A Country Doctor Writes:

“Once you start studying medicine you never get through with it.”

Dr. Charles Mayo

Marcus Welby, M.D. was 62 in the first episode of the TV series. My father, not a physician, retired at 62. As I am now beginning my sixty-second year, I seem to be thinking a lot about my place in time and in medicine.

Thirty years ago people often told me I looked too young to be a doctor, and I felt I had to work extra hard to seem wise. I developed a habit of carefully explaining what I understood of each patient’s condition, what I saw as the options for further testing and treatment, and what I expected the outcome to be. I also made a point of being respectful and seeking out each patient’s views and preferences.

That is still how I work, but I have found that over time, as my appearance more and more plainly suggests my years in the business, patients are more and more willing to take my advice with fewer explanations. They are also more openly seeking my opinions, support and advice in matters that go beyond the purely medical aspects of life.

It is an honor and a humbling responsibility to be in that position. It comes from not only looking like you have lived through a lot, and I have, but also from being privileged to see up close the joys and travails of so many fellow human beings.

Few professions see as much of the human condition as we physicians, and especially in these secular times, our role can sometimes have similarities with that of the village priest, especially because we deal with matters of birth, life and death.

Early on, I wrote a post titled “The Apostolic Nature of Our Profession”. The older I get in my vocation, the more I see of that; I feel more kinship and indebtedness to the ancient physicians and to my own mentors that guided me to where I am now, and I feel more tangibly the responsibility that goes with years of practice, suddenly graying hair and the earnest requests from some of my patients to fill their archetypal need for the services of a physician.

At the same time, I feel a strengthening of my desire to understand more of medicine. This truly is a lifelong pursuit, and every year I know more, but also wish for deeper and deeper knowledge than I have achieved. Dr. Charles Mayo said it succinctly in the quote above, and Sir William Osler elaborated eloquently:

“The hardest conviction to get in the mind of a beginner is that the education upon which he is engaged is not a college course, not a medical course, but a life course, for which the work of a few years under teachers is but a preparation.”

Like Osler, I believe medicine is a genuine calling for many physicians, but unlike him, I believe it can be practiced into old age, as long as we have the physical and mental vigor this kind of work requires.

I bring the enthusiasm of a young man and the experience of a sixty-one year old to my remote clinic five days a week, and most nights and weekends I read, think and write about doctoring.

I hold these words by Dr. William Mayo close to my heart as I imagine myself following in the footsteps of mentors like my senior colleague Dr. Wilford Brown, III:

“The keen clinician, as he grows in experience, becomes more and more valuable as age advances.”

In order to be as valuable as I can be to my patients thirty-five years after medical school, I need to read a lot. I need to read the major medical journals not only to learn what applies directly to my everyday work, but also to be cognizant of how the basic sciences are evolving. I need to translate my life experience and what I have learned from well over 100,000 patient encounters into a language with many dialects that I can use in familiar and unfamiliar situations with patients from a multitude of backgrounds. I need to continually learn about psychology, philosophy and religion in order to be a support to patients who face life altering circumstances and diseases.

I need to maintain my equanimity through busy clinic days in our tumultuous national health care environment, so that my patients don’t become pawns in the system any more than they have to. I need to maintain my sense of proportion in everything I do: in differential diagnosis, in helping patients set priorities, in managing agendas imposed on me by “the system”, and in my own expectations as only one mere human.

This is what I hope to continue to bring to work with me every day for as long as I can do it well.