Mastering Medicine – Being A Successful Doctor
I write a good deal about getting out of medicine but I am not escaping medicine due to an inability to do well in it. 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. In residency there was a finite number of diagnoses, a finite number of tools at my disposal and 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 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. 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. A lot of this applies not just to medicine but probably any other kind of niche profession.
Let’s start. Focus most of your energy on what’s common. Here is a stupid statement that is shockingly true, the things that are common are common. Learn the classic presentations of the major illnesses. Kidney stones, URI’s, allergic rhinitis, ganglion cysts and diverticulitis have classic signs and symptoms associated with them. If you can almost certainly rule the diagnosis in then you are done with 90% of the work. Because you work in an urgent care you also need to rule out anything that may be imminently life threatening to a patient. A patient with a URI could have PNA, a patient with kidney stones could have obstructive uropathy with hydronephrosis, a patient with diverticulitis could have an abscess. So, with each of your diagnosis you make you also rule out the immediately serious things that could be associated with it — and you move on. If you cannot rule them out then 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. To accomplish the above you need to constantly look up common diagnoses in order to burn the common signs and symptoms of common illnesses into your memory. Oh, and you need 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. Let’s talk about the patient first. You are not dealing with a logical individual who has a defined illness with a specific course of management. And that person is not in the UC looking for a diagnosis or a treatment. A large number of human beings can self diagnose their medical problem or at least sense that it’s not necessary to seek out medical attention. The majority of individuals that come to the urgent care (let’s call them patients) are there for attention whether in the form of pity, medications, 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 followed by high patient satisfaction.
I want to take a minute to justify what I said above. I may come across as a dick but I am not talking about the truly ill individuals that can benefit from medical care. In the US a patient is anything but that. It’s the 21st fucking century and people are coming into doctor’s offices for coughs/colds, opioid’s and benzo’s, 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 that is known as being a ‘patient’. Hope I’ve confused you… good, let’s move on.
Next it’s staff… oh, glorious staff. We can generally lump colleagues and staff together here. Staff is made up of MA’s, LVN’s, RN’s, xray techs and cast techs. Colleagues are PA’s, NP’s, MD’s and DO’s that you work with. There is nothing wrong if you are a prick, a bitch, a dick, 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 need to 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.
Your staff/colleagues may sense that you are having a shitty day or dealing with personal shit 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 shit. You come to work at predictable times and do your work in a confident and determined fashion. 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 shit out on your staff. In order to master your relationship with staff/colleagues you need 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.
So, we covered knowledge, the patient mentality and your relationship with colleagues. If you can do well in these then you will find yourself in the 90th percentile of successful clinicians. Your day will go by easier, you’ll hit less road blocks and you will likely make more money because you will get better shifts and become a better candidate for promotions.
To accomplish the skills above you need to read books and take seminars/courses on how to read people. How to deal with certain personality types. How to diffuse stressful situations. How to get people to listen to you and how to sell an idea or product to another person. You need to understand the dynamics and politics at work and learn how to be engaging but not involved. You don’t need to know the name of the bone that articulates with the scaphoid but you need to know the shit out of every common wrist injury, the mechanism of injury that causes it and learn how rule-in a diagnosis and how to rule one out.
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.