An Open Letter to My Fellow and Future Doctors

Acknowledge this reality: Technology is always going to affect how you practice medicine. Among all fields of human advancement, medicine will likely see the most changes. Embrace them. If you’re not going to be part of the way forward, someone else will be. The worst thing you can do is to banish these new developments or to hide from them. In doing so, you’re disenfranchising yourself from the progress and surrendering your autonomy to powers outside of the profession. Instead, take them in stride from the start. The incorporation of newer technologies into medical practice is inevitable — your task is to be part of the revolution and to blossom within it.

Present in every technology, at each stage of its evolution, is not only the potential for greater benefit, but also an equal potential to cause mistakes or to be abused. It’s our responsibility to continue to improve man-made systems to serve us better, but we shouldn’t forget that technology is filled with both possibility and destruction. Like raising a child or teaching a student, technology must be steered so that its talents are matched correctly to its inherent skills. Technology can bring to fruition the vision of personalized medicine, but it also leaves far too many options from which to choose.

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Our entire healthcare system, dominated by market forces and routinized practices, has become stuck in the fast lane. It hasn’t always been this way, but this is the result of our industrialization mentality, of the perception that “time is money.” Doctors are allotted only bite-sized

amounts of time, most commonly 10 or 15 minutes, to see each patient. In this brief window, we’re expected to evaluate an individual, discuss test results, educate, explain a treatment plan, talk to family members, and fill out relevant paperwork and complete charting. We’re also expected to identify and respond to patients’ expectations and fears and to check patients’ understanding of their diagnoses and recommended alternate treatments.

Much of our training has led us to quickly navigate through these hurdles, simply trying to survive the day. When we rush from patient to patient, it’s easy to focus on the illness, seeing someone only as a collection of signs and symptoms. We feel the crunch more than ever, and

we pick up habits that we don’t necessarily want — such as interrupting patients — as we try to find ways to stay accountable to the clock.

In a world of overpacked schedules and high-pressure performance measures, calling for change becomes important. Slowing down the process of care allows patients to take part in it. It strengthens the relationships between doctors and patients. This is a gain for both parties.

Beyond the obvious benefit of really listening to our patients, slowing down has a broader impact: mindfulness. When we have more time to examine and talk with a patient, more time to consult with other doctors, re-review lab test results, and carefully consider medications and treatments, we’re simply able to provide better care. Mindfulness helps prevent over-testing and over-treating, and it also gives us more time to educate our patients about lifestyle changes as part of a holistic treatment plan.

We have a responsibility to do better in finding a delicate balance between two opposing views: the ancient view of the human body as a garden to be tended, and the modern view of the human body as a machine to be fixed. To provide the education, tools, and supportive environment that activate the body’s healing response mechanisms requires patience and time. The happy marriage of technology and the human touch will happen only if we prepare for a change and then work hard to make it happen.

Ultimately, be mindful of your own conditioned thinking and practices. We are so habituated to our fast-paced lifestyle that unless we consistently remind ourselves to slow down, we’ll easily slip back into racing mode. Try incorporating moments of silence into your day. Make it a habit to spend time regularly reflecting on your experiences. Use what you discover in these moments to guide you toward not only what you can teach others, but also what you can still learn.

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There’s an old adage that claims, “If we do what we love, we won’t have to work for a single day of our lives.”

This is a misconception. No matter how much you love your work, every job entails certain duties that are simply unpleasant and cumbersome — there’s no way around it. For physicians, there are two main sources of frustration.

One is administrative duties. Charting patient records and the incessant back and forth with insurance companies just to get approval for certain medications, treatments, or tests are some of the elements that doctors and nurses typically don’t enjoy. But this sort of shadow work lurks in the depths of every job. The key is to not get overly distracted or frustrated by these ancillary tasks, nor to let them undermine our primary goal, which is to care, cure, and comfort the sick.

The second challenge for physicians is the delicate act of dealing with an angry, defensive, manipulative, or non-compliant patient. That takes work. The job of a physician is not easy, and we knew this before we embarked on our journey into this profession. But we signed up for this to serve a higher purpose — to be directly involved in the well-being of others and to see our patients get better because of the work we do. This is true no matter who our patients are.

The only way to achieve true happiness in this or any other profession is to express yourself through your skills and enthusiasm. You spent thousands of hours toiling to get here, and the payoff is a sense of purpose.

As physicians and as patients, we have many complaints about the system we collectively created. Positive change arises only out of dissatisfaction with the way things are, coupled with an active desire to steer things toward a more satisfying version of what we know. This is how the big shift happens — by small, incremental changes brought forth by each one of us day after day after day.

There are physicians who long for the return of the old days, those who have made peace with the present, and those who embrace the future of medicine. By whatever means necessary, a genuine healer adapts to the demands of the system we made. What ultimately matters is how far physicians are willing to go to ease another person’s suffering. If we compromise on this one objective, doctors will quickly become a disposable commodity. This is our litmus test.

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Though it’s critical to embrace technology, don’t underestimate the importance of the humanistic dimension in your practice.

In studying any activity or process of an organic life form, we see that a billion interacting deterministic factors influence it. Unraveling these factors became an intractable problem for medical professionals to solve. Fortunately, we invented a method to tackle this dilemma.

With the scientific method, we learned how to control the environment in which we study life processes. It is an objective method of validating the utility of a claim, and it worked. Using this approach, we understood more about the human body in a short span — something we couldn’t do for millennia. After a while, however, we took the process for granted. We forgot that this approach omits some of the most prized human attributes: our fears, beliefs, and biases when we encounter existential crises.

The scientific method provided us with verifiable knowledge. This is priceless. But living under the false assurance of knowledge, the notion that if something is not measurable, it is not important, is worse than ignorance.

Don’t get lost in the convention of “only things that can be measured are the ones I agree to tend.” This is blocked thinking. As physicians, we sometimes get lost in the activities with measurable outcomes, focusing all of our attention on the pieces of the puzzle that can be monitored and recorded. Yet many other elements within the way we practice care cannot be quantified but are equally important.

When you encounter a chronic or terminal illness in an individual, it’s disingenuous to hide under the false assurance of technology. When you’ve used up everything that science has to offer, don’t be afraid to embrace your own emotional vulnerability.

What really matters to a patient when all else fails is the presence of a comforting hand. Whether you do or don’t believe in God, or if you believe in a different higher power, it’s still okay to acknowledge the patient’s faith — a small act of kindness to help someone in a difficult time. Terminal illness is a lonely place. Do all that you can to help your patient navigate this uncharted territory. The full depth of our capacity lies in our compassion.

However much credit we must rightly give to the scientific method, don’t let these methods rule your mind. Use them only as guideposts — as tools to help you understand your patients. In the end, each patient is unique. An individual is not a statistic. Even in the age of real-time data analysis, remember that no quantitative analysis can factor in all of the known and unknown contributors affecting someone.

The only solution is a conversation, a deliberate engagement with the person under your care, aided by the use of the correct technology to find the most applicable solutions at the right time. It requires a heart to understand another heart.

Remember that you are not just a doctor, you’re a doctor-philosopher-educator and many things all in one, each merged by degrees into a single identity. Be generous. Realize that, despite any advances in medicine, no one can cure death. But you as a healer have the ability to help cure the fear of death in the person under your care. This, to some patients, means everything.

A condensed excerpt from Physician: How Science Transformed the Art of Medicine.