I’m obviously a big fan of reflective writing and of “advice columns.” So, when I got a submission that combines the two genres, and was written by an internal medicine resident, it was impossible not to share.
I’m still a Medical student and I read so many articles and comments where everyone “analyses” and points out the challenges and the stagnation of medical practices. I’m sure it’s a reality and it sounds so scary! I would love to see articles describing how we are moving from “challenges”, and “we need to do this or that” to “this is what we’re doing”, “these new things are happening for our future doctors in residencies, etc”. Innovation shouldn’t be only happening in medical research. I want to be excited to push through med school which is pretty hard in itself!!!
As most of you are aware, I hold doctors with the highest regard. While I had a general understanding of the knowledge and challenges they face, my admiration for them has only grown since embarking on this journey of reading, learning, and witnessing the depths of their training. I am in awe of individuals who dedicate their lives to a noble pursuit, even if it entails immense challenges and sacrifices.
However, I am deeply saddened to observe the attempts of AI to infiltrate the medical field and assume the role of patient care providers. It is beyond comprehension how AI can possess the knowledge, emotions, and compassion that are essential for effective patient care. The thought of AI replacing human physicians is deeply concerning.
Ours is the greatest Profession. Over the years we get to establish hundreds/thousands of meaningful relationships. Most of us, on a daily basis, interact with 20-40 unique individuals - patients and co-workers. Our work is important - making sick people well, and keeping healthy people healthy. To our collegues we are Scientists. To our Patients we are Caregivers and Counselors. Confidants and Clergy. We are respected, appreciated, and well compensated.
Always keep perspective. In the words of one of my colleagues "It is better to be rounding, than to be rounded upon."
As you perceptively note, illness exposes the fragility of the human condition and moves patients to seek the advice of a trusted medical advocate. That advocate will then ideally seek a diagnostic and therapeutic approach that optimizes the patient's outcome. That approach, however, may be influenced, consciously or not, by incentives to maximize income, RVUs, or protection from medicolegal liability, any or all of which may run counter to the patient's best interests.
These conflicting incentives will lead to moral distress or injury which the physician will be at great pains to avoid.
Emulate useful behaviors is good advice but I think the missive to not emulate bad behaviors must be included as well. The affective states of envy and resentment can develop in a group of very busy, overworked, highly competitive doctors.
They might be really good clinicians and otherwise relatable.
If they are above you, endure them and get away. If they are colleagues avoid them.
Too bad these student are matched to the allopathic form of medicine and never get any exposure to alternative and proven healing methods that do not incorporate endless drugs.
Well, if the naturopath I reached out to would actually respond to a medical student ... I did offer to shadow them in my break! So take it from me, naturopaths don't want medical students in their offices, so blame the complimentary medicine practitioners, not the medical students... I tried
An Enthusiastic and Optimistic View of That Space-Time Parenthesis Called Residency.
From the other side of that experience, I now see more clearly the gaps we’ve yet to bridge. One of the most significant? The fading transmission of the true "art of medicine."
Too often, we prioritize doing "our job," checking off boxes, adhering strictly to guidelines, and fulfilling industry-driven standards of care. While these are undeniably important, they shouldn't come at the expense of the humanistic, creative, and intuitive sides of medicine.
It’s time for change. It’s time to reshape how we prepare our future specialists.
We need to revive curiosity, critical thinking, empathy, and innovation—not just clinical efficiency.
Patients know when a physician is just doing their job rather than practicing the art of medicine. It’s demoralizing and dehumanizing. Thank you for your reminder.
I wish I had written that during my training because it all fits. One of my stellar mentors reminded me that I would have to work with some jerks. Do your best to remember that you can really learn a lot from them on how not to do it.
The part about residency I remember well is how each year I felt like I finally got fairly decent at each step: being a doctor (great! now you have to supervise the med students and first years), running a team (great! now you have to go back to being on the bottom of the specialty team), then finally being the motor of a specialty team (great! now we spit you out and you go back to the task of a first year resident except with no supervision). Not bad training for life: two weeks after you feel you have accomplished the bare minimum of competence, it's time to move on to our next activity!
What is your plan for after residency, Yianni? Are you hoping to do a fellowship, become a hospitalist, or do the most rewarding thing of all: primary care?
Good luck to you! Please remember to look critically at what you're taught, and even what you read in esteemed journals. There are conflicting agendas in medicine, as in life. Thank you for the walk down memory lane; be appreciative that IM did away with every third night call. Ha! :)
I’m still a Medical student and I read so many articles and comments where everyone “analyses” and points out the challenges and the stagnation of medical practices. I’m sure it’s a reality and it sounds so scary! I would love to see articles describing how we are moving from “challenges”, and “we need to do this or that” to “this is what we’re doing”, “these new things are happening for our future doctors in residencies, etc”. Innovation shouldn’t be only happening in medical research. I want to be excited to push through med school which is pretty hard in itself!!!
