Doctors are Not Immune From Illness

This article originally appeared on Doximity.com, where I was a 2022-2023 Op-Med Fellow.

This is a difficult story for me to tell. It is about facing our humanity and our mortality as physicians. And it’s about the truth that despite our desire to view ourselves as insiders with the keys to the hospital doors, the pact that we have made is one-sided.

There is no covenant with the universe, no deal with the devil that if you save others, you yourself will be saved. I saw my physician father fall victim to this implicit belief after he became ill. I witnessed with sorrow his misplaced trust that he would be treated differently, and his difficulty in disengaging from his identity as a physician.

I’ll start by telling you about my father before his illness. He was a brilliant physician and researcher, an immigrant and outsider who worked his way up to the highest position in his specialty. He taught and inspired generations of medical students, residents, and fellows from around the globe. He was described to me years later by one of his former fellows as “a god.” He saved, mended, and assisted in the conception of countless lives through his innovative therapy and research.

My father was a humble man in many ways. But he refused to submit to becoming a patient, and that’s what was ultimately his undoing.

My father’s family history was riddled with heart disease and early death. His mother died of a heart attack at the age of 45. Most of his siblings died young. But he was a vigorous and proud man, and even when he suffered an unexpected and frightening episode of hypertensive heart failure after returning home from a conference, he refused to see a cardiologist.

I will never know what kept him from seeking help, but I believe that he was afraid of what he might learn. That all the years of work and sacrifice might eventually catch up with him. That he needed someone or something else to become physically whole again. That his health, and thus his independence, might be irretrievably changed. That he, like those he cared for and those he loved, was mortal and vulnerable. Truth be told, he refused to even go to the ER for evaluation. Instead, he sent my mother, a physician herself, out to the pharmacy for a dose of furosemide in the middle of the night. It was she who made the diagnosis, with her stethoscope and blood pressure cuff.

To us, his children, this somehow did not appear inappropriate or unusual. Our parents were true medical do-it-yourselfers. They always seemed to have everything under control, so why should this be any different?

Yet I recognized that something was off. At the time I was a medical student out of state, and during my calls home my dad regularly assured me that his blood pressure was a perfect 120/70 on a low dose of medication. I thought he was misleading me, but there was nothing I could do about it but believe him.

It should have come as no surprise that my father suffered a terrible hypertensive stroke several years later. It was severely disabling, and despite appropriate care, there was no hope of recovery. I will never forget finding him in the radiology department of the hospital, a local facility where no one knew him. Slumped in his wheelchair in a faded hospital gown, he was shivering, weeping, and demoralized.

This was the unraveling of the deal that he believed he had made. No longer the professor, the department chief, the innovator, he was simply the stroke in Room 402. He had gone from a man of the world to a random patient, unacknowledged and unremarkable.

Plaintive pleas for water, request for assistance to the bathroom, and upkeep of simple hygiene were addressed by staff with disinterest, although he received timely care. Instead of being acknowledged as a respected and dignified physician, he felt like an outsider, just another task for the busy staff who had no time or reason to think any more of him.

After my father returned home, there was a brief period of hope and even optimism that things might improve, despite the devastation recorded on his imaging studies. But what little recovery he made was unimpressive and ultimately gave him no freedom or chance of independence.

He had been beloved by his patients and revered by his coworkers, but after the first brief flurry of visitors, the world moved on and he was mostly forgotten. He desperately wanted to return to work, to reclaim his identity, to be of service. He was unable to drive himself, so after much anguished pleading, my mother agreed to take him for a visit to his hospital and research lab. He found himself disoriented, lost, and humiliated, subjected to the well-meaning pity of his former staff.

It was clear to everyone that his days as a physician were over. Only a sole colleague regularly came by to see him for the next seven years of progressive decline that preceded his death.

From my father’s devastating story, I learned several hard but ultimately sustaining truths. These lessons have informed my life and my practice of medicine. I believe they have not only made me a better physician but have allowed me greater freedom to explore and discover the world outside of our profession.

Although I’d like to believe otherwise, the crucial lesson I learned was that being a physician does not provide us with a teflon shield. As physicians, we spend tens of thousands of hours learning our profession, honing our skills, giving up much of our 20s and 30s in service to our calling. Most of the time, we offer this sacrifice willingly, knowing that by doing so we will be worthy of our patients’ and colleagues’ trust. Even after training, the climb never ends. We may lose untold hours of sleep, delay time with family, forgo relationships and other passions. We take on the weight of our patients’ illness, fear, even their anger at the whims of fate.

Surely the scales must somehow balance out for us in the end, a karmic destiny in this life. That is the deal that I believe my father made.

The truth is that physicians are human, no matter how invincible we may feel. My father’s sad journey taught me that. But if we need any further proof, COVID-19 has shown us that nobody is beyond the reach of sickness and death. I believe that it’s important to live life with that understanding.

