(I tried this once already and the computer ate it. I hate it when that happens. . .)

Of all the lectures we’ve gotten on professionalism at medical school, I think the one I heard today will stick with me most – maybe because I’m getting inexorably closer to actually being the one on the spot, or maybe because of the passion of the speaker. He’s an Air Force doctor: 25 years of active duty, recently “retired” to reserve status. He addressed us on the occasion of this being the last lecture day of our pediatrics rotation. I think some of the other students tuned him out, as an older man with out-moded ideas about being a physician. But he was too impassioned for me to ignore. He obviously cared desperately about what he was telling us, and I know that he’s practiced this in his own life. He spends half of every month as staff attending at the children’s hospital, unlike many other attendings who only work staff every couple of months. He’s known to the students on his team as meticulous, demanding, but also surprisingly friendly.

His five points:

1) Care about your patients. “The day that you go home, and don’t wonder even at home about at least one of your patients, wonder if you made the right diagnosis, chose the right tests or treatment, that’s the day you should change your profession.”

2) Know your stuff. “This is the thing that patients automatically expect from all of us; but if they know some of the things we don’t know, they would be petrified.” And more about the importance of always keeping up with new developments; which is one of the reasons that he has stayed with academic medicine, so that he has to stay fresh.

3) Work hard, and don’t make excuses. He was clearly concerned about the 80-hr week, and the effect it has on residents’ mindset. “Don’t use ‘I’m post-call’ as an excuse for dressing sloppily, or hurrying your work to get away, or all the other things that it gets used as an excuse for.” He discussed the number of hand-offs between teams that occur in a regular day, and the immense possibility for error, or missing an important fact or change in the patient’s status, because of that. And, of course, “The day you finish residency is the day the 80-hr rule ends. The real world doesn’t have an 80-hr rule.”

He reminisced with admiration about an orthopedic trauma surgeon he worked with on an overseas deployment. Whenever he was called on his radio to come see a patient, this doctor would answer simply, “On my way,” without questioning why the patient was coming in, or mentioning what else he was doing at the moment. This same doctor did not wear a watch, because he said, “I come in to work in the morning, and I leave when the work is finished, no matter when that is.”

4) Stand up for your patients. If you first do all of the above, then you’re in a position to advocate strongly for your patients, whether to hospital administrators, or to senior members of the team. (For a heart-wrenching example of the importance of this, see Charity Doc’s latest dramatic post.)

5) Stuff happens. Even if you do everything you should, patients still die.

I was impressed. When I was entering medical school, I didn’t realize what I was getting into. This lifestyle was not really my goal. But if, as it appears, I am going to be a doctor, this is the kind of doctor I want to be: Dedicated to taking care of my patients, not ever slacking off, not hurrying to get away from them, as knowledgeable as possible in my field. Medicine is not just another job; it’s a calling. To be a good doctor requires a lot more commitment than being a good accountant or a good salesman. It’s a kind of mentality that you can’t switch in and out of; you can’t leave it behind at the office. We have the ultimate privilege, and the ultimate responsibility. We can’t maintain that, and also try to have a comfortable schedule like other people do.

(Which is yet another reason why I hate those “guidelines for asthma care” and all the other quality control measures that are coming out, as enforced by insurance companies. If you want medicine practiced by a nurse with a checklist, or even cheaper, a robot with a checklist, go for it. But you’re sucking what’s left of personal responsibility out of the physicians. The doctor this morning was right. One of the best antidotes to medical errors is in individual providers who care enough to double-check what they’re doing. All the forms in the world can’t make up for what the people are or are not putting in.)

(My preceptor the other day got a letter from the insurance company complaining that an insufficient number of his asthma patients had a written care plan, or a long-term control medicine, or whatever. He told me that they do, in fact, have all the necessary things; but it was inadequately documented, or occurred in a period of time other than what the insurance company chose to audit. So is the cure for asthma to consist of filling out all the check boxes on the insurance company’s list, rather than spending time with the patient? Faugh!)