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Dr Stein's Chronicles

Posted Jan 11 2010 12:00am


The Daily Grind

I recently saw a patient diagnosed with colon cancer. She was relatively healthy, and she was referred to me for a laparoscopic colon resection. I did what I always do. I spoke to her about the risks and benefits of surgery. I discussed what she can expect after surgery, from pain to bowel function. I discussed how we determine her pathologic stage and if she would need chemotherapy. Afterwards, she told me she was also seeking a second opinion and had the appointment already scheduled at a different institution. I told her, as I tell every patient, that I firmly believe my role is to help everyone who comes through my door, and that she has to be comfortable with and trust her surgeon, whether it was me or someone else.

She asked me all the usual questions – laparoscopic vs. open surgery, complications, and how many surgeries have I done, what are my results – and I gave her all my answers. She called me this past Monday morning and told me she was going with the other surgeon and his institution. I wished her the best and that was that.

Yet it gnawed at me for the rest of the day. Did I do something wrong? Did I not spend enough time with her? Did I make her wait too long in the waiting room? Did I not engender enough trust? Should I have done something different? Could I have done something better? Did I fail to help her?

It is inevitable that at some point in time each and every one of us asks the question “Am I doing a good job? Am I doing something worthwhile?” In healthcare, many people enter the field to do something special and to help make people better. In truth, most people enter a chosen area of work because they enjoy it, it stimulates them, and they like the people or lifestyle.

We are extremely excited when start on a new path – whether it is work, exercise or a hobby. We try to excel at what we do – whether it is trying a case, selling a product, cleaning a floor, running on the treadmill or programming a computer. However, as time marches on, the novelty and excitement wear off and we are faced with a daily grind. We become cogs in a wheel, and are unable to generate excitement and enthusiasm for our daily vocations. This is true in medicine as well.

After years of training, we enter practice, and treat thousands of people over the course of a few years. Yet it becomes a routine, tedious, mundane – no more novelty and excitement. Where am I going with this? No, I do not believe I am having a midlife crisis (my wife may disagree), nor am I planning on a career change, but I have started asking myself some tough questions - Am I doing everything I can to provide the best care? Am I staying on top of new research and developments in my field?

I recently read the book Better by Atul Gawande. The basic message is that to make yourself better than average, you need to be able to look in the mirror, critique yourself and implement a change. Whether it is a vocational issue or simply a lifestyle issue (I do need to eat more fiber……) we all have room to improve. It is how we deal with these day to day issues in our lives that will truly define us.

As the New Year begins – I am hopeful that we will all strive to choose an aspect of our lives that we can critique, improve upon and ultimately become better for it.









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