New Wisdom

I have recently learned a valuable lesson that I would like to pass on to you all. Next year I'll be going to my 20-year medical class reunion. That puts me kind of in the middle of practicing physicians. I'd like to share something that many of you may already know, but it is something that I wish I had put into practice several years ago.

When we first start practicing, we have to get comfortable with what we know and what we don't know. It seems the first 10 years out of residency we are constantly being shown what we do not know. And then we make attempts to learn more, or to diagnose more, or to care more. To try to fill up the 'hole' of what we don't know. After 10-20 years of this we end up knowing quite a bit. And I find myself not having to 'look things up' near as often.

Now let's put this knowledge next to our practices. Even in general practices (internal medicine, family medicine, pediatrics) after 15 years we find ourselves gravitating towards certain types of patients and not taking care of other types of patients. For example, as a pediatrician, I love taking care of newborns and infants. I've also found that I really enjoy a lot of the child and adolescent psychiatry that is necessary when the nearest pediatrician is 30 miles away and the nearest child psychiatrist is 100 miles away. But there are several types of patients that I find myself not enjoying taking care of. I'm sure you all know what I mean.

When I have medical things I'm not sure what to do with, I do what many of you do: Refer to a specialist! A good friend of mine is a dermatologist. I was seeing a kid last month who had a weird rash (that's the medical term). I saw him back for a different problem and asked what the dermatologist said about the rash. The mom informed me: "He didn't know what it was."

Brilliant!

I often don't know what something is. But then I do a combination of looking stuff up, ordering tests, radiology, or procedures, conferring with other doctors, or setting up referrals. So I easily admit to myself when I don't have an answer. But last week I translated this into a (hopefully) life-changing epiphany.

I saw an older teenager that had multiple vague chronic pains and problems. I found myself reading her chart before I went in and then not wanting to go in at all. While I was in the room she told me about the other doctors or specialists she had been to but 'nothing was helping.' And then it hit me! I told her something like this:

"I don't know what is causing all these problems. We've tried several things and you've been to specialists and they haven't been able to help you either. I don't know what to do and I don't think I can help you anymore at this point. It may be time to get you to follow up with a different doctor to see if there is anything else that can be done. I will still continue to see you for routine illnesses or injuries, but I don't want to waste your time or money so I'm not going to see you for this problem anymore."

I started doing this with my "problem patients". I define a problem patient as a patient that has a problem that I do not want to deal with. And I'm moving them on down the road. And I've realized that I only have a handful of these types of patients. Now most of the patients I see I enjoy seeing. And if I don't, I help them find a doctor that can help them more. It's not the 'good old days' of medicine where we have to do every kind of medicine for every kind of patient. Once I've given myself permission to "move patients down the road" for this reason, I find that an invisible load was lifted off my shoulders. It's awesome.

I know many of you have already realized this and put it into practice. But if you haven't, I encourage you to try it soon!