Advice for an aspiring physician

Dear Student Dr. Steele,

I thought perhaps you were meant to be a doctor the day you first listened to the dog’s heart with your Playskool stethoscope. I knew you were meant to be a doctor the day as an emergency medical technician in college you called all excited about your patient with the screwdriver sticking out of his head. (You did the right thing not pulling it out, by the way.)

You will be a fourth-generation physician, the latest to express the strange gene running through your family tree that makes for liking fractures, pus, skin rashes, screwdrivers sticking out of heads, and the poor souls who suffer from such maladies. As you start your second year in medical school, here are “Medical Student Rules for my Daughter.”

. Don’t tick off the nurses. (Actually, this piece of advice comes from your grandmother, a nurse.) Without nurses watching like hawks, you and your patients are hanging out on a clinical limb. You want nurses telling you what they think, making sure you ordered the right dose of the medication, and willing to insist you pay attention when they think you are missing something important about the patient.

. Related: Forget the idea of the heroic physician all alone between the patient and doom. The best physicians lead teams, and don’t act as though they are THE team.

. Don’t take anything from the pharmaceutical companies. If you accept their gifts, in return they get your attention, your bias, and some of your decisions in their favor. Physicians (including me in the past) have sanctimoniously denied they were being influenced by these gifts, but study after study has shown we were flat-out wrong. Your generation should end this embarrassment of our profession.

. Embrace the idea of computers in medicine and clinical guidelines that tell you what to do in certain situations. If you use such tools to remind you to do things you should be doing anyway, you can memorize less and think more, and provide better care for patients. The generations of physicians before you have often dismissed this as “cookbook medicine,” resisted hard-wired safety measures as insulting, and fought to preserve physician decision-making autonomy at all costs. The greatest cost has been borne by our patients, for whom we have too often forgotten key elements of care and sometimes harmed with preventable errors.

. Listen to the moms when they tell you they know something is really wrong with their child, even when they seem like alarmists. They are often right, not because they know a lot about illness, but because they know a lot about their children.

. Be humble despite your extraordinary talents. Just when you think you are God’s gift to medicine, you will screw up and your fallibility will take you down several pegs. If you are lucky, it will not take one of your patients down, too.

. Never, ever, be lax in your care of patients. You can cut corners almost everywhere else in life, but not in medicine. You may forgive yourself for mistakes made in ignorance, but not for mistakes you made because you were lazy or careless.

. Remember that being a great doctor does not make you a great spouse or parent, or even a great person. Those are different jobs requiring different skills. Your white coat at home is just another piece of laundry, the world is not your operating room, and your stethoscope is not the key to the entire kingdom.

. When you make a mistake and you are certain you harmed a patient, to heck with lawyers and fear of being sued; tell the patient and apologize. Many patients may forgive you for harming them, but few will forgive you for hiding the truth.

. The smartest docs know what they don’t know and get expert help when they need it, whether in a diseased abdomen, affairs of the heart, or at home.

. Thank the housekeepers and other staff who cleaned up after you today. Better yet, pick up a mop and clean up after yourself occasionally. Five minutes in someone else’s worn shoes will teach you more than any medical book.

. Wash your darn hands. We in health care are killing patients with our carelessness about this simple, crucial task.

. Respect bloody needles and other sharp tools of your trade – a careless second with one could give you or a colleague a life-changing disease.

. Treat those afflicted with addictions to alcohol or other drugs with compassion and respect. There but for the grace of God and good luck could go you or yours, and some of my best friends are addicts.

. Take a moment to give thanks every day for the privilege of being a physician in the service of others. You will never want for purpose or value in your life, never have a day that does not remind you of the magnificence of human beings if you look for it, and you will rarely want for the respect and appreciation of others. On top of that, you get paid well for the work. You will work harder for all of this than most can imagine and sacrifice more than most others ever would.

. Finally, always remember how proud we are of you, and that when you place your stethoscope over the patient’s heart, the hands of your father, grandfather and great-grandfather are there gently on yours.

Erik Steele, D.O., a physician in Bangor, is chief medical officer of Eastern Maine Healthcare Systems and is on the staff of several hospital emergency rooms in the region.