To that end, I have made it my mission as a cardiologist to focus on preventive care. Paying attention to our own personal preventive health care is a simple matter of routine checkups and necessary procedures, along with a healthy diet and regular exercise. Addressing the sources of stress and dysfunction in our lives is equally important.

The time to act is now. Even with the best preventive practices, there are no guarantees, but these straightforward measures have the power to extend and improve the quality of the life we have. Waiting until retirement to take preventive care seriously may mean waiting too late. Through my father’s suffering, I was able to appreciate the importance of taking the earliest risk factors seriously. My patients valued my drive and care, even when they didn’t share my concern.

My father’s story also taught me that eventually, most of us will leave the fraternity of medical practice, whether we do so willingly or not. We must take the reins and be the driver of our own lives; otherwise we will one day find ourselves separated and bewildered, without a North Star to follow.

This guiding principle has led me to pursue interests and passions outside of the medical world that have enriched and opened up my life; among other things, I teach yoga and compete as an equestrian athlete. I believe the perspective I gained from my father’s experience also made me a better doctor. For this I am eternally grateful.

I retired from my cardiology practice in 2022 after nearly 35 years in the medical profession. I hope that when I need them, my former colleagues will be there to keep me well and care for me. But nothing is promised. And there is no time to waste.

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Stop Being So Hard on Yourself: Five Reasons To Celebrate Physicians

If you’re like many physicians, it may be easy to lose sight of your value. Healthcare today faces unprecedented challenges and stressors, and it’s sometimes hard not to take it personally.

Physicians in particular are some of the worst at self-flagellation. It’s common to feel frustrated and disappointed when you feel as if you haven’t lived up to your own ideals, or those that are imposed on you. Some days it can seem as if being a doctor is a thankless task. Doctor’s Day comes once a year, but your work is never done. So I’d like to share five reasons that you deserve to be appreciated and celebrated every day.

You Want to Do Good in the World

Medical practice is a field that naturally attracts individuals who are both highly intelligent as well as driven by a desire to impact the world positively. But wanting to do good and actually doing the work are two very different things. You do the work. Although your efforts may not always be acknowledged, your actions, big and small, directly affect the health and well-being of your patients and your community.

You Do Hard Things Every Day

Physicians face an array of challenges daily, from navigating complex medical and social issues to making life-saving decisions under pressure. On top of that, societal, economic, and administrative pressures may add levels of frustration that test your empathy and determination. The work of a physician requires an extraordinary level of resilience and fortitude, especially when, despite your best efforts, things don’t always turn out as you’d hoped or expected. It is no exaggeration to say that this level of commitment and grit far exceeds that of most other professions.

You Are Passionate About Your Work

Passion is the lifeblood of innovation and motivation. Physicians often pursue their profession because of a deep-seated passion for healing and discovery. This enthusiasm is often what spurs you to continually learn, grow, and push the boundaries of what is medically possible. Even on days where you feel less than enthusiastic, your years of focus and commitment drive you to do your best work.

You Come from All Walks of Life

Each physician comes to the profession with a unique array of backgrounds and experiences. Whether you come from a rural town or a large urban community, from a US metroplex or a country thousands of miles away, each physician carries a distinctive set of perspectives and skills. This diversity enhances your ability to connect with and care for a wide range of patients with a rich mix of cultures and viewpoints.

You Are a Change-Maker

Physicians are often at the forefront of change, not only in their clinics or hospitals but also in the broader context. Collectively, you have the power to initiate significant health policy reforms, improve patient care standards, and lead community health initiatives. What you do makes a difference in ways, big and small, that ripple out into the world.

As a doctor, you are not just a healthcare provider or a widget in a faceless system. You are a resilient, passionate, and dedicated professional committed to making the world a better place, one patient at a time. Most importantly, the work you do matters.

If you’ve enjoyed this article and would like to stay in the loop for more insights on creating a sustainable, fulfilling, and happy life as a physician, sign up for my newsletter or reach out on my website. I’d love to hear from you.

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Maximize Your Time: Essential Toolkit for Physician Time Management

Being a physician often means that you are expected to be a wizard with time, creating minutes and hours out of thin air. It’s not your imagination. A recent study found that in order for a primary care physician to provide guideline-recommended care and communication, they would have to work nearly 27 hours every single day.

With burnout impacting more than half of US physicians, some healthcare systems and many medical associations are beginning to take note. The problem is multifactorial, but administrative burdens are an important issue for many physicians. System-wide commitments to streamline tasks and automate simple processes are beginning to take hold. But true reform is likely to be several years away.

Meanwhile, when every second of your day seems to belong to someone else, managing your personal time isn’t just an option, it’s a necessity. But despite the ever-growing demands of the profession, the skills of time management are rarely taught in our training years.

As a cardiologist in a busy practice for many years, I developed a keen interest in productivity, educating myself by studying some of the masters in the field. The skills I learned allowed me to practice more efficiently. And equally important, I found meaningful ways to nurture my interests outside of medicine, and to create more time and energy for my friends and family.

