My advice to a new generation of doctors

My advice to a new generation of doctors

“There’s no passion to be found playing small, in settling for a life that is less than the one you are capable of living.”
-Nelson Mandela

Amidst the chaos of our noisy world, it’s hard to know where to begin a new career as a healthcare professional who’s about to inherit an American disaster called healthcare. And it’s likely that in a few years, you may find yourself lost inside a daily bombardment of unsettling, paradoxical messages, and then begin to wonder, “What just happened? What did I do wrong?”

Many physicians today are asking themselves this very question.

I recently had a job interview with a newly graduated physician assistant. As we talked, her eyes widened. She shared with me her recent experience on a pediatric rotation.

“All those doctors did was ask these poor kids how they were doing with their prescriptions for ADHD (attention deficit disorder). And then they just wrote another prescription! Some of them were only in grade four! I wanted to say something, but…”

Her voice faded.

Our society is filled with incongruent messages. Nowhere is this irony more evident than inside healthcare. We’ve been taught to believe that a physician should be at the center of a healthcare delivery model. We’ve been taught to prescribe, fix and cure. We’ve been taught to think that by working backwards from disease, we will be able to prescribe health.

Our word is God. And we teach you, our fledgling off-spring, to believe it.

Inside the stress of studying diseases, cures, fixes and treatments, the lines of health practice have become obscured. You’ve been taught to deliver paradoxes for health in the form of prescriptions for disease. You’ve been taught to diligently search for disease as soon as a patient enters your office. And you’ve been taught to declare, upon receipt of all those negative tests, that your patient is healthy!

Fast forward to today.

Inside America’s now crumbling model of inefficiencies, disease epidemics and sky-rocketing cost structures, you will exist. Your role models, we doctors, are burning out at 80-90% job dissatisfaction rates. Many would never in a million years recommend this profession to their kids.

You’ve seen their faces on rotations, in offices, their monotonous voices repeating these words again and again, “What can I do for you today, Mrs. Smith? Why don’t you try this pill for your depression?”

But the real question is, “What just happened? What did I do wrong?”

It’s tough to emerge intact from healthcare training today. But despite a crumbling institution, there’s a ray of light gleaming from under a door that’s just waiting for you to unlock! The key, however, isn’t easy to find.

Our society is intolerant of individualism. Ironically, America has been founded upon this very ideology. But inside a profession that stands on paternalism – - father knows best – - we don’t easily tolerate dissent from our trainees, let alone our patients. These messages sink deep into the very curriculum that you’ve just studied.

There is a fix and cure for everything. We declare that we will find it if we spend trillions and trillions of dollars, keep our mouths shut, and keep forging ahead without stopping to see the big picture.

We don’t question our preceptor’s choice of pills over simple words of encouragement and support. We don’t question their referrals to surgery instead of chiropractic manipulation; their dosage of narcotics instead of acupuncture and massage. We don’t understand how to practice health as democratic providers who can work together as complete equals from both alternative and conventional fields, without resorting to turf wars.

We only know science and medicine. And we’re taught to hold our tongues when we want to question our forefather’s practices: “But doctor, isn’t there a better way to do things?”

What happens if you don’t agree with that prescription you’re about to write anymore? What happens if you have a very different idea of who should be helping your patient, and that someone isn’t your orthopedic physician preceptor but a licensed acupuncturist instead?

That’s an uncomfortable thought.

Our future in healthcare is still unknown. Maybe, you should be questioning these messages. Maybe you should disagree with what you’ve just learned. Maybe you should be searching for that hidden key.

The question isn’t so much “What do you want to do in your career?” but more, “Who exactly are you? How much courage do you have to stand against a several trillion dollar industry that keeps searching for pills, fixes and mechanical cures using outdated Newtonian physics instead of accepting a different approach to disease and health, one that’s infinitely more cost-effective?”

I used to believe that my preceptors knew everything. I wanted to be just like them and so I never questioned what they told me to believe. Much of it was delivered with sarcasm if I didn’t know the answer, or I thought about things very differently than they did. As I look back at my journey, I only now realize that the answer to the question was inside me all along. I wasn’t strong enough to unlock the door.

Physician assistants and nurse practitioners will inherit the primary care market in America in the next few years. Over 90 percent of the total medical care in our country is delivered here. At 3 to 1 specialists to primary care, America has not invested in a sustainable base to allow a smooth transition to occur. At the same time, modern disease is now in epidemic proportion, waiting for end-stage disease care rather than an entirely new paradigm from which we should operate. The curriculum that you’ve been taught is already archaic because the healthcare delivery model it has been based upon is grossly outdated. You, dear graduate, are being asked the toughest question of your life.

