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Seven Marks of a Great Physician

It struck me just today that I’ve been a physician for over twenty years. It seemed to be just yesterday that my professor of medicine placed the green doctoral hood over my neck, and pronounced that a scrawny young student was suddenly a healer. Now I find that I am the teacher, trying to impart to my medical students a little skill, a little wisdom, a little taste of what it is to be a physician that you cannot get in a lecture hall.

I thought about what I have learned over the past twenty years out of the classroom. I thought about what you won’t read in any medical textbook. As this new generation of physicians set out, what do they need to know? What principles will lead them to lasting success in medicine and in life? So for the young doctors in my life, here are my seven marks of a great physician:

A great physician sees medicine as a profession, not a job. A profession, historically, is far more than a way to make money. For millennia, medicine has stood only second to the clergy as a vocation of sacred honor and importance to society. Multiple forces both within & without are now trying to reduce medicine in your eyes to just another job, but you must keep before your eyes the vision of medicine as something far more.

When you receive your hood, you have been bestowed an honor & duty unlike any other in this world. You are accepted into a fellowship of men and women that stretch back thousands of years. The knowledge, skills, & tools that you possess are the culmination of the dedication & sacrifice of countless physicians who have come before you throughout the centuries. This mantle of healer you will wear for the rest of your life. Feel the weight of it, & do not forget it.

You have been given the trust of entering into the lives and the deaths of your patients. You have been given the duty to heal to the best of your ability. You have been given the honor of passing on the knowledge & wisdom you acquire to the next generation of healers. All of this is yours as a physician.

Please do not shrink the wonder & glory of this profession into a job. The moment you begin seeing it as just a job is the moment you stop being all that you were called to be & that you are capable of being. Never lose what it means to be in the profession of medicine.

A great physician masters the business of medicine. Learn basic economics & business accounting. Understand how money flows in the healthcare system, and why. Know contracting, coding, negotiation, insurance, & cash flow.

Why, you ask? Why bother with these dollars & cents when I am supposed to be healing the sick? Because no matter what type of practice environment you find yourself in, you need to know the business of medicine in order to practice the art & science of medicine. If you cannot pay yourself & your employees you cannot serve your patients.

A prime example was the Nalle Clinic of Charlotte, NC. For 80 years it served hundreds of thousands of patients as one of the preeminent multi-speciality clinics in the nation. But in the financial turbulence of the 1990s its physicians did not adequately understand the business of medicine. As a result, 140 physicians found themselves without a job as the Nalle Clinic was forced to shutter its doors forever in a financial collapse.

Part of being a good steward of your skills includes being a good steward of the money that flows through the healthcare system as a result of your labors. You don’t have to get an MBA, but you cannot just assume that “the money will take care of itself.” Do not ignore the business of medicine.

A great physician is a confident physician. One lesson I did not understand when I was a young doctor is how much patients want and need to trust their physician. Especially in times of crisis and illness, patients are looking for a rock of stability amidst their uncertainty & chaos. They need you to be that rock of calm confidence that they can put their trust in.

You don’t need to have all the answers, you don’t need to reach beyond your limits, you don’t need to act like a god. But what you do need is to show patients a clear and confident path that they know they can follow. Not sure of the diagnosis? “We will do this & this & this until we find out what is going on.” More than one option? “We can do A or B or C, and they are all viable options. How would you like to proceed?” There is always a way to relate to your patients that bolsters their trust & confidence in you and their hope for their health.

A great physician finds his own path. As you practice medicine be observant of your life. Look at yourself & notice where your strengths are best displayed, where your energy is pumped, where your joy is renewed. As you learn more about yourself, opportunities will open, and you will become the doctor that is most you, which will be your unique greatness.

I know a physician who trained as a cardiologist but heard about a relatively new procedure at the time: renal artery stenting. Intrigued, he pursued it & became one of the nation’s authorities on renal stenting— a far cry from his resident days of torturing unfortunate medical students such as myself. I know another physician who after decades as a pathologist looked at himself and realized he had other gifts. He went back to get a masters in counseling, & returned to his medical school not to peer into microscopes but to mentor & guide hundreds of young physicians.

