The Gen Y Physician

photo: Sura Nualpradid,

Do Gen Y physicians want more by doing less? Are they less dedicated than prior generations? I read an article written by a physician that put this group in a less-than-positive light.

I have heard similar observations from a colleague who practices in an academic environment. We often comment on advances in pharmaceuticals, procedures, imaging, and public policy. But there have been cultural shifts in the practice of medicine as well: a move away from paternalism, more collaboration between specialties and teamwork with other physicians, and work-life balance for physicians, for example. While I would agree with some aspects of the aforementioned post, there are a few things to consider.

 The “working to live” trend is not limited to healthcare. This appears to be a common philosophy among the young adults in this country who grew up with parents who labored with one or more jobs or overtime while sacrificing time with family. Perhaps this explains why we see many young, intelligent women choose to stay home rather than work. Or why people work at home rather than in the office.

Other factors have helped to mold the current and up-and-coming generation of healthcare providers who are being criticized in this post. For example, the general public, the media, and the healthcare industry, itself, have minimized the role of the physician. They no longer perceive physicians as “gods” (a title that was unlikely self-described by the members of this profession). When insurance companies that are run by nonmedical administrators dictate the rules of practice and larger physician offices are run by – again – nonmedical administrators that want more productivity, it creates a factory-like environment. Read: hamster on the wheel. Furthermore, the utilization of midlevels (who can earn more per hour than physicians, if you take into account taking call and working on weekends) in the healthcare industry, while quite helpful and valuable, also creates a sense that physicians are potentially dispensable.

There are now more female physicians graduating from medical schools than 10-20 years ago. They typically play many more roles than the role of physician. They often do not have the luxury of staying late at the office  – and, yes, I view it as a luxury – because they may have to pick children up from daycare and make dinner and take care of household duties while husbands stay late at their own jobs. Women have entered into previously male-dominated professions faster than the societal expectations of their roles could practically adjust to take that into account.

Whether we admit it or not, a lack of balance in our lives does translate into our interaction with others. We have often seen or heard of a disgruntled physician interact less than ideally with a patient. As the healthcare industry becomes more customer-service oriented, this would be detrimental. Sometimes finding balance does not align with the Type A expectations of our peers. But I am doubtful that any physician would risk being negligent in order to make it to a soccer game.  

Lastly, I would like to suggest that physicians who are concerned about the work ethic of the next generation of physicians consider being role models or mentors to them, as my friend in academic medicine does. Having a relationships with our peers (regardless of age) is essential for mutual support and can also help younger physicians grow into professionals with excellent work ethics.

The Millennial Physician

photo by jscreationzs.

There was a post on KevinMD that sparked my interest. It has to do with a perception that Generation Y physicians essentially want more by doing less.  I agree with the observation that there is a cultural shift in how younger physicians view the practice of medicine. What’s missing in the argument are potential reasons why this may have occurred and a lack of recognition that there is also a cultural shift in how medicine is practiced in America and viewed by the public.

In my next post, I will attempt to fill in some of the blanks.

How Music Can Be Like a Drug

photo from by dream designs

I couldn’t agree more with this post I came across on I also agree with the song choice represented. Adagio for Strings is one of my favorite pieces, but DJ Tiesto’s version takes it to another level.
(I wonder if I should play this when patients who are depressed or in pain are waiting in the exam room for me.)

Happy listening.

Medicine Meets Art, Gets Schooled in the Art of Medicine.

A few days ago, I went to see art, and somehow got reminded about the “art of medicine.”  Jesse Higman, a Seattle artist, was demonstrating his current medium and discussing his collection (Illuvium) at a local art gallery.* At that event, I had an opportunity to meet him in person and – along with other audience members – use his techniques for making art. I poured a liquid paint with mica flakes onto the black surface of a masonite board that had been engineered to have valleys and hills and just watched the art take shape. I talked to him a little bit about this seemingly less controlled form of making art and that I – of a mostly type A nature – might not have as much confidence in letting paint direct itself on the canvas.

Surprisingly, the flow of our conversation touched on the practice of medicine.

Higman philosophically drew analogies between being a doctor and being an artist and reminded me of an oft-referenced yet difficult-to-teach aspect of medicine. Despite the hard work and skill that is required in both disciplines, the ability to embrace and utilize the fluidity and unpredictable forces of our subjects or our medium is what allows us to perfect our craft.