Who exactly are you? And what do you stand for?

Me? I believe in forging my own destiny at all cost. I believe in questioning dogma, standing strong in my beliefs and for my patients, not my institution … although it’s not very popular amongst physicians to do so. You get a lot of flack. You get rejected.

But your future is yet unwritten. To be ahead of the pack, learn from those who have minds as expansive as the sky, and not from those who hide their right to independent thought behind the myopic lens of history, operating as automatons of a dying breed.

Can you choose to write your own story, dear graduate, at all cost? Can you find the key? If you do, one day you just might shout from the rooftops, “This is what I did right! This is who I am!”

Natasha Deonarain is the founder of The Health Conscious Movement. She is the author of the upcoming book, The 7 Principles of Health and can be reached on Twitter @HealthMovement.

Image credit: Shutterstock.com

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  • http://www.facebook.com/profile.php?id=881580563 Kristy Sokoloski

    What a very powerfully moving and thought provoking piece. I am now in Nursing School going through my General Education requirements, but I also know that there will be a lot that I will see during my clinical rotations that I would not otherwise see. This piece I will keep referring back to as I go through the rest of my program. Thank very much for writing it.

    • http://www.7POH.com/ Natasha Deonarain, MD, MBA

      Thank you Kristy…please, be one of the pack of courageous individuals who can see truth and not deception. Hang out with those of us who get it, and want to DO something about it!! :)

  • Coconutskinss

    Thanks for this. I’m a med student applying for residency and I think your message is a powerful ands good one. We’re just waiting for the old timers to move over so we can do things in a better way — not sure when we’ll be able to stage our coup.

    • ninguem

      What do you want to do differently? Wouldn’t mind hearing it.

    • http://www.facebook.com/dave.james.90410 Dave James

      As an old timer moving over, I wish you well. Once upon a time, as a medical student, I too thought I knew how to do everything better. And with time and technology that became mostly true. Now I find myself saying (as they said about me in my early years)’ “These young docs just aren’t the same as us.” And fortunately, we both are partially correct and times change.
      Truth is that we follow the same paths a generation apart. Medicine changes but remains a marvelous calling and feels like the ultimate brotherhood to us old guys. I wish the same feeling for you future doctors. So my soon to be brother, I move over (with a touch of nostalgia and envy) and hope your career is as satisfying and fun as mine as you embark on someday becoming an “old timer”.

    • http://www.7POH.com/ Natasha Deonarain, MD, MBA

      The answer, little coconut, lies in these simple words…come together and collapse a system that’s keeping us sick, from the inside out. How? By first changing yourself and what you have been taught to believe is true, and then showing others the way out of hell…http://www.youtube.com/watch?feature=player_embedded&v=LgMQIi5Pafo

  • http://www.facebook.com/people/Steven-Reznick/100000549195050 Steven Reznick

    I think the message is to go into medicine because you want to help people ,prevent disease, and help people live with the highest quality of life possible. Whatever system evolves put the patient first and be their advocate. Use the data being collected to bring the best evidence to your treatment plan but have the flexibility to tailor it to the individual characteristics and needs of your patient. Do not become a slave or beholden to an employer who is not a physician and tries do dictate the method of diagnosis and care. Most of all approach each patient and treat them the way you would want to be treated or you would want your loved ones to be treated. That is the message to the next generation of doctors and nurses and caregivers.

    • Suzi Q 38

      “Most of all approach each patient and treat them the way you would want to be treated or you would want your loved ones to be treated.”

      I had to remind one of my doctors that if I were a relative or friend of his, I would have been given better treatment a lot sooner than I did.

      • medicalstudent

        What field is immune from this? My dad’s a software engineer and if I ever had some issue with my laptop, he will drop any other work he’s doing, no matter how important, to help me fix my computer first. I also get better deals on getting my car fixed because a good friend of mine is a mechanic. Another friend of mine is an accountant who always offers us (our circle of friends) to look over our tax forms for free if we ever wanted to. This isn’t something unique to medicine — this is seen in everything, everywhere. So, I’m not really sure what you’re trying to say here.

