Light Along the Journey

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.