Your path as a physician will be exactly that: your path. No one else can lay it out for you, and even you can not dream where it will take you. Keep your eyes open, and your path will astonish you.

A great physician is known by his influence, not his competence. All of medical school seems to revolve around one word: competence. From studying obscure diseases to memorizing muscle groups to passing board exams, formal medical education shouts out that the greatest doctor is the most competent doctor.

Not so. Yes, you must be competent, but competence is only the first step, not the finish line. The truly great physicians are the ones who leverage their competence with influence to produce a lasting legacy.

Case in point: the founder of the medical group I work for, Dr. Jerry Miller. He took a rural family practice and led it to be a multi-speciality group of over 150 providers, with cutting edge research, diagnostic facilities, & information systems that have dramatically impacted the healthcare of an entire region. Did he do this by having the highest scores on his board exams? No, he did it through influence: knowing the power of his vision, his words, his example, & his presence on those around him.

Although your path may not lead you to be the president of a multi-speciality group, the principle of influence has the same power over your life. Your vision, your words, your example, how you treat your coworkers and patients, the tone you set daily in the office, the dreams you dream for yourself & others— these will be the determinants of your true greatness. Learn the power of your influence, & use it wisely.

A great physician takes good care of their self. You are a human being. You have physical, emotional, & spiritual needs. You cannot ignore them & expect to operate at your best.

The great healer Jesus went to weddings, cried at funerals, ate at feasts, took naps when he was tired, withdrew by himself to spend hours in prayer. If such a man as he needed to do such ordinary things as a human to continue to minister to the people who needed him, do you really think you cannot?

Don’t allow short-sighted thinking or simple carelessness to shorten or impoverish your life and diminish the legacy you can leave. Take care of yourself, and let others take care of you too.

A great physician loves. You heal the sick. This is a good & noble thing. But no matter if you cure a patient’s cold or their cancer, it is only temporary. If by your skill your patients live to be 110, they will still all die.

If you make enough money so that your family is never in want, it will one day fail. If you build the greatest clinic in the world, it will one day crumble to the ground. If you win the Nobel prize, it will one day be forgotten.

There is only one thing that will eclipse and outlast any other achievement, and that is love. Ponder the wisdom of Saint Paul:

If I have the gift of prophecy and can fathom all mysteries and all knowledge, and if I have a faith that can move mountains, but have not love, I am nothing. If I give all I possess to the poor and surrender my body to the flames, but have not love, I gain nothing.

I know it might sound trite or unrealistic or touchy-feely, but it is true: there is nothing greater you can do as a physician or human being than to love.

Love your patients. That doesn’t mean you have to form unhealthy bonds with them, or let them rule your life, or that you can’t put some of them out of your life for their & your own good. But whether you are seeing them for five minutes in an urgent care clinic or care for them from cradle to grave, you can love each & every patient you serve. It really does make all the difference, both for you & for them.

Love the people in your life: your coworkers, friends and family. For each one of them, you have the opportunity to relate to them in a totally unique & irreplaceable way. Whether you play a big or small role in their lives, they need you to love them. No one else can love them in the way that you can. Love them, & let them love you.

Treat medicine as a profession. Learn its business. Be confident. Find your path. Use your influence. Take care of yourself. And above all, love, and I guarantee that you will be a great physician.

Book Review: The Spark

True or false: People fail to lose weight and keep it off because they don’t realize they need to eat healthy food and exercise.

We know that isn’t true– everyone knows about healthy food and exercise. But isn’t that the message of most “diet” books? Once you find the right magic foods and the right magic exercise, once you have that secret knowledge not found in any other diet book, then YOU will lose that weight!

If we are willing to be honest, the real reason we are not losing weight is US— we end up choosing to eat that dessert, to sleep in instead of pounding the pavement, to say to ourselves “this is never going to work.”

And that’s where The Spark starts: with how we view and live our life and how we can make sustainable positive change. In fact, it doesn’t even start talking about what foods to eat until page 84.

Where it starts is with four “cornerstones” of positive living: focus, fitness, fire, and positive force. The author takes a chapter on each of these concepts and lays out how they apply to life in general and a life shift like weight loss in particular.

