Esquire Magazine features a regular column called “What I’ve Learned.” There, a celebrity or a leader in his field, and often in the twilight of his life, reels off a collection of pearls, some well polished, some of little value. I am not famous and my doctor assures me actuarially I am not in the twilight in my life. But, this is what I’ve learned, so far.

Timing: Resist the urge to schedule 10 surgical cases of some procedure you just learned at a meeting. The most dangerous time for a patient is the Monday after you return from a national meeting. What you learned was how it was done. You probably don’t yet understand why it was done or what happens long term.

Mark Twain reportedly said, “When I was a boy of fourteen, my father was so ignorant I could hardly stand to have the old man around. But when I got to be twenty-one, I was astonished at how much the old man had learned in seven years.” My father often directed the same quote toward me – when I was 18. You will feel smartest just as you graduate your residency or fellowship program. Experience and time will humble you. But, you will be wiser.

Caution: You spend your entire residency and fellowship learning how to operate. You will spend the rest of your career learning how or when NOT to operate. The same can be said for managing patients in general. What’s different between residency/fellowship and your practice in later years? Follow-up.
Your patient’s default assumption is no news is good news. If you order a cervical MR looking for a herniated disc, and the patient never hears from you, he will assume all is well. You might get away with it. But, depending on luck is a bad long term policy. Tell the patient that you plan to get back with him (or schedule the follow-up that day). Tell the patient if he does not hear from you, the system broke down. No system is perfect. Make the patient your partner in healthcare. Tell him the default assumption is that no news means no news.

Doctors must police our own. Most are talented professionals who care deeply about their patients. Here’s a litmus test. If you had to take your very ill child to an ER in extremis, and this was the only specialist in a 60 mile radius who was available now, would you let him get to work? Or would you risk the 60 mile journey? There are talented professionals who are suffering from untreated mental illness, substance abuse, alcoholism, and more. If we stand by and do nothing, eventually someone will be hurt and the story will land on page one. The public trusts us. That trust is earned and it is fragile. Helping a colleague get help is a no-brainer. That said, resist the urge to bad-mouth a colleague merely because he is an economic competitor. If you are both talented, you will both do well.

The World Out There: In residency, you are generally sheltered from the legal system. That is not because you are immune. You are not. Residents and fellows can be and are sued. Once out, you will likely be sued. Some plaintiff’s attorneys are seasoned veterans who pick and choose their cases carefully. Others are dilettantes who do not even know what they do not know. To such practitioners, malpractice is merely a series of transactions with insurance companies, and you are the means to an end. Their summons will claim you recklessly, negligently, and with wanton disregard for safety did x, y, and z. You will not recognize this butcher in print. You might not even remember the patient, now a plaintiff. But you will never forget this day. There is much you can do to prevent being a deer in headlights. Prepare for the day.

The Internet: It was a Department of Defense tool when I was a resident. Much has changed. There are now over 30 consumer doctor rating sites. This number will grow. These sites aggregate comments from patients posting anonymously; and those posing as patients, including disgruntled employees, ex-spouses, and even competitors. If you believe that people are more inclined to spend time heaping praise rather than scorn, you are wrong. There is much you can do to prevent being a deer in headlights. Learn what you can do.

Your First Job: Your first job offer will often be memorialized by terms in a contract. Some terms are more important than others. Learn to give to get. What’s important? Try and figure out what happens if things do not work out. Tail for professional liability coverage? Can you still practice in the same community? Will you owe the practice any money? No one likes to plan for a breakup. These details will likely be more important than your first year’s salary.

Respect Other Professionals: I worked in a small Midwest community. Many of the night-shift nurses on the neurosurgical unit were twenty to thirty year veterans. They knew what they were doing. I knew them all and trusted them. Show these professionals the respect they deserve. They will never call you at 3AM for a laxative order. If they do, you have lost your way by disregarding the rule.
Love What You Do:

There will be days you wished you chose another career. In the late 90’s, if you were not starting a business, you made a bad move. In 2007, if you were not an investment banker, you missed the boat. It’s almost 2009, and things change. Saving a person’s life or limb will always be in demand. On any given day, you profoundly impact many patients and their families. For you it’s another day at work and it often seems routine. For the patient and his family, these decisions resonate for years. When my son was five, he had several major operations. Two of these procedures took eight hours. Every second seemed like an eternity. My son did well. But, I learned something. Reassurance is one of the most powerful tools in the doctor’s armamentarium. In the OR, nurses would often ask me if I had any news for the family. I never understood why that made a difference. If everything was going well, then I would be out to tell them soon enough. If I was knee deep in blood, what would they do, come in and help me? When my son had surgery, many messages were sent to me in the waiting room. I learned each message meant the doctor and the team was always aware of the patient and his family. When you understand that, you’ll understand why being a doctor is so important.

A prediction: Healthcare will be a great profession over the next ten years. Read that sentence one more time. We are about to experience significant change. Change can be frightening. But, Americans place a premium on care. We spend $2.3 trillion a year and I doubt we will spend a penny less. We will do things differently. But, who among us does not believe care can be delivered more efficiently. Yes, the average patient may be steamed about a $10 co-pay. But, most patients want their doctor to be well trained, available, and well-compensated. If we take our place at the table as reforms are proposed, policy makers will listen. Woody Allen said 90% of life is just showing up. Pull up a chair.