Category Archives: Motivational

It’s a man’s world?

When I was a medical student, now over a decade ago, we had a fairly active “women in medicine” chapter, despite the fact that our class was at least 50%female. Understandably, the whole work-life balance debate was a main topic of discussion, although thanks to the recent uproar over part-time docs, that issue is forefront again. At any rate, one thing I remember from these gatherings is a statement made by an upper level resident offering her worldly advice to us impressionable young medical students.

“I watch Sports Center with my boyfriend every night,” she said. “That way I have something to contribute to conversations with the guys while we’re in the OR.”

Consider the opposite scenario – a group of male medical students getting together for support, being told to read In Style magazine or watch a reality TV dating show so they’d have something to talk to their female colleagues about (I know, gender stereotypes abound).

The question arose back then – do we, as female medical students and residents have to play in a man’s world to get ahead? And is it over when we’re attendings?Are we still excluded from the clubhouse?

A few months ago I attended a local medical society women’s group where we explored the very same questions. We discussed how women tend to emphasize group collaboration over individual achievement. When given a compliment, many women will deflect or minimize the praise. Does this partially explain the reason women physicians are paid less than their male counterparts? Through role playing exercises, we learned how to craft PAR (problem, action, results) statements and borrowed other concepts from the business world, such as having a ready-to-go elevator speech about your accomplishments in the event you meet an important contact. I have to admit, I do like knowing that I have a way to communicate my current projects to the CEO or a colleague from another institution when I run into him or her at a meeting.

However, a lot of these changes are conversation styles or body language typically attributed to men. Someone raised the point I had been wondering years ago, “Do we really need to try to act more like men to get ahead?”

Sorry, new medical students and residents, I have no conclusions for you today. Concentrate on learning as much as you can and caring for your patients. Be confident. Be assertive when you need to. Respect each and every member of the healthcare team. The vast majority of your patients won’t care if you’re a male doctor or a female doctor. They just want a good doctor. Happy July 1st – happy medical new year – and good luck!


The Post-Conference High

What do you call a gathering of 15,000 Rheumatologists and Rheumatology health professionals? There’s got to be a good punch line to that opening question. Having recently spent 5 days in Atlanta in the company of this nerd fest geekdom medical brilliance, for me it was a walk down memory lane. Imagine a giant convention center, people streaming from building to building, Starbucks lines snaking down the hall, massive ballrooms with projection screens displaying video of the scientific talks like a rock concert. With thousands of doctors, nurses, research scientists, industry and press milling about, would I see anyone I know?

Strolling through the maze of poster presentations, I turned around and ran smack into my mentor from medical school and residency, or THE REASON I became a Rheumatologist. Memories of events, people and places long since forgotten instantly flooded my mind. Saying goodbye to him with a promise to email more often, I grabbed a coffee and almost dumped it on the person behind me – a mentor from fellowship. Over the next few hours on convention day one, I saw another attending from residency, a former co-resident, a current Rheum fellow who had been one of my residents here in MA and another few attendings from fellowship. Each was greeted with a hug and a smile and a “Remember when . . . ?” Later that day during a quick snack and rest break, I overheard some valuable advice during a mentor/mentee discussion. As we go through our careers, there is a constant interplay between being the one giving and the one getting the advice, and maybe both at the same time.

As important as these conferences are for our CME and learning the most up to date practice and research information, the opportunity to form and renew relationships is equally important. I’m sure my colleagues across all specialties will agree. What this really illustrates is the often repeated phrase, “Medicine is an art and a science.” While the art lies in the nuances of treatment and the doctor/patient relationship, it also lies in the interpersonal mentorship we cultivate all the way back from those early pre-med days to the present. Remember picking the brain of any doctor you met? “Should I go to medical school?” During school, “What type of doctor should I be?” And as careers progress there is, “What should I look for in a job?”

As a group, I’ve noticed doctors are less apt to network than, say, business types. Friends and family members in other fields are constantly going to networking events, coffees and the like to meet and greet. Events like this conference remind me how valuable it can be to get out there. Say hello. Give advice. Get advice. Mentor a student. Thank your mentors. And since we can’t all traipse around the globe attending conferences and meetings each month, get connected through social media. Both in person and online, the relationships help make it all worthwhile.

Grand Rounds

I’m proud to be included in this week’s education edition of Grand Rounds. Thanks to Spice Island!

A Love Letter to Primary Care

Faneuil Hall, Boston

Living in a major metropolitan area means taking a lot of things for granted. Especially here in the Boston area, with its many renowned hospitals and universities, one can find physicians practicing and conducting research in specialties within specialties. Nothing seems too far out of reach. However, this city mouse recently traveled down the Blue Ridge Parkway for some R&R and to learn how the country mice work and play.

