Don’t lose yourself. — Many people go into medical school looking to make a positive impact on the world, but end up losing sight of that goal. What is worse is that some people who get weeded out in their journey to becoming a doctor would have been the best ones. If you think you can make a difference in this world, don’t give up — we need you! And to those that make it — don’t forget why you became a doctor. It will be a struggle not to abandon your purpose; there will be pressure to conform and it might take everything you have to survive. It’s happened to me several times. Find it in yourself to remember every year, every week, and every day why you chose to become a doctor. That mindset can dramatically change the path you take and the shape of your career.
I had the pleasure to interview Dr. Michael Richardson. Dr. Richardson is a family medicine physician at One Medical in Boston, Massachusetts. He graduated from the University of Massachusetts Medical School before completing a Family Medicine residency at Boston University Medical Center. He is also a faculty member at Tufts University School of Medicine and is on the legislative committee and board of directors for the Massachusetts Academy of Family Physicians. He is a passionate advocate for public health and has a strong interest in sports medicine — but his all-time favorite activity is running after his two kids.
I never grew up wanting to be a doctor, but I did have an interest in health and fitness. I loved being active and playing sports, but I was also worried about my personal health as diabetes and cancer ran in my family. Staying fit was my way of taking control of my life and I hoped it was enough to stave away any bad hand that my genetics had played me. It wasn’t until I attended Tufts University where my perspective of health dramatically shifted and set me on my path of becoming a family physician.
During my sophomore year of college, I happened to take a class in public health that opened my eyes on multiple social factors, such as race, gender, and income, and how they can impact health on both an individual and community level. With this new insight, I was able to look back on the health of my mother’s and father’s family and recognize the disparities between the two. My mother is an Irish blonde haired woman with a thick Worcester accent (think Boston accent but stronger on the A’s) who grew up with her 5 sisters, mother, and father in a middle class neighborhood, whereas my father is a tall African American and Native American man who grew up in a low income neighborhood with 5 siblings and a single mother. My mother’s side of the family was generally healthy, while my father’s side suffered from diabetes, cancer, and heart disease that I previously chalked up to genetics.The public health class helped me realize that genetics was not the sole driver of this significant health disparity, but was instead related to access to resources, racial discrimination, and socioeconomic status differences between the two families. After coming to understand these seemingly preventable disparities, I knew I wanted to make a difference. Becoming a doctor, specifically a family physician, was my way of confronting these social determinants of health and making a greater impact in my community.
However when I started my medical training, I quickly learned how challenging it would be to address these social determinants. The medical community places a heavy emphasis on the biological sciences and often defines care as treating diseases instead of treating the whole person. This in combination with a system that pushes primary care physicians to see 4–5 patients an hour and complete a seemingly never ending stream of paperwork fosters an environment where the doctor-patient relationship is secondary to any acute medical concern and the paperwork that follows.
Many people enter medical school to change the world, but the challenges we face as doctors bound by the constraints of the medical system lead many well intentioned doctors to burn out, and I was no exception. I found myself falling into the same routine, focusing on the disease processes instead of the people that had them, and questioning whether I was helping anyone at all. One of my lowest points was when my father was diagnosed with colon cancer.
My father is a pretty stoic guy. He is not one to complain and definitely not one to see a doctor if something was wrong as he never grew up experiencing regular visits to the doctor. He surprised me when he went to the emergency room one day for some abdominal pain he was having. I remember arriving in the emergency department just as the doctor was handing my father his discharge papers and diagnosing him with dyspepsia (fancy medical term for upset stomach) and told him to just follow up with his doctor and take some over the counter heartburn medication. No imaging was done, but as a fellow medical professional (I was a med student at the time), I trusted that the doctor gave him a thorough evaluation and that everything was fine. 3 months later, my father went back to the ED for severe abdominal pain. At that time they did a CT scan and found an enormous mass completely blocking his colon. It was stage 4 colon cancer, which he would latter pass from on August 10th, 2018. The initial doctor not only underappreciated my father’s level of pain, but also failed to elicit that he was not up to date with his colon cancer screening and the fact that he had been having bloody stools for months.
These are pretty basic questions that I’m sure the ED doctor thought he asked appropriately, but his communication style likely lacked the cultural sensitivity my father needed to be open about his health and become an equal partner in his care. What was most disappointing in that initial ED visit was if the roles were reversed and I was the ED physician, I think I would have made the same mistake, focusing more on the symptoms than the patient. Its the nature of the job, no matter what speciality you end up in, but its not the type of medicine I wanted to practice. Not advocating for my father on that day is a regret I will always have. It serves as a constant reminder to recognize the person behind the disease and take the time to communicate effectively with my patients.
When doctors don’t take the time to get to know their patients, which frequently occurs to patients with language barriers or are from marginalized communities, key indicators of illness can be overlooked. Culture, socioeconomic demands, level of education, health literacy, and trust in the healthcare system are just a few of the social determinants that can impact the way a patient reports their symptoms and how physicians perceive them. My father’s cancer diagnosis might have been caught sooner if his physician had the time to build a trusting relationship with my father, but the current healthcare system does not make it easy for this to happen or reward physicians who take time to bond with their patients beyond their urgent medical concerns.
