Thou shalt follow these 10 tips to live well

Observations on the state of medical practice and medical life

By Eric Anderson, MDis a semiretired family physician in San Diego. His commentaries from 2000-05 are available on amednews.com. Posted Oct. 11, 2004.

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At his trial in 399 B.C. before the citizens of Athens, Socrates famously questioned whether the unexamined life was worth living.

That might give physicians pause. Busy doctors seldom have time to step back -- and look back. We are too busy as individuals to see the big picture as we work away on our own little paint-by-number canvas.

More recently, in his classic work of the 1950s, Childhood and Society, neo-Freudian Eric Erikson introduced his concept of the eight ages of man. His last and final age was of integrity and despair -- if we were confident we had lived life well, we could die fearless.

So if we can take a moment for that necessary backward glance to answer that question, have we lived well? Do any principles emerge? As we talk to older, apparently successful, physicians, do they have any advice for younger doctors? What worked for them? What has given satisfaction?

Are there, as it were, Ten Commandments for doctors when their careers start -- at the very time when they might become engulfed with responsibilities?

There is surprising agreement of practical and metaphysical points among those doctors who have been there, done that. If we were to list their "Thou Shalt" comments they might include:

1. Create systems in our work including rising early and staying on schedule. That's the only way we'll be able to get home to family in a timely fashion at the end of the day. As we hear repeatedly, no one says on his or her deathbed, "I wish I'd spent more time at the office."

2. Develop an interest in some, but not all, diseases. Sure, primary care doctors need a broader acquaintance of the ills of man (and woman) rather than a deeper knowledge of disease, but our professional lives are more satisfying for us in all specialties if we expand our curiosities into certain areas. It is stimulating, say our mentors, and keeps us intellectually sharp.

3. Form a solid understanding of a few, relatively fundamental drugs and know them really, really well. This was easier for older doctors.

I remember studies in the past that pointed out that one dozen basic drugs figured in a high percentage of all prescriptions written. Now there are so many drugs available no one physician can know them all. But it's never been easier to find out what new drugs to use when our needs extend beyond our favorites. We have, today, unprecedented access to pharmaceutical information, whether by handheld computers or pocket-sized manuals. We just need to know where to look and to have a system that lets us do so.

I had a country doctor friend in the 1950s who told me he always asked, on house calls after his examination, if he could wash his hands before he explained what was going on. And what was going on was that, after a quick hand wash (but with the water still running), he rapidly scanned his Merck Manual so he could emerge as the complete physician.

4. Start our careers with consultants of our own age and grow with them in relationships that will last a lifetime. Learn to be able to say, "I don't know" to some patients' questions. Patients respect honesty even as they need reassurance.

5. Learn also to recognize our limits in helping persons with problems.

I am constantly surprised at medical meetings that might, for example, discuss substance abuse among patients, to hear how colleagues have gotten into trouble by prescribing controlled substances to obvious addicts. They accept stories that rival "the dog ate my homework," and write the prescription, then suffer agonies when the realities emerge. We need to establish parameters to our practice the way psychiatrists do to stop abuse of their time by patients. We need sometimes to say "No."

6. On the other hand, look for something nice in every patient, even in those who are impossible. I once had a patient whom I couldn't handle at all and didn't enjoy. I said to his wife I was going to give up on him and suggest he get another doctor. She whispered to me, "Please stay with him, doctor. He's impossible; I know that. Even his own mother doesn't like him." After that I could cope -- I knew it wasn't me!

We should also keep notes apart from our medical charts; one day we may want to write our memoirs.

7. Realize nurses and staff make our day. We need to be nicer to them.

A smile and a thank you cost nothing. Adequate pay, on the other hand, does cost, but it's a necessary expense, and we are foolish and unfair not to address it. The persons we work with have a pretty good idea of what we earn and, though it's a lot less than the public thinks, it still creates a huge gap between what we make and what our staff does.

I was once, for fun, shooting some photographs of San Diego harbor as the sun set. Standing beside my tripod was a man with, obviously, similar interests. He saw the luggage tag on my tripod, realized I was a physician and suddenly said, "Why are doctors so cheap with their staff?" He explained he was a financial consultant and often saw in practices he was asked to rescue that staff tended to be stiffed by cheap medical employers. I didn't have a riposte because I actually had the same thought.

8. Get a hobby, something in which we have to submerge ourselves completely. If the hobby is demanding so we break off all contact with our professional life, it may be more restful than a less busy hobby. For some, scuba diving or flying may be more calming than taking photographs or collecting stamps.

9. Live in the present and don't dream about retirement; it may not happen, especially for physicians.

I read somewhere our longevity is not exactly above normal. I had a cousin who worked in Toronto for a public utility. He told me one of his co-workers came into work every day, even when ill, because sick leave could be saved toward early retirement. The worker managed to retire with a full pension at age 61 but died a week later. I recall, too, some statistics that a high number of retired workers died within a year or so of retirement -- as if of boredom.

So take vacations as they become available. If we enjoy traveling, we should make time to read some of the great contemporary travel writers. Some favorites might include P.J. O'Rourke for tongue-in-cheek stuff, Tim Cahill for adventure, Bill Bryson for wit. There are superb travel books out there from William Least Heat-Moon's beguiling Blue Highways to Bruce Chatwin's acerbic In Patagonia.

10. Have someone to love. That's what life boils down to. Or so I'd think. But what do we older doctors know about that?

Socrates talked about more things than the unexamined life. He also said, "I know nothing except the fact of my ignorance."

Eric Anderson, MD is a semiretired family physician in San Diego. His commentaries from 2000-05 are available on amednews.com.

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