So, does this work? Does the effort to really understand the principles of positive change make a difference? Well, this book is really just the distillation of a website & online community,, which has helped tens of thousands of people make meaningful change. In fact, the center of the book contains short bios and color photos of seventeen people, real people, real people who you can actually contact through the sparkpeople online community, who have used the principles to lose big weight (most of them 100+ pounds) and keep it off and really change their lives.

Yes, the healthy diet and exercise tips are in there, just like in every diet book. But what makes this book different, and special, is that the focus isn’t the food, but you: a practical plan to change your outlook and jump-start your motivation so that you can practice a healthy lifestyle and change your life. A very good way to start out the new year, or any time you decide to change for the better. More information on the book is available at the book’s website.

Book Review: Born to Run

In Born to Run, Christopher McDougall spins a wildly careening tale of colorful personas, from hidden tribes to research scientists, penniless college coeds to bizarre millionaires, shameless promoters to reclusive loners. From the plains of Africa to the mountains of Colorado, from Death Valley to the Sierra Madre, he weaves one common thread that binds them all: the love of running.

McDougall, an editor for the magazine Men’s Health, had to stop his recreational running due to foot pain. That pain triggered a bizarre cascade of events that culminated in a secret grueling ultra-marathon in the remote mountains of Mexico that included some of the best runners on the planet. Born to Run is his travelogue of those events.

Each chapter whips and turns like an out of control roller-coaster carrying you on a wild ride where you never know what’s around the next bend. Along the way, McDougall explores the body and soul of the runner, visiting bio-mechanics, evolutionary anthropology, philosophy, nutrition, and more.

I tremendously enjoyed this book on several levels. One, the story itself was a trip, living through all the people and places that culminated in this amazing race. Second, the dips into science were fascinating to me: how uniquely engineered the human body is to run down to the placement of specific ligaments. But most intriguing was the explorations on the spiritual aspect of running, how nourishing running is to the human spirit and how closely tied it can be to our capacity to love.

Born to Run is fascinating reading for anyone with a taste for adventure and a love of running. I had a blast reading it.

Book Review: The UltraMind Solution

One of my guiding principles has always been: Never read a book that has the word “ultra” in the title.

However, interesting perspectives on diet & health intrigue me, & when I saw endorsements from such respected doctors as Dean Ornish, Christiane Northrup & Mehmet Oz, I decided to break my rule and plunge into The UltraMind Solution.

I’m glad I did, for this book is an engaging read that’s full of cutting edge science & practical advice.  Dr. Mark Hyman has been on a mission to do medicine & health differently since conventional medical thinking failed him in his own debilitating illness twelve years ago.  He convincingly argues that maintaining the body’s health is essential for the brain’s well-being, and that many mental & psychological disorders can be rooted in physical, biochemical derangements in the body’s health & metabolism.

In part one of the book he details the background: his personal story which led to his changed philosophy & practice of medicine.  He is an advocate of what is termed functional medicine, a relatively new discipline which focuses on not the established “label the disease, give it a drug” approach but “find what’s functionally wrong behind the patient’s symptoms, then correct the body’s metabolism back to optimum function.” 

The second part of the book contain the outline of his “Seven Keys to UltraWellness” (argh! there’s that word again!).  He covers optimizing nutrition, balancing hormones, reducing inflammation throughout the body, fixing digestive tract problems, enhancing the body’s detoxification, boosting energy metabolism, & calming the mind itself. The third part of the book covers a six week plan to initiate many of these changes, while the fourth part goes into specifics for each of his seven key areas.

Ok, so what’s the bottom line?  There’s a lot of intriguing information and sound advice in the 400+ pages, & I saw nothing that I absolutely disagreed with.  Like any diet or health book, he has his own viewpoint & focus, & some of his strategies & recommendations will work better for some than others.  This book was a major swing factor in my own decision to try a vegan gluten free caffeine free water only lifestyle, which was difficult but very beneficial for me in multiple areas.  I can see this book being useful for two groups of people: First, people who are suffering from problems such as anxiety, depression, “brain fog”, adhd, migraines or other brain related problems might find something helpful or even life-changing in his plan.  Other people, like myself, who are interested in new approaches & optimum health will certainly find new concepts & tools that they can implement in their own healthy lifestyle.  Either way, an excellent book to read.

