Sunday, February 3, 2013

Requirements for Being a Family Doctor

1.   Personality.   You should be able to carry on conversations with complete strangers.
2.   A love of stories.  Before I applied to medical school, one of my favorite books was The Lives of Ordinary Americans.  After I became a family doctor, it was as though I lived in the center of that book, surrounded by its subjects, whose stories had become legion.

3.   A high tolerance for uncertainty.  Family doctors never get to stare at coronary plaque or a bona fide brain tumor.  They work in the dark.  They never know anything, for sure--not in a scientific way.

4.   Gentleness.  Patients are like children:  when they want to know the hard facts, they'll ask.  There's no need to slam them with the truth before that.  Besides, who knows the truth?  Sometimes doctors, made uncomfortable by a patient's inconsolable suffering, think they have to say:  You're going to die--and soon.  Is anyone made better by this?

5.   Honesty.  When patients want to know, you have to tell them, even if it's hard.  A single lie can never be made right, not with a thousand bits of honesty, any more than a fractured porcelain pitcher can be mended back to the original, no matter the glue.

6.   Faith.  It helps to have a connection with the divine, and the easiest way is through prayer.

7.   Open-mindedness.  Every new idea is interesting.  Every patient's suggestion deserves consideration.  Sometimes the cures patients proffer have symbolic significance, and aren't ploys for drawing you into a pyramid scheme.  Sometimes you'll be the recipient of folk remedies that turn out to be really good, and you'll pass them on to other patients.

8.   Adherence to science.  This is the best tool we have for sorting out what works.  Everything else is heresay, and belongs to the Middle Ages.

9.   An interest in what people knew in the Middle Ages, as well as in every other era, and how that knowledge might inform your practice.

10. Respect for specialists, who, after all, know more about their fields than you do.

11. A capacity to identify personality disorders, like borderline, sociopathy, antisocial, obsessive-compulsive, dependent, and narcissistic, and then to forget the categories, and see the individuals.

12. A repugnance for pigeonholing--as in: smoker, alcoholic, drug addict, COPDer, manipulator...or cancer, Alzheimer's, Asperger's, or bipolar--alongside a rational acceptance of similarities, and an understanding of group process.  People are helped most, sometimes, by other people who are a lot like them.  But they don't want to be defined by those similarities.

13. Industriousness.  A willingness to work long hours for patients, after hours, by researching their problems and looking for cures.

14. Inventiveness.  When nothing else works, and specialists have been exhausted, patients end up on the doorstep of the family doctor.  They have the same symptoms they started out with.  That's when family doctors get to experiment, calling on reserves of personal experience, anecdotal knowledge, and quirky remedies.  Sometimes the remedies work--but it may be because patients see how much you want to help, which triggers untapped powers of self-healing.

15. Ability.  The more techniques you know, especially manual, surgical, diagnostic, and hands-on treatments, the more you can do in your office.  Patients appreciate not being sent here, there and yonder.  Do everything you can under your own roof, acquiring new skills at conferences or from colleagues.

16. Good hands.  Good eyes.  The more you look and touch, the better you become at reaching inside the patient and figuring out what's wrong.  Learn what Degowin and Degowin knew about diagnostic examination, because their generation of doctors cured as many patients as ours.

17. A high tolerance for administrative stupidity.  Busywork--such as filling out prescription override forms, justifying wheelchairs for the fifth time, translating English into ICD-9, CPT and HCPCS codes, and writing office notes in fifth-grade language so insurance reps won't deny payment on the basis of incomprehensibility--will probably never end.

18. Amazement that the human heart beats, without instigation, and that cells manufacture the stuff of life, without being told.

19.  An arrangement with death which, after all, wins.

20.  An arrangement with life, which, after all, wins.


  1. items #19 and #20 sound like a follow-up to the clock
    post........hmmmmmm I think I am confused.....

    Maybe the super bowl game will help????

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