Part of why I became a primary care physician was to treat people and the communities they live in, not just a constellation of symptoms. When I get to know patients as people and look at their health holistically, I develop a better understanding of what led to a situation and create solutions that not only treat the disease, but prevent it from recurring. It will take a system-wide change to improve healthcare, but primary care physicians are on the front lines of making that difference every day. That’s what brought me to One Medical, an institution that shares my passion for holistic primary care and puts that priority into practice. We offer patients longer appointments and remove some of the administrative burden primary care physicians face with a supportive virtual team so I feel empowered to connect, treat and follow-up with patients to follow through with the care they need. It’s a workplace that allows me to maintain my passion and pushes me forward. I can’t ask for more than that.
1. Remember you’re caring for people. — It’s important to remember we’re not just treating a set of symptoms or a puzzling case — we’re treating people. What that means is that we need to engage our patients, make them a participating member in their care team, and find out what matters most to them. My advice would be to take the time to listen to your patients and make them feel cared for — otherwise you’re missing why they came to you in the first place.
2. Over-communicate with patients. — I saw three different patients in recent weeks who felt they had received terrible care at another clinic. After assessing their treatment plans, it was clear to me that they’d actually had amazing clinical care, but no one took the time to explain to them what was happening and why. It’s vital that we take the time to answer questions and alleviate fears by communicating openly and honestly with our patients every chance we get.
3. Find mentors. — People think they only need one mentor to serve as their guiding light, but that’s not true. You should view each new person you meet as a potential mentor. My greatest mentors are my friends, family members, colleagues and people that I’ve met at various stages of my life. Anyone who can offer even one piece of advice or wisdom that will make you a better doctor, or a better person, is a mentor.
4. Do more. — As a physician, you have so much power to make a change beyond the doctor’s office. Use your position to make a difference in your community. Go to your local politician’s office and use your position of influence to speak up for the people whose voices aren’t being heard.
5. Don’t lose yourself. — Many people go into medical school looking to make a positive impact on the world, but end up losing sight of that goal. What is worse is that some people who get weeded out in their journey to becoming a doctor would have been the best ones. If you think you can make a difference in this world, don’t give up — we need you! And to those that make it — don’t forget why you became a doctor. It will be a struggle not to abandon your purpose; there will be pressure to conform and it might take everything you have to survive. It’s happened to me several times. Find it in yourself to remember every year, every week, and every day why you chose to become a doctor. That mindset can dramatically change the path you take and the shape of your career.
I think it’s incredibly helpful for people in the medical field to know they’re not alone. It’s a very private field — a lot of type A personalities (including myself) who are leaders among leaders and hesitant to reveal any weaknesses. It can seem that our peers are accomplishing so much and have it all together, but in reality, everyone has their own personal battles to overcome. Doctors have some of the highest suicide rates than any profession in the US, and the rates of suicides are significantly higher than the general population. 15–30 percent of medical students and residents will screen positive for depression, yet it often goes unrecognized and undertreated.
Health care professionals can think they’re struggling alone, but they’re not. During my lowest points in my medical training, it was my family, friends, and peers that helped me get back on my feet, and I wouldn’t be where I am today without them. I hope that by sharing my personal story and the struggles I’ve faced, others will find comfort and strength in knowing they’re not alone and will reach out for help when they need it.
“You can’t take care of others until you take care of yourself.” — Physicians can become lost in the care of their patients, putting the needs of the patient before their own. They continually perform heroic acts of kindness and will go the extra mile to improve their patient’s lives, but over time, this selfless behavior can come at the detriment of the physician’s own physical and mental health. Every physician we lose to burn out is a loss for an entire community, so its important for physicians to maintain their self care in their daily practice. My personal mantra is if I can’t take care of myself, I shouldn’t take care of others — and if I can’t take care of my family, I shouldn’t take care of someone else’s family. The same thing applies to taking care of a community. By maintaining my personal base of wellness, I can become a pillar of wellness for my patients and community to lean on.
Provide a platform for underrepresented groups to grow and share their unique perspectives. — I’m the first doctor in my family. The only reason I was able to get where I am today is because of the mentors who opened my eyes to the possibilities of what I could do.
One of the most impactful opportunities I experienced was at the Summer Medical and Dental Enrichment Program at Columbia University; a program for premed students who were minorities or interested in working in minority communities. The program not only exposed me to the world of medicine, but taught me how to learn, noting that every person has their own unique learning style. My experiences through this program allowed me to thrive in my future classes as my study habits changed to match how I learn best, instead of how the material was being taught to me.
One day, I’d love to open a similar program in STEM education for women and minorities, providing them with the tools to succeed in higher education and increasing the diversity in the science and technology workforce. In order to expand diversity in these fields, we need to actively reach out to these underrepresented groups, provide mentorship, and give them the resources to succeed at an earlier age. Teaching young learners professional skills and creating access to mentors that can guide them can open their eyes to new opportunities that they never thought possible. I am hoping to be involved or start a STEM program in the near future, but for now, I need to find interested partners who will be able to make a STEM program successful and sustainable.
Originally published at medium.com