I write a good deal about getting out of medicine, but I am not escaping medicine due to an inability of clinical performance.
I didn’t have the highest scores in the didactic years of medical school, but I started killing it in residency. Residency was easier than my job as a fish and reptile specialist at Petco.
I am rewriting this post with a few new thoughts from February 2016 when I first wrote it.
Residency Years Were Straightforward
In residency, there were a finite number of diagnoses and a finite number of tools at my disposal. I would spend 90% of my time connecting those two. I reserved the other 10% for the zebras which probably took up 80% of my time and 90% of the hospital’s resources.
I don’t think that becoming a better doctor starts in residency. The structure of medical education is such that you often have just to make it through.
Setting yourself apart may not happen until you are an attending with more autonomy and headspace to define your practice and your clinical style.
Mastering Medicine is a Myth
I haven’t mastered medicine, but I have arrived at my personal best in the field that I’ve chosen. I accomplished most of it in an unconventional sense without fully understanding my own methodology.
You, on the other hand, may have no desire to be better at what you do. You may just want to do the least possible to make the highest income; call this minimalism or laziness or efficiency.
Even if you are in the latter category, to do that effectively, you have to understand the game and know which aspects of medical practice to put more effort into. This applies to medicine and probably any other kind of niche profession.
My recipe for becoming a better doctor, granted, by my own standards, is outlined below. I grew up in an urgent care setting and urgentcarecareer.com was the name of this website before I changed it to Digital Nomad Physicians.
It’s a shame to state that to become a better doctor it’s not the science or art of medicine you must master but the administrative and interpersonal relationship with coworkers. And a lot of customer service.
1. Focus on the Highest Yield Items
Focus most of your energy on what’s common because the common things are common. Learn the classic presentations of the major illnesses.
Kidney stones, URIs, allergic rhinitis, ganglion cysts, and diverticulitis are classic signs and symptoms.
If you can almost rule-in the diagnosis, you are done with 90% of the work. If you work in an urgent care like I do (did) you also need to rule out anything that may be imminently life-threatening.
2. Rule out the Risky Things While You’re at it
A patient with a URI could have PNA, a patient with kidney stones could have obstructive uropathy with hydronephrosis, and a patient with diverticulitis could have an abscess.
So, with each of your diagnoses, you also rule out the immediately severe things that could be associated with it — and you move on. If you cannot rule them out, you have to decide whether that patient can go home that day and be observed or if further testing is needed.
Maybe the paragraph above seems obvious, but for every fast & efficient urgent care doctor, there are 10 slow & frustrated ones.
Follow the above algorithm to make your decision tree more streamlined and less time-consuming.
3. Focus Your Learning on the Common Things
To accomplish the above, you need to constantly look up common diagnoses to burn common illnesses’ common signs and symptoms into your memory.
Oh, and you need to spend the first few years of your career seeing a shitload of patients… a nonstop, back-to-back onslaught of patients.
Clinical knowledge is a sizable chunk of medicine, but another 70% of urgent care medicine is the psycho-social interaction with the patient and staff.
4. Mastering the Customer Service Aspect of Care
Nearly 6 years ago, when I wrote this article, I didn’t think I’d be running my virtual telemedicine practice. Customer service – or mastering the patient journey – is front and center for me.
Let’s talk about the patient first. You are not dealing with a machine with a defined illness or a specific course of management.
That person is not necessarily in the urgent care looking for a diagnosis or a treatment. Many human beings can self-diagnose their medical problem or at least sense that it’s not necessary to seek medical attention.
Most individuals who come to the urgent care do not need urgent care; they are there for reassurance, whether in the form of sympathy, empathy, medications, a diagnosis, tests, or self-harm by proxy.
You are simply a tool to get them to that destination. You must master the art of reading people, being a salesman, and appearing empathetic – this is your golden ticket out of the exam room, rewarded with high patient satisfaction scores.
5. Distinguishing Customer Service from Patient Care
I want to take a minute to justify what I said above. I may come across as a jaded ass, but I am not talking about the genuinely ill individuals that can benefit from medical care.
In the US, a patient is anything but that. It’s the 21st century, and people are coming into doctor’s offices for coughs/colds, opioids and benzos, work notes, and STD checks.
I am not placing any blame on the person that is the ‘patient,’ but I am pointing out the condition known as being a ‘patient.’ I hope I’ve confused you… good, let’s move on.
6. Interpersonal Skills are More Important than Patient Care Skills
Next, it’s the staff… oh, the glorious staff. We can generally lump colleagues and staff together here. The staff comprises MAs, LVNs, RNs, x-ray techs, and cast techs.
Colleagues are PAs, NPs, MDs, and DOs that you work with. Nothing is wrong if you are a bit cold, conceded, narcissistic, selfish, whiny, detail-oriented, picky, or judgmental. You don’t need to change who you are to be successful at what you do.
Instead, you must come across as consistent, fair, and determined and keep your true personality at home. I could have picked 3 other adjectives that would have gotten the point across – consistent/fair/determined really hits home, though.
7. Master the Art of Consistency and Reliability
Your staff/colleagues may sense that you are having a bad day or dealing with personal things, but they can never be sure of it if you are consistent in what you do and how you do it.
You consistently order the same tests for the appropriate presentations. You treat the drug seekers consistently the same without treating them like … drug seekers.
You come to work at predictable times and do your work in a confident and determined fashion. Being a great doctor has more to do with these characteristics than the occasional zebra you might diagnose.
You’re not wishy-washy, and you don’t hold up the urgent care flow because you don’t know what to do next. And of course, you don’t take your personal stuff out on your staff.
To master your relationship with staff/colleagues, you need to understand the human psyche and how they expect to be treated at work. Then, at the end of the day, you can go home to your pets or family and take out all your insecurities on them… manipulate them… belittle them… ignore them or project your inadequacies on them.
The Motivation to Becoming a Better Doctor
So why master your field? Because you will not feel like you are missing out on something.
Why be in the 90th percentile of competency? Because it will get you first pick of whatever you want out of your job.
Why be the easiest doc to work with? Because that’s how the new managers and bosses will remember you the first time they hear your name.
Why feel like there isn’t much else you can do to improve yourself as a doctor? Because then you won’t feel guilty if you decide to pursue something else in life.
The skills you’ll learn in aspects of customer service, interpersonal skills, and emotional control will be assets you can take into any other future endeavor.