  • http://www.facebook.com/todd.solomon1 Todd Solomon

    My advice: DON’T DO IT

  • Rob Burnside

    My undergraduate degree is in Art, not pre-med, but I learned a few valuable lessons from a treasured professor of pottery that I’ve always tried to apply throughout my healthcare career: 1) You have to be “bad” before you’re “good.” 2) Learn the rules and use them until you have the confidence, and competence, to break them. 3) When in doubt, go back to the basics and try again. 4) Trust yourself 5) Observe, Listen, Do

  • http://www.7POH.com/ Natasha Deonarain, MD, MBA

    I’m sorry you are stuck. When you are ready, you will know what to do next ;)

    • medicalstudent

      Stuck? What does that even mean?

      You see, unlike you Dr. Deonarain, I don’t have an agenda. I’m not pushing anything — pills or unproven alternative therapies. What I am learning, however, is how to use my clinical judgment in deciding appropriate treatment plans for my future patients. Whether that means I’ll prescribe a pill, refer a patient for a procedure/surgery, or refer them out for yoga, it’ll be based on sound judgment of that particular situation.

      I have no books I’m pushing on to the public. I don’t have to convince anyone of anything in order to sell more books. You clearly have a conflict of interest here. You’re attempting to mislead others into discarding Western medicine and pursuing unproven therapies while advertising a book you wrote about these alternative therapies. Can you really not see the conflict of interest here? This is pretty similar to what big pharma does. You’ve proven yourself a hypocrite.

      I’m sorry that you sold out your profession and your patients. When you are ready, you will know what to do next ;)

  • http://www.7POH.com/ Natasha Deonarain, MD, MBA

    Thank you all for taking the time to read this article. I think we all learn a great deal from each other about who we are, and what we are here to do. This is what I’ve done; had the priviledge to teach and learn from this young physician assistant.
    http://www.kevinmd.com/blog/2012/12/inherited-health-system-broken-repair.html

    And this is who I am….http://www.youtube.com/watch?feature=player_embedded&v=LgMQIi5Pafo .
    May you find the courage to find your OWN truths, and your OWN answers in the face of what America will be witnessing next in the upcoming years; not just inside the trauma of healthcare, but also inside its collective soul…

  • http://www.7POH.com/ Natasha Deonarain, MD, MBA
  • LBENT

    As a clinician (surgeon for kids), researcher, and patient and doctor advocate for more than 30 years, I find this article and the u-tube video to be very disturbing. The message here is one that is meant to frighten. It is based on partial truths and a lot of unnecessary hype. That is unfortunate.

    The “healthcare delivery system” has morphed into something much larger than intended. Doctors were meant to heal the sick. Now, we are held responsible for keeping people well. That is a huge, and impossible, shift.

    We have to face up to the facts that there is shared responsibility for the “health” of our society. Doctors do what we can. And then there are things we just cannot do. Things we don’t understand. Things that are beyond our reach and are societal/cultural/personal in nature. Most of us try our best, carry pagers for days and weeks at a time, in case someone wants our help, work crazy hours, listen to people who are hurting and take our jobs very seriously–take the patients with us to bed, on vacation and into our hearts and souls.

    I appreciate and put my doctors on pedestals for what they do for me and my family and the patients I send to them. You, Dr. Deonarain, have put yourself on a different pedestal (to paraphrase your you tube video). I hope you don’t get hurt too badly when you take your fall.

  • http://twitter.com/tcoss tcoss

    There’s no conspiracy here, Medicine isn’t nearly that organized, still look around. Patients to to Jenny Craig, South Beach Diet, Weight Watchers et. al. for weight loss, not physicians. They go to Wellness Clinics, Massage Therapists and Pharmacists, all the time most physicians are saying nothing as more and more people step between them and their patients.

    If you think this is benign, I commend to you The Innovators Dilemma, by Clayton Christensen. There is nothing that unique about medicine that makes it immune from forces and consequences experienced by other industries.

  • http://www.mightycasey.com/ MightyCasey

    This gives me great hope for the future of primary care, which should be primarily little in the way of traditional American “medical care” – i.e. pills and procedures. RNs/NPs/PAs are trained to listen (MDs, not so much), which means that they just could revolutionize the system. IF.THEY.ARE.ALLOWED.TO.DO.SO.

    The biggest barrier there is the “collaboration” requirements in all but 14 states mandating that NPs must work in an MDs office, they can’t practice independently. That translates into 72% of states with restrictions. That’s a stat that’s gotta change.

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