When I told my high school guidance counselor at the age of 14 that I wanted to become a doctor, I had this sense of what that meant. It had a lot to do with my dad, who has been a primary care physician trained in Internal Medicine practicing in NYC for the past 32 years. It also had something to do with my position in a local Emergency Department as a volunteer clerk after school and on weekends. I had witnessed my dad speak to patients and their families, fielding phone calls during family outings and dinners, or while we watched old sitcoms on “Nick at Nite” when I was young. Sometimes I would go to the office and do homework in one of the empty offices while my dad worked. I met his partner and the administrative staff that worked in his busy private practice in the center of Queens. I met some of his patients, too. They loved my dad. They never stopped gushing about how much they loved him. They sent cards thanking my father for his support and help. They sent gift baskets, chocolates, and even alcohol, which my father gave up early in my childhood. So, when I sat down with my guidance counselor and spoke the words for the first time, “I want to be a doctor,” I thought of my dad, and what I had seen until that point. I had no idea what I was actually signing up for. The photo attached to this piece is of my dad and me when I was exactly 374 days old. It was my first time putting on a stethoscope.
I have seen and done some incredible things over the past 12 years. I have grown from a naive, inexperienced and socially awkward young child who suffered from tremendous self-confidence issues into a hard-working and eager young physician. Today, I can walk into a patient room in any of the 12 Emergency Departments I have worked in over the past two years, introduce myself, and get to work helping patients, without even blinking. I can obtain their medical history, figure out what’s ailing them, and come up with a plan to help them – most of the time. When I am not sure, or if I am going down the wrong path, which happens, my attending physicians and supervisors reel me in and get me back on track.
Practicing medicine is not a yes or no question. It is not a multiple choice question where you choose the best answer (like all of my unhelpful board exams to date have been.) Sometimes, the answer is black and white. Sometimes, when doctors are lucky, the issues they face are clear. It is then easy to move forward, and do what is best for your patients. However, I must emphasize that this is not usually the case. There is incredible variation in how doctors manage disease and treat their patients. They have such wide styles in how they communicate – or don’t communicate – with their patients and their families. Physicians of different fields and specialties all have different focuses and strengths, as well as weaknesses. Talk to a generalist like me, and you will likely get answers that address a bunch of information about a variety of organ systems and diseases. Talk to a specialist like one of my social media heroes, Dr. Eric Levi, a seasoned fellowship-trained head, neck, ear, nose, and throat surgeon, and you get a ton of expertise in a more focused area. Most people think that a doctor is a doctor. And that we are all the same. But that’s just plain wrong. Each physician, even within the same field, is a different human being. And every human being sees the world differently, sees disease and its treatment differently, communicates differently, has different values, and thus, will treat a patient differently. If there was one thing I wish I could share with those who are not familiar with a physician’s work, it’s the incredible uncertainty and lack of clear answers for what we do. More often than not, when I take care of you in my Emergency Department, I will rule out life threats and emergencies, and if I think you can survive to live until you can get follow-up with your primary care doctor or a specialist who knows more about your issue, I will discharge you home. But just know that for hours, days, weeks, months, and sometimes, years, I will wonder whether I did the right thing for you, and if you are okay.
I know I do the best I can, but I don’t have all the answers, and any physician who tells you they know everything, or they know better than you and that’s why you should listen to them, you ought to walk the other way and find another one. There is nothing more dangerous than a physician with hubris. Eventually, all physicians are humbled. Sometimes it happens quickly in their career, like with me. Sometimes, they may carry on with their pride and “I am God’s gift to mankind” attitude for a longer period. But one way or another, we are all humbled. The part of medicine that we don’t discuss enough is the art of it. The gray areas. The nooks and crannies. These areas make our work challenging, but not impossible.
If not for these difficult and complex scenarios and situations, being a physician would be, well, boring. Computers and artificial intelligence systems can analyze an incredible amount of data and use protocols and reach decisions which can closely mimic or even surpass those of human beings. But the reason that AI systems or computers can never fully replace or replicate what I do at work is that a tremendous part of my job involves holding a patient’s hand, letting a family member cry on my shoulder when there’s a bad outcome, or getting someone a turkey sandwich and a blanket. There’s a human factor to what I do. The pro is that if I do it right, I can give someone support and guide them through complex situations to the best of my ability, and hopefully guide them toward better health and a better tomorrow. The cons are that I am imperfect and as a result, my decisions, recommendations, and professional work is, sadly, also imperfect.
That being said, physicians and other medical professionals are constantly researching and learning. The world of medicine is ever changing and ever growing. There is much to learn and better understand about what we do. The best physicians, in my humble opinion, are passionate about delivering quality care for their patients, and they understand that in order to do that, they have to be the best students for the rest of their lives. Our learning never ends. Do not be frightened when a physician says they don’t know the answer. Don’t be scared if they say, “I don’t know, but I will look it up, and find out for you.” It means they care to take the time to grow themselves, so they can provide you with the best recommendations, advice, and guidance humanly possible.
Physicians and the medical professionals they work with are part of numerous systems. These systems and the people that work within them are healthcare. There are a tremendous number of moving parts and the entire ordeal is more complex than I can begin to understand. The best I can do at this point is be passionate about the areas I am a part of on a regular basis – namely, the Emergency Departments where I work and the community I live and work in. Often, medical professionals are burdened by the systems they are a part of. Resources are distributed poorly. Laws are passed which are not based on the latest research or knowledge. Politicians play games with people’s lives. Hospital administrators emphasize and prioritize a better bottom line than better patient outcomes. And no, no matter what anyone tells you, a better bottom line and a better patient outcome can never be the same priority. Because better patient outcomes by definition require the worst bottom lines, and administrators, insurance companies, and the big wigs in healthcare will never let that be the case.
Next time you see a doctor who is stressed out, or doesn’t know the exact answer right that second, or seems exhausted or troubled, it’s not because they are incompetent and can’t do their job right. It’s not because they’re inexperienced, “too young,” or a “bad doctor.” It’s because they’re not just thinking about prescribing you antibiotics for that cold you have. It’s because in the room next door, someone is dying of cancer and them and their family need help getting into a hospice program. It’s because before they walked into your room, they just lost a young patient who went into cardiac arrest because they had a genetic abnormality of their heart that was not previously diagnosed and it was too late for them. It’s because yesterday, they sent an elderly patient back to their nursing home, and when they got to their shift today, they got a call from the patient’s mother that she passed away on the floor, in her sleep, of uncertain causes. It’s because the week before, their supervisor called them into their office and told them they weren’t working fast enough and they needed to pick up the pace. It’s because when they decided to go into medicine, they thought it was about saving lives, when in reality, it’s about reading research and textbooks and translating it into terms their patients can understand, and then doing their best to guide them to the choices that are right for them.