My Evolution as Physician

I graduated from medical school in 2001.

It feels like yesterday and a million years ago.

After that, I did 4 years of OBGYN residency and 3 more years of fellowship in Reproductive Endocrinology and Infertility.

That’s a lot.

Since then, I’ve been practicing medicine full time.

“Practicing medicine.” Think about that term. It implies that medicine always keeps us striving and learning, while never being perfected.

During my time as a physician, I’ve evolved. As I should.

These are my subjective observations after nearly two decades in medicine.

What is different for me: 

I have experience under my belt. There are times in medicine where you can’t Fake It ‘til You Make It. I am Board Certified in OBGYN and my subspecialty, Reproductive Endocrinology and Infertility. I earned my stripes. More than 11 years into practicing my sub-specialty, I have seen a lot. When I quote you success rates about my practice, I am giving you facts about my practice. Mine. I have done thousands of egg retrievals and embryo transfers, not dozens or hundreds. Part of counseling patients is discussing the risks, benefits and alternatives to a procedure. We call this informed consent. Of course we do everything possible to minimize risks, recognize and treat any complications, but when you are doing something long enough and with sufficient volume, you will encounter complications and tough situations. I have. It’s humbling. But on the flip side, if you’re a patient, you want someone who can quickly and competently handle a problem, plus keep you out of trouble in the first place. 

I work harder than ever to build relationships with patients. I am genuinely interested in where you grew up, how you met your partner (if you have one) and what your ideal family looks like. The reality is that while many patients will be successful, some will not. Investing in the relationship along the way pays multiple dividends. I have some patients who did not achieve pregnancy yet still express deep gratitude for their care and have transitioned from patients to friends. 

I’ve aged into a new demographic. A whole generation of physicians has now come behind me. It is exciting to meet younger physicians or medical students who are the future of the field. They’re so bright and shiny! I love it. We’re in an age where women physicians get to be their authentic selves and I embrace it all. I love this army of Boss Lady Doctors.

With my darling co-fellow, circa 2005. Babies!

I delegate more. I get it. Patients want access to their doctors, and we should be there for our patients. Should I personally answer every patient’s routine question or call with a non-urgent lab result? Maybe. But with a robust practice, it is impossible to sustain or scale this over the long term. When your patient load is building and time is less limited, I wholeheartedly agree that every patient would prefer to speak directly to her doctor with every question, problem or concern. As you get busier and time becomes your most precious resource, you *must* find a way to divide and conquer tasks. This is true for life at home, as well. 

I am more skilled at having difficult conversations. My specialty requires a lot of them. Patients put their hopes, dreams and resources – emotional and financial – into our care and sometimes, it is not going to work out. It is never easy telling a patient that her eggs are not likely to create a baby. It is not easy telling a couple that none of their eggs fertilized in an IVF cycle and there are no embryos to transfer. While you should always bring your A Game to these conversations, I used to fear and dread them. Now I don’t. I might wish we were talking about something completely different, but I will be present for you and we will figure the next steps together. 

I thank patients for letting me take care of them. This is something I have done for a long time, and I mean it. Thank you for letting me in. Being a physician is a unique profession; we care for others at their most vulnerable and in the end, it is mutually satisfying. A word about thanking patients: do not do this if you cannot be sincere. This isn’t a place for phonies. A healthcare provider I saw once for an acute issue with my daughter asked at the end of the visit what he could do to ensure a five star rating if we received a patient satisfaction survey. That left a bad taste in my mouth. Don’t be that guy. 

I am better about recognizing when my tank is low. I’ve been burned out. Now I’m not. I’ve also come to think of my emotional reserve as a fuel tank: there are times when it is full and others where I am running on fumes. Now I’m better able to determine when I am down to my last quarter tank and then re-fueling prior to becoming completely dry. When I say “better,” I also do not mean perfect.  

I remain a work in progress. 

—————————————————–

What is the same: 

I will tell you “I’m sorry.” I’m sorry that your pregnancy test was negative. I’m sorry for your pregnancy loss. I’m sorry that you have to be my patient in the first place. I will acknowledge the Elephant in the Room. It isn’t a failing as a physician to say “I’m sorry.” Doctors aren’t gods, and I believe the “God Complex” stereotype is woefully outdated. I certainly don’t think of myself as anything other than deeply human, and part of being human is being honest and vulnerable with others. Saying “I’m sorry this happened to you” is often the humane thing to do.  

I understand how much this matters to you. It matters to me, too. Every negative pregnancy test is hard. The one thing I have told myself over and over is that the day a negative pregnancy test stops being hard, I should quit the field. There isn’t room for ambivalence. 

If you send me a birth announcement or a holiday card, I will save it. Not only will I keep it, I will look at it. Often. Especially on tough days. 

If I ever get to meet your baby, I will cry. Probably ugly cry. They will be happy tears, though. 

I stay curious.  

I am always learning.  

I remain a work in progress.  

2 thoughts on “My Evolution as Physician

  1. I’ve missed you… So happy your blog is back.
    I heard your voice as I read this blog- such music to my ears.
    Your authenticity is amazing, and a tribute to the amazing, kick ass FLD that you are.
    Towards the end of our work time together, I often worried that you were in the midst of a spiritual crisis; the life you were living was not aligning with the person you were and the life you wanted to live.
    That worry is no more… you are EXACTLY who you are meant to be!
    Rock on sister.
    Love you.

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