One summer during medical school, I broke up with my boyfriend after a long relationship. To help get my mind off of it, I signed up for my pathology rotation. I hadn’t realized that one of my duties was that–night after night–I had to clean out massive amounts of feces from the intestines of patients who had recently died. I had to clean every last bit of excrement out with my hands so we could carefully examine the gut wall. There was no special suction or pooper scooper we could use for the job. I spent my summer in the dark, humid hospital basement with no windows to the outside world, with sweat dripping down my face, smelling a repulsive mixture of formaldehyde, blood, and feces, and sometimes wearing a hot space suit that weighed over 15 pounds. My friends were traveling abroad, my boyfriend was out of the picture, and my family was thousands of miles away. I cleaned out fresh human feces for months. I was haunted by the stench. But as taxing as those times were, it didn’t matter. I held up my chin and did it. I wanted to be a doctor so badly that….there was almost nothing I wouldn’t have done to achieve that goal. The question you may ask me now (several decades later) is “Were all the sacrifices worth it? Was serving as a human pooper scooper worth the goal of becoming a doctor?” The morale of practicing doctors is dismal. Seventy percent of physicians would not recommend the profession to their children and the majority of physicians are burned out or depressed. Many physicians are retiring earlier than they had originally planned or are searching for side projects outside of medicine to find more meaning in their lives. Despite the growing spirit of dissatisfaction among doctors, I am part of the small minority who feels that the sacrifices were all worth it. When high school and college students ask me, ”Would you do it again?” My answer is a resounding “Yes.” But there is a large caveat. It is a “yes” only when you have the freedom to practice “meaningful” medicine. So what does that mean? I began to practice meaningful medicine when my priorities shifted from practicing “transactional medicine”—medicine focused on data and results–to “relational medicine”—medicine focused on growing relationships. A Harvard study interviewed 268 men and studied them over 80 years of their lives. The researchers concluded that the most important metric that led to happiness at the end of these men’s lives was not financial success or fame, but the presence of strong, long-term relationships. Warren Buffet’s advice on achieving life’s greatest fulfillment is based upon building deep, meaningful relationships with others. I find it both surprising and enlightening that one of the richest men in the world measures success by the strength of his personal relationships, not by his billion-dollar financial portfolio. My first job after residency training was purely transactional. I saw 70 patients a day, I didn’t remember patient names, and my patient visits were timed to under 5 minutes each. I was shuttled to a different clinic every week. I felt like an anonymous cog in a wheel that churned out automated and repetitive patient encounters. But then things changed. I stopped focusing on transactions and built a practice based on relationships. By prioritizing the unique needs of patients and their referring doctors, I started to look forward to going to work, my practice quadrupled in size, and my revenues doubled. My procedures, prescriptions, emails, and notes now serve a greater purpose—they are key parts of the life stories of my patients, many of whom I have known for over a decade. Through the years, I have grown to care about my patients like they are part of my family. But how feasible is it to practice relational medicine in a world that has become increasingly transactional? We can get one or two-day deliveries of virtually any item we need, we can get a burger prepared for us in under a minute, we can instantly transfer money from our phones, and we can get a ride in less than 2 minutes. We don’t require a relationship with a particular person to get what we want in minutes. The healthcare system is headed in the same direction. Urgent care centers are cropping up in record numbers so patients don’t have to wait weeks to see their primary doctor. Telemedicine companies are emerging so that patients can do instant video consults with any doctor. Locum tenens jobs are on the rise so that temporary doctors can take care of patients without delay. As society naturally evolves towards more on-demand healthcare transactions, we must integrate these new business models into a system that enhances continuity of care with a core team of physicians. We can devise ways to build better lines of communication with local urgent care centers, fully integrate our practices with telemedicine solutions, and aim to use temporary work as a stepping stone for permanent full-time or part-time positions. We cannot risk losing the powerful relationship building which lies at the heart of meaningful medicine. After all of the sacrifices to become a physician, we will become disillusioned if we define success by the fast rewards of medical transactions as opposed to the fruits of long-term patient relationships. As we look into the future, our career satisfaction as clinicians will depend on working with innovators who can satisfy society’s demand for rapid access to healthcare while protecting the sacred patient-doctor relationship. Melinda Hakim MD Source
