A pre-med student asks some probing questions

Here are some questions from Lionel, a pre-med student.

What is something you wish you had known before entering medical school?

It would have been nice to have known what changes were going to occur over the 40+ years since I graduated.

If you had the opportunity to choose a specialty all over again, would you do surgery again?

Yes. While I have often envied the controlled lifestyles and flexibility of radiologists and anesthesiologists, I don't think I could have stood the sitting in the dark all day (radiology) or utter boredom 95% of the time (anesthesia).

If not medicine, what other healthcare occupation would you consider to be more rewarding?

It depends on how you define rewarding. It seems to me that being CEO of a hospital is more rewarding financially these days. I have blogged about that. Is it more satisfying on any other level? I don't think so.

Is it possible to carry a healthy relationship where the significant other is not a medical student? Would it be more/less difficult in residency compared to medical school? [this is one I'm mostly interested in especially since you are a surgeon]

I am living proof that it is possible to have a healthy relationship with someone who is not a med student or physician. I met my wife, who is a nurse, when I was an intern. We were married when I was a third-year resident and still going strong at 39 years.

What implications have enduring medical school/residency had on your personality?

I was always kind of a pessimist, but med school and beyond amplified that trait a lot. As some people have written about lately, med school and residency can induce cynicism, and I'm afraid I am a classic example of that.

Does every single day of the year feel stressful or are there days where you feel in control and free to relax?

Since I retired late last year, the days are not particularly stressful right now. When I was an active surgeon, just about every day was very stressful. It took at least the first five days of every vacation to unwind, longer if I had gone away and left a sick patient to be managed by someone else. Here's a link to a post I wrote about "collateral damage," which is about how complications affect surgeons.

I have always dreamed that being a physician would help me feel more connected spiritually to god/universe by seeing all the unfortunate people and being able to lend compassion. However, does being under constant stress distract a physicians focus from that feeling and does it make you just want to finish the job and go home?

There were many days when I just wanted to finish the job and go home. I would like to think though that I was able to get past that and offer my patients the compassion and support they needed.

What do you like/dislike the most about your journey thus far?

I liked the challenge of figuring out what was wrong with a patient and having the ability to fix it. I liked the feeling of satisfaction after helping someone who was really sick get better. Today I got an email from a former patient who is 10 years postop from breast cancer surgery and disease free. Hearing that is hard to beat.

I took every complication, whether it was my fault or not, very personally. That can wear you down. I didn't like the empty feeling that I got when I operated on a patient and found something like incurable cancer. It was frustrating not to be able to do anything about it. It is very hard to look someone in the eye and tell him that the surgery did not solve the problem.

A patient wants to know when to speak up

Matthew writes:

My only experience with the medical profession is strictly as a patient. I'm wondering what is an appropriate balance between being an educated patient (willing to ask questions, make observations, etc.) versus being one of those supposedly "self-educated" know-it-all patients that I'm sure are one of the banes of a doctor's existence.

We've all heard the stories of the patient whose doctor didn't listen to their concerns until it was too late, but on the other hand, I don't deny that my doctor knows worlds more about my body than I do, or ever will.

I want to trust my doctor, but without having to blindly accept whatever he tells me. Yet I've dealt with members of the medical community who see anything BUT blind acceptance as a personal affront.

As such, is there ever a time to research symptoms online before making an appointment? Is there ever a time to disagree with a diagnosis? Is there ever a time to request or ask about alternate treatments? And if so, how can this be done in a way that is respectful to my physician?

You ask some excellent questions.

I’m not sure I have all the answers. I hope some of my physician colleagues will comment. 

There is a fine and very fuzzy line between asking good questions and being a pain in the ass. And that line is drawn in different places by different doctors. It ranges from zero tolerance for questions (See Dr. Sung on “Monday Mornings,” who, when asked a question about a procedure he recommended, said, “Not do—dead.”) to the most open-minded, usually a primary care doc or psychiatrist. There are issues of time, urgency, the physician’s perception of the patient’s level of understanding, the complexity of the disease or operation and many more.

I had no problem with patients who researched their symptoms online. However, I would hate it when a patient brought a portfolio with 100 pages of downloaded material for me to comment on. There is a lot of garbage on the Internet.

I think you should always ask what your options are. Informed consent discussions should include the risks, benefits and alternatives for any procedure. The doctor should also tell you what the risks and benefits of the alternatives are too.

Go with your gut. If what the doctor says to do does not sound right, say you will think it over. Don’t be afraid to get a second opinion. Run away quickly from any doctor who discourages second opinions. I always encouraged second opinions for patients who were reluctant to have surgery I recommended. I felt that if I was proposing the right thing, the second opinion doctor would support me.

One of the worst things a patient can do is be too acquiescent to the physician. I used to tell patients “Don’t worry about hurting your doctor’s feelings. This is your life we are talking about. The doctor will get over it. If she doesn’t, you don’t want her as a doctor anyway.”