My Favorite Visit: “25 Minutes with More than 50% Spent on Counseling and Education”

I only applied to one medical school. Maybe that was hubris, but I didn’t think so at the time. Then, in a moment of sudden insecurity, I asked myself, “what if I don’t get accepted?”

During the six months between my military service and the beginning of classes at Uppsala University I worked as a substitute teacher in my home town, teaching second to eleventh grade depending on where there was a teacher out on sick leave. I loved it, the lower and higher grades the most, ninth grade the least.

I love explaining things and reducing seemingly complicated matters to easily understood fundamentals – things like good fats and bad fats, comparing the human body to cars or household appliances, simplifying drug math by using dollar bills, twenties or coins for comparison, and so on.

When that thought of not getting into medical school struck, I knew in my heart that the thing I was put on this planet for was to help people understand and do better – whether as a doctor or in some other teaching capacity. I could of course resign myself to reapplying to Uppsala until I got in or consider the almost-as-good (there is a longstanding Swedish rivalry here) Karolinska Institute in Stockholm.

I think it was useful for me to have that insight, especially since I had the vision from early childhood, reinforced by parents, teachers and everyone else, that I was going to be a doctor. It was like I couldn’t really explain why until I thought “what if I couldn’t be a doctor?”

It became clear to me that my desire for a career in medicine was because it would allow me to teach, coach, explain, motivate and guide fellow humans in medical matters. I never fantasized about heroic procedures or brilliant diagnostic victories – I have since understood they are usually a little too infrequent to sustain a doctor week after month after year.

“Helping people” is often cited as a motivator for becoming a physician, but I don’t think that is precise enough. “Repairing their body parts”, “comforting them and relieving their suffering” or “helping them understand their options” are more likely to translate into professional satisfaction.

In today’s medical practice environment, there are plenty of opportunities to do what I enjoy the most, and I receive plenty of positive feedback for doing it. My favorite compliment is probably “Nobody has ever explained it like that before”.

I have no sympathy for the mechanistic notion of being reimbursed depending on how many body systems were queried in the Review Of Systems or clicked off in the Physical Exam. I mean, the template for a urinary tract infection visit in one EMR includes a notation that the pupils are round, reactive to light and accommodation. How silly is that?

For at least Medicare patients, I can comfortably and in good conscience charge a 99214 for simply sitting down and explaining diseases, testing strategies and treatment options for what ails my patient. I can explain how to lose a pound a week without feeling hungry or the real reasons people get heart attacks or how moderate chronic hypertension compares with not upshifting to fifth gear on the highway.

I could talk about things like that all day long, and I do, and I get paid for it.

Medicine is fascinating, and sharing the medical knowledge that is relevant for everyone who walks through my door makes every day rewarding; it is what has kept me satisfied and stimulated ever since I started classes at Uppsala University 46 years ago this month (I was accepted) – a timespan that is almost hard to comprehend.

I love my job.

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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.


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