For the last five years, I've been working to answer a question most of us have struggled with at some point in time: how do we live a life we love that fulfills us?
In the last six months, I've been working to put all these thoughts into one cohesive document that will one day become a book. Although many of the concepts I'm writing about apply to any human in any profession, there are distinct nuances I'll highlight that can only be understood by those working in medicine.
My perspective behind these thoughts is a by-product of three major life events:
Practicing medicine as a physician assistant
Starting, growing, and managing Medgeeks (medical education) for the last decade of my life
Experiencing the health care system through the lens of a patient as we look for answers to help my daughter
Then, on March 16, 2022, our daughter Chloe was admitted for thrombocytopenia with a platelet count of 17,000. As a father, much of my worry for her health came before she was born. During the pregnancy, I often wondered if she would be born with an illness or defect we missed during our routine prenatal workup.
Even though I know that disease can strike at any age, I believed we were clear once Chloe was born.
Then, seemingly out of nowhere, we were hit with a hematological problem. At the moment, I believed this was nothing more than an acute problem that would be diagnosed and treated during our hospital stay; we would be well on our way to living life as usual once discharged.
I remember going to get breakfast for Liz and me after waking up from our first overnight stay. As I walked towards the elevator, I noticed a room with glass walls that was a dedicated playroom. This room had video games, board games, and all types of various entertainment.
Instantly I realized this playroom was for children undergoing chemotherapy.
As I saw the children playing, I felt an immense feeling of gratitude fall over me. It was a reminder that things could always be worse; things are worse for many others. It's been 11 months, and I still think about that room and how we were only a few doors away. This memory helps to put things into perspective.
After our initial dose of IVIG, we all celebrated as her count increased to 41,000 after just a few short hours. Our physician reassured us that this was nothing more than Immune Thrombocytopenia (ITP) and that we should be good to go.
It has been 11 months since that day, and Chloe has been refractory to four medications. Her platelet count continues to be under 10,000, although she's stable with minimal bleeding symptoms.
It wasn't until eight months into her diagnosis that I truly understood what it meant to be a patient in our current healthcare system. On November 7, 2022, I experienced the inefficiencies that often result in subpar care and burnout.
For five years, I've been looking to solve this problem of patient care and burnout.
But it was when I had my own experience as a patient that I've come to see how narrow my focus truly was.
Don't get me wrong; I always knew bedside manner, communication, and patient rapport were crucial to every visit. But, I never had to experience what that looked like from the other side of the looking glass.
For those in practice, always remember patients are people, not just a set of labs. I know it's hard, but you have to remember their lives continue even after they leave your office. Clinicians are so focused on morbidity and mortality that they often forget what patients go through between visits.
In all fairness, it's not something focused on during their training, and it would be impossible (at least on an emotional level) to truly empathize with every patient. But there must be something in between because typical concerns can turn into worst-case scenarios for many patients.
Every patient wants to know that their clinician is competent and compassionate. How much of each trait is dependent on the type of visit.
For example, if my father were to collapse due to ventricular fibrillation, I would want a competent clinician who can think on their feet and bring my father back. Because of these time constraints, there wouldn't be time to show how much they care, and I wouldn't put as much emphasis on that aspect from a patient perspective.
On the other hand, if I'm going to a provider for a chronic condition that has gone undiagnosed for eight months, empathy and compassion play a much more significant role.
But, it's hard to be a compassionate provider when they are overworked. It's hard to think through an unusual case when you have to see patient after patient. It's hard to think outside the box when you burn out.
It's much easier to follow a standardized algorithm that will work for 95% of patients. I truly understand how hard it is to practice medicine. I also understand how important it is for patients to receive the proper care they deserve.
We live in a dichotomy where we put patients first or profits first. The truth is, they are both critical. Without profit, the hospital goes bankrupt and can't continue to help patients. But on the other side of the coin, there is no point in a hospital existing if it's not improving their patients' lives.
I believe it's possible to create an ecosystem that:
Fosters the creativity and advancement of medicine
Establishes a schedule that is individualized to the clinician so that they can do their best work
Delivers outstanding personalized patient care that changes lives
Creates profits for the hospital so they can reinvest that money into improving the entire system
Otherwise, mistakes will continue. All these mistakes are at the expense of another human being; this is a BIG deal.
In fact, In 2015, the Institute of Medicine published a report that says:
About 5 percent of adults who seek outpatient care annually suffer a delayed or wrong diagnosis.
Postmortem research suggests that diagnostic errors are implicated in one of every ten patient deaths. Not every death is scrutinized, however, so the findings can't be generalized to all hospital patients.
Chart reviews indicate that diagnostic errors account for up to 17 percent of hospital adverse events.
Diagnostic errors are the principle cause of paid malpractice claims and are almost twice as likely to end in a patient's death than claims for other medical mishaps. They also represent the biggest share of total payments.
Errors happen because of a system failure; there isn't one thing to blame. In its simplest form, we have three groups of people involved:
Clinical staff (physician, physician assistant, nurse practitioner, registered nurse, etc.)
Non-clinical staff (hospital executives, receptionists, medical billers, etc.)
Patients (patient, parents, spouse, etc.)
Each group has subgroups. Each subgroup has various professions. Every profession then has a unique set of goals. If these goals do not align, chaos, resentment, and burnout inevitably ensue.
For a person to have a set of goals, they must:
Be aware of each goal
Have an environment that fosters and encourages them to reach their goals
For goals to align, there must be proper communication between each group and subgroup.
This is a very complex problem to solve.
I liken this to having 100 families (three generations to a family) all living under one roof and trying to accomplish a singular unifying goal. Thinking about it this way put's things into perspective.
I wouldn't treat my dad and grandmother the same. So, why is it okay to group every clinician and treat them all the same? Why do we manage every patient the same? It may seem easier logistically in theory, but in the real world, this theory falls apart.
This book allows me to write down and organize my thoughts. In doing so, I hope it sparks the necessary conversations with the right people to create the change we need.
That said, it's much easier to change an individual when compared to a system. For that reason, the first half of this book will focus on the clinician and everything they can do to live a life they love that leaves them fulfilled.
These chapters will be published for free here on Substack because I want to share these ideas with as many people as possible. Next week, I'll publish the first installment in this series. If this is something you resonate with, then I have a favor to ask:
If you've read this far and listen to the podcast, please leave an honest rating and review on the platform of your choice, as this will help the algorithm spread this message to more people. Then, please share this post/podcast with a colleague so that they can be part of the conversation.
Remember, if you don't decide where you want to go, someone else will surely make that decision for you.
Talk next week!
Join me: medicine needs an update