Physicians, by virtue of a weeding out process that takes years, are high achievers who can often have issues with control. Our ideal patient remembers and follows all our directions explicitly, has great health insurance, does not have to worry about taking time off of work to see us, and has predictable responses to our treatment plan. This patient actually lives in the isolation of a textbook. Real life certainly doesn’t operate that way and to expect it to be so would result in frustration.

Certain subspecialties, such as anesthesia and intensive care medicine, are numerically driven or algorithm-dominant and lend themselves to more predictable results. (Note that patients being cared for in these examples are generally sedated). In a field like primary care, patients cannot be forced to be something that they are not. We will often prescribe or suggest or give our opinion to our patients. But to not take into account the underlying rhythm of an individual patient’s life can lead to failures of our treatments.

The art of medicine is about more than bedside manner. It also incorporates a certain level adaptability and creativity to work with the various situations before us. A patient who has a blood pressure of 150/90 is very different from another patient with a blood pressure of 150/90. I personally have found most satisfaction and better “results” when working with a patient’s current and individual situation, rather than dictating a one-size-fits-all  set of instructions that takes into account only the disease itself. However, this involves paying attention to verbal and nonverbal cues, which can be difficult with the limited time doctors often have. I am by no means an expert at this, and it is something I continue to work on. As the American healthcare system increasingly places emphasis on certain numerical goals and “quality measures” (which are still a very important part of our care), my hope is that we don’t miss the trees for the forest and that we continue to value the art of medicine.  

I admire Jesse Higman for the work he created. I also unexpectedly drew inspiration from his universality of thought and all-encompassing spirit, characteristics that enabled him to draw parallels between seemingly disparate individuals (him and me) and the fields of both Art and Medicine.

*(See my prior post to learn more about Jesse Higman and his work:  ).

An Artist Who Defies Our Perception of Disability (But Never Mind That, It’s The Work That Moves Me)

This past weekend, I happened upon a bar in Seattle that also functions as an art gallery. Add music and good conversation, and I may never leave this place. The current exhibit housed at Vermillion on Capitol Hill is – just as its name –  at once ethereal and earthly. Illuvium is a collection of pieces created by Jesse Higman, a Seattle artist who defies our perception of disability and defines himself by his work and creativity. The name of the exhibit, itself, refers to the dispersal of soil by flowing water.  His current medium engages the forces of gravity, flow, chance…. and, most interestingly, collaboration. Check out his website for his story and the details of what appears to be a painstakingly elaborate mechanism for distributing and directing his fluid paint. While Higman’s personal story has the makings of a tragedy-into-triumph script, his art really does eclipse it. I assure you that the online images pale in comparison to experiencing these pieces in person. If you are in the area, you might consider attending his live art demonstration this week, during which he will call upon audience members to help him create art.

Healthier in 2011: There’s an App for That

Photographer: Nutdanai Apikhomboonwaroot,

This is it: the first workday after New Year’s. Do you have your plan in place for being healthier in 2011? Here are two important tips to stay accountable:

  1. Make sure you commit to your workout days, by circling them on a calendar AND telling family and friends which days they are.
  2. Keep a food diary.

Keeping a food diary can be done in one of two ways.  The old-fashioned way is when you write down everything you ingest in a day and the calories next to it. It very underrated. It works.  The newer way of keeping a food diary is, of course, with an app.

I just purchased MyNetDiary for the iPad because I read so many great reviews on it and wanted to test it out. In fact, it boasts a 4.5 out of 5 stars with 1110 ratings. The usability of this app surpasses the others I have tried. First, you enter your profile info (height, weight, age gender, and your goal weight) and your activity level. Then you can just start typing in foods. For example, I was able to enter a detail like a half tablespoon of catsup and a tablespoon of a certain brand of creamer. I didn’t think I would find a particular brand of apple chai oatmeal, but there it was. 170 calories.

As you enter the foods, it also tells you the fat/protein/cholesterol content as well as the calories. What is also nice is that you can modify to view sodium content, for example, if you have high blood pressure or heart failure. If you can’t find a food on the extensive list, you can create a custom food item.

If you have a goal for weight loss, it tabulates the current day’s totals and the remaining calories you can consume in order to stay on track.

There is a section for exercise, even mowing the lawn and playing with kids. The Progress section tracks your weight  in graphical form.

The app was certainly not free, but at $9.99, it may well be priceless if it gets you to your goal weight.