Book Review: Slow Burn

slow burn by Stu MittlemanI’m not a fountain of positive mental attitude when the subject of exercise comes up.

I usually exercise in spurts of a few months when motivated for health reasons, but fall away when the pain or drudgery or boredom take their toll.

But when a friend encouraged me to read this book, and when I saw that the author had RAN across the United States, averaging 50+ miles a day for 56 straight days, I thought, “Maybe he knows something about running…”

He does.  This book has cleared away a lot of misconceptions I had about the physiology of exercise (even as a trained physician), & given me both a new philosophy & a new set of tools to apply to a sustainable exercise program.

The book is divided into three sections: Part one deals with how to THINK, part two with how to TRAIN, & part three on how to EAT.  He lays down his philosophy about how movement, whether walking or running, is both natural and integral to our bodies & can be a source of joy.  He covers a broad variety of topics, from aerobic vs. anaerobic exercise, workouts, healthy diets, even a chapter on selecting the ideal running shoe.  Intermixed are anecdotes about his own insights, successes and failures and those of people he has coached.

Some of his interests, such as kinesiology, alkaline food, & blood microscopy are on the fringe or beyond currently accepted medical science, but these shortcomings do not detract from the value of a book that is both an easy read and chock full of helpful ideas for anyone from the couch potato to the experienced marathoner.  I loved this book.

Book Review: This Is Your Brain on Joy

Can knowing if your cingulate gyrus is overactive change your whole life?This Is Your Brain on Joy by Earl Henslin

Can the right drug or herb do more than just cover up depression or anxiety, but actually restore & heal the brain?

Can physical dysfunction in the brain rob a committed Christian of the joy that is possible in Christ?

If you read this book, you’ll discover the answer to all these questions is an unqualified YES. 

This Is Your Brain on Joyis a highly readable introduction to cutting edge concepts of brain function in health and emotional disorders.  The author, Dr. Earl Henslin, is a practicing psychologist who has collaborated for ten years with Dr. Daniel Amen, a pioneer in the field of brain imaging.  They treat people suffering from depression, anxiety, panic, rage, “ADD” and other problems not by labeling them with a disease, but by considering what anatomic part of their brain is malfunctioning, and then helping them through supplements, therapy, medicine, & other supportive & healing measures.

This is not the typical paradigm that was taught to most physicians, including me.  ”Business-as-usual” medicine is to fit a person’s symptoms to a standardized diagnosis, then use a drug recommended for that diagnosis.  That approach was formalized decades ago, when we had few tools to see function & dysfunction within the living brain.

There is a better way. Physicians like Dr. Amen are performing advanced brain scanning on tens of thousands of patients and seeing the correlations between symptoms and brain function, and seeing how different therapies targeted toward specific areas of the brain can bring radical improvements in people’s lives.

This book starts out with an introduction to the relationship of a biochemically healthy brain to a joy-filled life, and how damage or dysfunction within the brain will sabotage any effort to live a fulfilling life.  The second section of the book details what dysfunction in each of the brain’s mood-related centers (prefrontal, cingulate gyrus, basal ganglia, deep limbic, and temporal lobes) look like, and details specific therapies to help each area.  There is a final chapter which draws on the New Testament book Philippians to list six ways to increase joy in your life.  The book’s only major weakness is that it largely overlooks the spiritual components to a life of joy such as freedom from sin & the new birth, but it is understandable that this book’s focus be on the physical/biochemical, while there are many other fine books to read dealing specifically with the spiritual.

If you or a friend or family member struggle with any emotional or mood disorder, this book will give you new insight, new hope, & new ideas on how your brain & your life can be all that it can be.  Highly recommended.

The Decision Has Already Been Made

determination by Baston via Flickr

Workouts are like brushing my teeth; I don’t think about it, I just do it. The decision has already been made.” ~Patti Sue Plumer, US Olympian

I got up and ran this morning.  I am not a “runner”— running is not the center of my existence.  In fact, most days I don’t even like it.  But I know I need the exercise; I know that running is good for this body that God has given me.

That’s where the above quote comes in.  If I had thought about it, if I had turned over in my mind whether or not I should run this morning, there’s a pretty fair chance that my lazy butt could have come up with a lame excuse for not running.  But the decision had already been made.  I was running.  And I didn’t give myself the opportunity to “think it over” and back out.

