Success, Money and Medicine

Edwin Leap over at edwinleap.com will be hosting grand rounds and started a topic that got me thinking about money and medicine. My experience in the medical field is limited to being a paramedic for a volunteer agency, working in an ER, doing some shadowing and currently trying to stay sane as I traverse the challenges of the first year of medical school.

I have two neighbors who are both internists. They went to the same medical school and residency program. They are also partners in a private practice. The one who lives to the left (Dr.Left) works 4 different jobs as a salaried employee. He was a physician in his home country and he went to medical school again here in the states. He is in the upper middle class bracket.
The one on the right (Dr.Right) has the biggest house on the block. He drives nicer cars. He makes more money and works fewer hours. They have the same level of education, and post-graduate training. The doctor on the right is a better businessman. He is aggressive. He takes charge. He squirrels around in search of a way to make a quick buck. The one on the left is way more passive in his approach in making money. Obviously he needs to support his family but he is just not as cutthroat. Dr. Left works 6/7 days a week. Dr. Right never works more than 4 days. Dr. Left does not take risks. Dr. Right does.

Who do I consider to be the more successful physician? After my training, which lifestyle would I prefer to live? That’s right. All puns always intended.

Besides my family, nobody sacrificed anything for me. Nobody went to college, worked, volunteered, studied, and trained for me. And I am not obligated to do so for anybody. Nevertheless, I still volunteer on an ambulance, and I plan on doing so for a long time. I will continue to help people in third world countries because I have a skill-set that can potentially save a life, and for selfish reasons medical work abroad really keeps me grounded in life at home. But I do not feel like I need to give donations in my everyday job. My mechanic never fixed my car for free, he doesn’t care that I’m an unemployed student in debt. My dentist takes all he can get from my insurance company, nothing for free. So how can anyone look down on me if I want to be compensated very well for my job? It makes no sense.

Being a successful businessman is almost as important as being a successful student. I am thinking about making money all the time. That doesn’t mean I’m not thinking about good patient care. These things don’t have to be mutually exclusive. I strongly believe that anyone who wants to be rich and went into medicine is in for a surprise. You don’t go to medical school if you want to be extremely wealthy. It’s a service industry, where you bill for the hours you worked. Yes, you can hire other physicians to work for you, you can have a good business model like Dr.Right, but to make millions doing solely medicine is very unlikely. That doesn’t mean physicians shouldn’t be compensated and shouldn’t look out for their own pockets.

I look down on the doctor who is rude to his/her patients, who thinks they are superior to others, who thinks they are always right, but I would never look down on a doctor who makes a lot of money, I admire those.

Edwin Leap Gives Us A Present

Thanks for the truth Edwin Leap. This was a great present.

When I'm riding in the ambulance

12 Cranial Nerves

Where is my 100?

So I’m about half way done with my first year. I’ve taken quite a few exams and every time I leave an exam I just don’t feel good about it.  First there is the feeling that I just gave birth to a child, the child got taken away from me, and now I have to go home, study and prepare to give birth to another child.  I’m sure it’s not as painful physically, but mentally it is.

Then there is another issue. I get my grade and I’m just not that happy about it.  In undergrad, if I put in ¼ the amount of time I do on these exams I would be guaranteed above a 90/95.  In medical school, I study for over 40 hours for an exam, expect to get somewhere close to 100 since I should know everything and rarely break 90. WTF?

I guess my expectations are set too high.  I have to learn to accept that I will not know everything. There is too much information. Too many books to read, too many powerpoint slides, too many atlas photos, not enough time.  I just haven’t been able to accept that yet.  I need to accept that getting an 85 on a medical school exam is OK.  Getting a 90 is not going  to make or break me in getting the residency I need. Getting a 95 will not make me a better doctor.  But I’m still going to study the same way I have been. I’m aiming for a 100 on every exam.  If I get anything less, I’ll go over my mistakes, and not make them again.  

How about a free flight?

I was sleeping in an aisle seat when I was rudely awoken by the foot of a young boy directly across my face.  This boy was being carried in the arms of his father, who was running towards his seat from the back of the airplane.  Real nice I thought.  A few seconds later, the father ran back towards the restrooms alone and asked for help from the flight crew which immediately made an announcement over the speaker activating a medical team and asking for any doctor on board to help.

No doctor's on board, I decided to be the hero.  I told the stewardess I was a paramedic and could help them out.  My diagnosis: micturition syncope.  7 y/o boy syncopal episode in the bathroom while peeing. The crew was great, had oxygen, a BP cuff and a scope.  After laying the kid down, checking vitals, giving a bit of O2 and comforting the parents the crew offered me unlimited alcoholic beverages, which was nice.  I would have preferred a free flight, but drunk beggars can't be choosers. 

One of the people sitting next to me said "Hey are you a doctor? You're so young." "No, I'm a paramedic, but I will be a doctor one day." I replied. "I'm jealous, I wish I had a job that I can help people with, I feel so useless in these situations" he replied. 

That felt pretty good. 

What makes a good doctor?

Dr.Knowitall  is not someone you want to go and have a couple drinks with.  He's not very social, doesn't take much interest in his patients' lives, doesn't listen to the story, but rather asks the questions that get to the point.  He knows it all, and let's you know it. He is up to date with the latest research/treatment/protocols and his colleagues often come to him for consultations. 

Dr. Human on the other hand is warm and inviting every time he steps into the exam room to see you.  He smiles, shakes your hand, remembers things about your past visits, asks about your family, and treats you like a real person.  He is a human being first, and a doctor second.  He really wants to see you get better.  He may not have read the last study on which is the best statin to use.  He may not remember sensitivities and specificities off the top of his head.  But he has been practicing for a while and is experienced enough to know when someone is really sick and when it is something minor. 

So who do you choose to be your primary care doctor if the choice lies between these two? Do people want their doctor to be the top-of-the-class superstar, but will sacrifice personal attention and that feeling that your doctor cares about you as much as his own wallet? Or would you rather have a doctor who may not have been the top of the class fact spitting gunner, but instead makes you feel good and reassures you when you go see him or her? 

It is my opinion that a good doctor has to be trained well enough to pick out the red flags when a patient presents with certain symptoms.  A good doctor has to know that there are things he doesn't know.  But a good doctor also has to be a human first.