As a physician coach, I enjoy sharing these simple techniques and insights with my clients. For some, they can be transformative. By optimizing your personal time, you may find that the more rigid pressures of work feel like less of a burden.

You can pick and choose what works best for you, but the important thing is to commit to making at least one change. When you invest a little time and energy to get started, you may be surprised by how much you get back.

Bullet Journal

A bullet journal is more than just an old-school planner. It's a customizable, hand-written system that combines planning, organizing, goal setting, and reflection.  Here’s why it’s beneficial:

• Customizable Layout: Tailor it to your specific needs, whether it’s daily to-dos, long-term goals, or reflective journaling. Don’t worry about making it look pretty. I use a very simple to-do checklist, and scribble notes as they pop into my head during the day.

• Mindfulness Practice: The act of writing by hand encourages memory retention and mindfulness and will help you to prioritize tasks. I like to take 10 minutes every evening to set up my plans for the next day. Even if I don’t meet all of my goals for the day, simply writing them down creates an intention and makes it more likely that they will be completed in the future.

If you want a deeper dive into bullet journaling, check out The Bullet Journal Method, written by Ryder Carroll. There’s no rush to get through it. Commit to reading just 10 minutes each evening (or morning), and over time you’re likely to create serious momentum.

Colored Pens

Never underestimate the power of colors for organization. When you use your colored pens for your Bullet Journal or to take notes while studying for boards, talks, or other commitments, you will:

• Enhance Organization: Assigning different colors to various tasks or appointments helps create quick visual categorization.

• Boost Memory Retention: Color coding  will help you to remember important ideas, tasks and deadlines.

Audiobooks

In general, multitasking is overrated. That’s because most people tend to do both things halfway. And multitasking can make you more vulnerable to distractions. But listening to a good podcast or audiobook on your commute or while exercising can be a great way to safely and efficiently feed two birds at the same time. That could be CME, a good story, or personal development.

Here’s a brief list of some of my favorite productivity audiobooks:

• Atomic Habits by James Clear focuses on the development of small, incremental habits to achieve significant life changes. The book emphasizes the compound effects of your small daily decisions and the importance of establishing systems rather than focusing solely on goals.

• Stolen Focus by Johann Hari delves into the modern crisis of attention, exploring how various factors in our environment and daily lives erode our ability to concentrate. Hari argues that the decrease in attention spans is not an individual failing, but rather a systemic issue influenced by technology, diet, sleep patterns, and societal structures. Although Hari advises systemic change, simply being aware of these forces can help you to push back.              

• Deep Work: Rules for Focused Success in a Distracted World by Cal Newport advocates for a practice of deep, focused work as opposed to the more common shallow, multitasking approach. The book offers practical advice on how to cultivate a deep work habit, minimize distractions, and maximize your cognitive capabilities. Although the ideas in the book are not always applicable to the reality of a physician’s practice, you will come away with a greater understanding of the importance of focus and the negative impact of constant distractions.

Online Yoga (or other activities)

Physical and mental well-being is integral to managing time effectively. As a registered yoga teacher, I love the option of online yoga classes. That’s because they offer:

• Flexibility: Yoga apps allow you to practice at your convenience, fitting sessions into a busy schedule. Most yoga apps give you a range of types, levels, and duration. I like DownDog, AloMoves, and YogaWorks. All three also offer options besides yoga, including strength training and meditation. And some offer live options as well.

• Stress Relief: Yoga is a great way to unwind and maintain physical and mental health. So are many other forms of physical activity. If you want to start, but exercise isn’t part of your routine, simply commit to 10 minutes twice weekly, and see where that takes you.

One caveat: if you’re new to yoga, Pilates, weight training, or any other chosen activity, consider taking a few classes or working with a private teacher first. That way you’ll have the basics, get your questions answered, and develop a practice that is safer, more effective, and more enjoyable.

 Time Tracking App 

Understanding where your time goes is the first step to better time management. My favorite easy-to-use option is Toggl. Time tracking apps can help you to:

• Identify Time Drains: When you track your time online, you may pinpoint activities that take up unnecessary time. That doesn’t mean you shouldn’t stay up to date on email or social media, but when you know where your time is going, you may find that you naturally begin to make choices that are more aligned with your priorities and values.

• Create Structured Work Intervals: I especially like the Pomodoro Technique. It goes like this: Work for 25 minutes, then take a 5-minute break. This structured and repeatable process can enhance focus and prevent burnout. You can also use time tracking to break larger projects (as well as tasks like charting) into smaller intervals. That way you’ll maintain your focus and create a more manageable and efficient process.

What time management tricks and tools have you found that keep you organized and on task? Drop me a line. I’d love to hear from you!

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If you’ve enjoyed this article and would like to stay in the loop for more insights on creating a sustainable, fulfilling, and happy life as a physician, sign up for my newsletter or reach out on my website. I’d love to hear from you.

And if you’d like to schedule a complimentary introductory meeting with me, click the link below.