The evolving definition of doctor


Doctor: (from Latin docere “teach” Greek phusikḗ epistḗmē “knowledge of nature”) a specially trained and skilled person who holds an advanced medical degree and is licensed to practice the healing arts.

My definition of doctor keeps evolving. As a child, I was cared for by FPs who helped set bones, suture skin and fight infections like measles, chicken pox, and strep. Though I didn’t like going, I usually experienced healing on leaving their antiseptic-smelling office.

In sixth grade, a teacher took me to visit her neonatologist spouse. I was awestruck by the life-saving team’s battles to save the second set of quintuplets born in the U.S. This lit a spark to know more about our bodies as doctors do.

In 1976, I joined the Leonia Volunteer Ambulance Corps and got a sense of the special training needed to be skillful. Premed college freshmen students telling us seniors their horror stories led me to study actuarial science while getting a side of EMS. But halfway through the desire to know more about nature led me to change to premed. Within a couple weeks, my definition of doctor changed to cutthroat survivalist.

In medical school, the definition of doctor morphed to crazy and near impossible. Then I realized a corollary definition for doctor is P=MD. (Passing was all I needed to earn a piece of paper that would define me as a medical doctor.)

My first patient as a medical student was a mystery. He had thrush, abnormal labs, and unidentifiable pneumonia. Physically, he kept deteriorating despite specialists adding their insight. Throughout his stay that eventually led to the ICU, he kept telling everyone that I was his doctor, despite my trying to correct him that I was just a student. He was one of the first HIV patients in the U.S. and died from complications of what we now know was pneumocystis. Webster didn’t mention responsibility, but it is a huge part of being a doctor that I felt even as a student.

Practicing emergency medicine for 33 years enlarged my definition of “doctor” beyond anything I ever dreamed. I’ve cared for thousands of patients — delivering hundreds and pronouncing way too many. Being defined as a doctor has allowed me to enter race cars, prisons, ORs, helicopters, secure military bases, fireworks launching areas and even a secret tunnel transporting the Pope (who waved at me). I’ve touched virtually every human body part inside and out — living and dead. More striking has been patients allowing me deep into their lives by telling me things they could never say to anyone else. Most of these remain locked even from family, as another unwritten part of the definition is trustworthy. It’s humbling to hear: “You’re my doctor. I trust you!” Though trust needs to be earned, we docs do begin with a head start because of our title, breaking this only when there is a danger to our patient or others.

Being defined as a U.S. doctor translates to many languages and cultures. This allowed me to be welcomed into hospitals in Argentina, Brazil, and Paraguay without months of verification.

I’ve been called many subtle variations. The respectful “Doc” that police, fire and EMS providers use confirms being partners in a hazardous brotherhood. Because emergency providers need to be quick and concise (and I’m short), I’m known in the ED as “Dr. B.” There’s also the hauntingly drawn out “Doooctoooorrrr” with no last name used by lawyers trying to unnerve me and make me say that I am a poorly trained uncaring idiot who didn’t really deserve to be called a doctor. Though many think perfection is in the definition of a doctor, it can’t be. I have human flaws along with good days and bad. However, intentionally trying to harm is never in my definition.

I’m amazed at the power of my words. People often read Dr. Google, but need to hear it from a doctor to believe it. “It’s cancer.” “It’s a girl … and a boy!” “You’re going to be all right.” “I’m sorry, he’s dead.” “That’s normal.” Honesty and presentation are important in framing these. Our touch can emphasize these in an equally powerful way.

Last year, I cut back my ED shifts to begin working three days a week at a primary care clinic. In the ED, I often was the only doctor many patients would ever see. Now, I truly would be defined as their primary care physician. Long-term relationship was added to “doctor.” My definition of a patient also changed. I must look at their entirety (body, mind, soul, and spirit) today using their past to prep for the long haul. I’ve had to learn many new aspects involved in the healing art of medicine. Teaching that diabetes is not just from sugar. Devising a plan to use however much insulin one can afford, despite this not being enough to meet the ideal goals some experts say define a good doctor. Finding key motivators to change bad health habits. Learning everyone’s real story and its’ effects.

Caring and compassion is part of being a doctor, but this has also recently blossomed. Our clinic has celebrated births, birthdays, lives transformed by gaining victory over addictions and medications withdrawn because of health changes (and miracles). We’ve been saddened when one of patients is found to have cancer, goes to jail or ODs. We feel a loss when one of ours dies. I’ve cried at some funerals, but I’m grieved even more deeply by the funerals I couldn’t go to because the patient was so alone and broke that there wasn’t any memorial.

I trust that my life has added a positive spin to “doctor.” I am honored to see those that have shadowed me go on to success in life (only a few choosing to be a doctor) and to see healing in many of my patients.

I’m not sure how my definition of a doctor will be fine-tuned as I finish out my career. I’m sure I will be learning more about the “healing art” of aging and about how death is a part of life. Can’t wait to see what will be added to the amazing perspective on life and death that I have been honored to live out so far.

Joe Bocka is an emergency physician.

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