, the same approach can be applied. Removing a mole isn't just a minor procedure-it can be a life-saver. That antidepressant order isn't just a simple script, it's a contribution to human happiness. An insulin dose adjustment may seem like nothing much, but more than 15 million people living with diabetes would have died at an earlier age were it not for insulin.

Granted, it's not always easy to think this way, especially when results are slow and I'm striving, as most physicians are, to run a business and deal with a litany of practice management problems. It helps me to remember that it's not just the success of my practice or my day-to-day efficiency, but my patients' health that's at stake. And wonder-a sense that's reawakened by stepping back and taking a second or two now and again to look at the big picture-helps to balance my perspective.

At the end of that lunch so many years ago, one of the skeptics said to me, "We'll see what you say in 20 years."

Hard to believe, but it's been almost 20 years, and I still feel the same way. Being a doctor can be a hassle. But it's still a joy and a privilege.