My FP friend's happy old horse

I was thrilled to meet up with a medical school friend who practices family medicine in a rural area a bit further south. We spent a lot of time catching up and reminiscing, of course, but we also did a fair amount of “shop talk.” Touring her office space, she shared with me some examples of what her typical day might be like. The pride in her voice was evident as she talked about what it means to be a family doctor. I was surprised to hear about all the office procedures done on site, as I think locally a lot of procedures here in the city are referred out to specialists. We hear so much about how medical students these days don’t want to go into primary care. Maybe they need to spend more time seeing what it truly means to be someone’s family doctor. Through blogging I’ve been touched by the words of some fantastic doctors who are living and sharing this life, but it was also wonderful to hear about the struggles and inspirations from my friend over lunch. “You know what I wish,” she said, “That people didn’t think you only go into primary care if you’re not smart enough to specialize.”

Barn cat

Maybe this sounds strange coming from a specialist, but I couldn’t be a bigger advocate of primary care. And the further I get away from my general internal medicine training, the more I’m struck by just how hard it is to have to keep up to date with ALL the body systems! Not only do I value the teamwork and co-management of the primary care providers I work with, but I want my OWN doctor too. Everyone is a patient, and don’t we all want someone to call “my doctor?” Having gone to medical school at an institution with a strong primary care commitment, I don’t think this value has ever been far from my mind. In fact, of my group of close friends from medical school, the majority are family doctors, one is a pediatric specialist and one is an internal medicine hospitalist. Then there’s me, in rheumatology, which I do love for the multi-system nature of many of the conditions I see.

Some medical student blogs I follow occasionally talk about “specialty bashing” or how residents and attendings they encounter put down other areas of medicine. Some have said, “Oh, I could never be a XXX doctor. How boring! What torture!” (Well, more colorful language may have been used, but you get the picture). I’m GLAD we all find some things boring and some things exciting. What if every medical student in the world wanted to practice in the same field? That wouldn’t work at all. This post didn’t start out as a love letter to primary care. My original intent was just to say thanks to my good friend for the visit and share some photos. But after thinking about it, I want to also say thanks to all the primary care internists and family docs for what they do. Thanks for inspiring my friends and colleagues, who will hopefully be able to inspire today’s medical students to follow in their footsteps.

Dr. Fix-It

A few months ago at my house, as the oil burner kicked on, black smoke started billowing out of the chimney and the smell of burning oil permeated the house. CRAP! What’s going on? Is my oil burner going to explode? Do I have a leak worthy of the BP engineers? Should I gather my valuables (i.e. dog, laptop and eyeglasses) and vacate? Will my vacation budget get blown on a new furnace? Will I even have a house left???

I make the early morning call to the emergency answering service. “Someone will call you back,” I’m told. I wait a while, thinking the worst, then get the call, “Someone will be with you today.” Several anxious hours later the repair man shows up. “Soot,” he says immediately, as he looks at the furnace, “Something’s clogged. I’ll have to sweep this out.” He didn’t seem too concerned, quickly got to work and all I heard was a lot of banging and vacuuming. Problem solved.

Now, what does this have to do with medicine?

I don’t know a thing about oil burners and heating systems but I know a lot about the human body. When I didn’t know what was wrong with my furnace, aside from alarming symptoms of oil smell and black smoke, I panicked. I had myself thinking the house was going to imminently explode. However, two seconds and the technician knew what to do. Similarly, when my patients come in with back pain or a swollen knee or fatigue and joint pain, in their minds their “house,” or body, is going to explode. Is it cancer? Are my bones collapsing? Will I be in a wheelchair by the time I’m 50? Will I be able to work? Will I die? Sometimes medical conditions take a while to diagnose, but sometimes I know in two seconds, “Oh, that’s just osteoarthritis of the knee,” just like my heating technician knew “Oh, that’s just a clog.”  However, just like I did, my patient has other concerns.

One of the challenges of medicine, especially in the outpatient setting where time can often run short, is balancing the wants and needs of doctor and patient. It may only take a few minutes to inject an arthritic knee and in the doctor’s mind the problem is solved. However, the patient may still leave with fears about why he or she has this scary condition called “degenerative arthritis” and what that means in the scheme of his or her life.  Always useful is this reminder that everyone has a backstory, an agenda, fears and expectations. Usually when rushed and stressed is the time we need to remember this the most.

I Can’t . . .

I love this post of Roni’s. Thinking about laminating it and posting it in all my exam rooms. We’re all guilty of “I can’t” behavior and I seem to spend a lot of time with patients brainstorming about how to turn the excuses into action. Thanks, Roni, for ongoing inspiration!