This principle can apply to more than running.  At any decision point, I have a choice to do less than what I know to be God’s best, God’s will.  (That’s ”temptation” and “sin” for you theologically minded folks)

In my humanness, if I give my mind a chance, it is going to try to talk me out of God’s best for my life.  But I can say “the decision has already been made”— I am going to follow Christ.

If you look back, this is where Eve messed up:

The serpent was clever, more clever than any wild animal God had made. He spoke to the Woman: “Do I understand that God told you not to eat from any tree in the garden?” The Woman said to the serpent, “Not at all. We can eat from the trees in the garden. It’s only about the tree in the middle of the garden that God said, ‘Don’t eat from it; don’t even touch it or you’ll die.’”

The serpent told the Woman, “You won’t die. God knows that the moment you eat from that tree, you’ll see what’s really going on. You’ll be just like God, knowing everything, ranging all the way from good to evil.”

When the Woman saw that the tree looked like good eating and realized what she would get out of it—she’d know everything!—she took and ate the fruit and then gave some to her husband, and he ate. (Genes 3:1-6 The Message Bible paraphrase)

Did you catch it?  She started wondering, thinking, questioning, “What if?…..” when she could have just said, “The decision has already been made.  I will follow God’s instructions.”

Where in your life do you need to put a resolution about what is right in concrete?  Go ahead and make your choice to follow God in that area now, so when confronted with the opportunity to compromise you can firmly say “The decision has already been made.”


Open Heart Surgery Assembly Line

krispy kreme doughnuts assembly line

Well, I visited for the first time one of the crowning glories of American Culture, Krispy Kreme.  I was fascinated by an assembly line that Henry Ford would have been proud of, capable of taking flour and oil and churning out 2600 delicious globs of sugar and fat per hour.  Staring after line after line of doughnuts emerged from their oil and sugar bath, it suddenly came to me:  this isn’t an assembly line for doughnuts, it’s an assembly line for open heart surgery patients!  And each little doughnut became in my mind a gurney being wheeled into a surgical suite to have its chest split open.  Just a little cheery thought to start your week from your friendly neighborhood blogging physician.

Web Watch: CMDA

This week’s Web Watch is on the web home of the Christian Medical Dental Associations,  Even if you’re not a health professional, there are some unique and useful resources available on this website.  They have a variety of publications, position statements and downloads on a variety of topics such as end of life issues, cloning, abortion, and the relationship of faith and medicine.  There is a “Christian doctor finder” which allows you to search for a doctor who belongs to CMDA (Yes, I’m listed under Tennessee family medicine).  There is an online store that only stocks quality reviewed books, audio and video materials.  Interested in bringing an expert in medicine or bioethics to speak at a church or conference? CMDA is the place to find the best. They also have a multi-year archive of their weekly chapel services at their headquarters on a variety of topics available for MP3 download.  Interested in being involved in missions work?  The site has a variety of resources and connections there too.  All in all, great resources from a great organization headquartered in (might I add) the great state of Tennessee.

Blasts from the Past

So, you want to put that iPod to good use? (that means you, Centurion!)  Then start a New Year’s exercise resolution with some tunes to get your physical and spiritual heart pumping!

I’ve got a new sport iMix in iTunes loaded with some goodies for Christians who are old enough to remember going to concerts with Steve Taylor (before he launched sixpence none the richer) or Steve Camp (before he was the reformed blog hatchet man).

Who could resist running to lyrics like:

had my hands in my pockets on the Judgment Day
nobody told me there’s fire in the hole
had the world by the tail but I lost my soul


He wants some angry young men
Ones who can’t be bought
Ones who will not run from a fight
Ones who speak the truth whether it’s popular or not
Ones who’d give up anything to walk in His light

not to mention…

Shake me to wake me
I’ve been sleeping too long
Put some fire in me!

Attention: bonus points for anyone who knows the artist, song, and album for each of the above lyrics without googling!

So, what are you waiting for?  Click here to launch iTunes and see my sport iMix.  And if you have a Nike + iPod Sport Kit you can go over to the Nike website and deride my meager attempts at physical fitness—my handle is “jjhmd”