Rules for being a happy doctor mean caring for others

Commentary. By Michael Greenberg, MD, amednews contributor. March 20, 2000.

COMMENTARY

Observations on the state of medical practice and medical life

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What kind of drugs are you on, Michael?" a colleague recently asked.

"Drugs?" I inquired.

"You're always so positive about medicine. Not like the rest of us who buy lottery tickets, hoping for an early retirement."

I opened my wallet and handed him a small, well-used white card. "Four rules," I said.

He looked at the card. "This is it?" he asked. "Who wrote these?"

"I did," I said. "During my residency. I watched the attendings and noticed what I liked and disliked about how they treated patients. You can keep this copy."

"It's too simple," he said, shaking his head. "It can't be this easy."

"It's simple," I agreed, "but not always easy."

During almost a quarter century in private practice, I've tried to live by the four rules I wrote during my training. Far from being a magic formula, they are a quartet of practical advice based on the conclusion I reached long ago that most of our upsets as physicians occur when we forget that the primary reason we became doctors was to care for others. Following these rules has helped me be a happy doctor despite the many difficult challenges that have confronted my practice over the years.

The first rule is to treat all patients as if they are members of your own family. Each time I formulate a treatment plan, I ask myself what I would do if the person sitting across from me in my exam room were a member of my immediate family and, even more important, what I would not suggest or do. It's no wonder that so many of my patients treat me the same in return.

The second rule is to always tell patients the truth -- no matter how frightening the truth is. Occasionally, a patient has left my practice rather than face an uncomfortable reality, but the vast majority of my patients appreciate direct honesty and return it in kind. And some of those who have left angry have eventually returned. In the long run, honesty is the only sure route to happiness. As my father taught me, if you tell the truth, you never have to remember what you said.

Rule three is that if somebody else does something better than you, send your patient to them. We physicians have a sacred duty to ensure that our patients get the best care. Despite the whispers from our own egos to the contrary, an appropriate referral to another doctor is the best way to earn your own self-esteem as well as respect from patients.

Rule number four is the most difficult: Learn to say, "I don't know" comfortably. All of us hate to expose our ignorance, but patients (and colleagues) learn to trust and respect us when we admit our humanness. Owning up to the fact that we are not omniscient offers us a healthy dose of humility. Patients generally understand that we can't know everything. Our sacred responsibility to them demands that we tell them when we don't.

I have, more times than I care to admit, strayed from my own guidelines -- usually to my discomfort and embarrassment. But with experience, I have learned to stay more on track than off.

Perhaps after all these years, it's time to add a rule to the four that have been such a successful prescription for happiness in my practice: Learn to say, "I'm sorry." I've been rude to patients my share of times. And I've learned the value of a heartfelt apology. It follows from rule number two, telling the truth -- I'm human and sometimes act or speak in ways I regret.

Honesty, intimacy and humility -- the basis of my five rules for happiness in medicine -- are not always the easiest ways to practice. Some patients are difficult, and the current environment of medicine is not always the most physician-friendly. But I believe the ancient adage that you reap what you sow. If you offer friendship and compassion to your patients, you will be rewarded with a lifetime of satisfaction. Maybe you'll become so happy that your colleagues will begin to wonder what kinds of drugs you're taking. But you might take a moment and ask yourself if that would really be so bad.

Dr. Greenberg is a dermatologist in Elk Grove Village, Ill. and author of the novel A Man of Sorrows (http://www.anovelvision.com/). You can contact him by email (offped@aol.com).