As most of you are aware, I hold doctors with the highest regard. While I had a general understanding of the knowledge and challenges they face, my admiration for them has only grown since embarking on this journey of reading, learning, and witnessing the depths of their training. I am in awe of individuals who dedicate their lives to a noble pursuit, even if it entails immense challenges and sacrifices.
However, I am deeply saddened to observe the attempts of AI to infiltrate the medical field and assume the role of patient care providers. It is beyond comprehension how AI can possess the knowledge, emotions, and compassion that are essential for effective patient care. The thought of AI replacing human physicians is deeply concerning.
I love that quote by Jean-Claude Larchet-thanks!
We are truly fortunate.
Ours is the greatest Profession. Over the years we get to establish hundreds/thousands of meaningful relationships. Most of us, on a daily basis, interact with 20-40 unique individuals - patients and co-workers. Our work is important - making sick people well, and keeping healthy people healthy. To our collegues we are Scientists. To our Patients we are Caregivers and Counselors. Confidants and Clergy. We are respected, appreciated, and well compensated.
Always keep perspective. In the words of one of my colleagues "It is better to be rounding, than to be rounded upon."
Wise beyond your years.
As you perceptively note, illness exposes the fragility of the human condition and moves patients to seek the advice of a trusted medical advocate. That advocate will then ideally seek a diagnostic and therapeutic approach that optimizes the patient's outcome. That approach, however, may be influenced, consciously or not, by incentives to maximize income, RVUs, or protection from medicolegal liability, any or all of which may run counter to the patient's best interests.
These conflicting incentives will lead to moral distress or injury which the physician will be at great pains to avoid.
I wish you best of luck and every success!
Thank you Dr. Seiden! Thanks for reading!
This is a fantastic article. My time working in medicine supports this.
Insightful and beautifully written. Reminds me of some reflections I had 30 years ago: http://userwebs.inreach.com/famdoc/artfulscience.html
Emulate useful behaviors is good advice but I think the missive to not emulate bad behaviors must be included as well. The affective states of envy and resentment can develop in a group of very busy, overworked, highly competitive doctors.
They might be really good clinicians and otherwise relatable.
If they are above you, endure them and get away. If they are colleagues avoid them.
Don’t forget the nurses! You need them as much as they need you. Much can be learned from an experienced nurse who is there for you and the patient.
1000%! Very true
Amen. Nurses are equally important imho.
BEAUTIFUL! You give me hope for the future of medicine.
Thanks for reading and for the kind words Jim!
Too bad these student are matched to the allopathic form of medicine and never get any exposure to alternative and proven healing methods that do not incorporate endless drugs.
Well, if the naturopath I reached out to would actually respond to a medical student ... I did offer to shadow them in my break! So take it from me, naturopaths don't want medical students in their offices, so blame the complimentary medicine practitioners, not the medical students... I tried
An Enthusiastic and Optimistic View of That Space-Time Parenthesis Called Residency.
From the other side of that experience, I now see more clearly the gaps we’ve yet to bridge. One of the most significant? The fading transmission of the true "art of medicine."
Too often, we prioritize doing "our job," checking off boxes, adhering strictly to guidelines, and fulfilling industry-driven standards of care. While these are undeniably important, they shouldn't come at the expense of the humanistic, creative, and intuitive sides of medicine.
It’s time for change. It’s time to reshape how we prepare our future specialists.
We need to revive curiosity, critical thinking, empathy, and innovation—not just clinical efficiency.
Patients know when a physician is just doing their job rather than practicing the art of medicine. It’s demoralizing and dehumanizing. Thank you for your reminder.
I wish I had written that during my training because it all fits. One of my stellar mentors reminded me that I would have to work with some jerks. Do your best to remember that you can really learn a lot from them on how not to do it.
It's rare to hear from a Dr who writes so well. Both you and Dr. Cifu are terrific writers! Best of luck to you Yianni!
Thank you and thanks for reading Sabrina! I appreciate the kind words! :)
This was a beautifully written piece. I bet your patients are super lucky to be under your care. It comes through in your writing.
The part about residency I remember well is how each year I felt like I finally got fairly decent at each step: being a doctor (great! now you have to supervise the med students and first years), running a team (great! now you have to go back to being on the bottom of the specialty team), then finally being the motor of a specialty team (great! now we spit you out and you go back to the task of a first year resident except with no supervision). Not bad training for life: two weeks after you feel you have accomplished the bare minimum of competence, it's time to move on to our next activity!
And a great reminder that the more we learn the less we know.
What is your plan for after residency, Yianni? Are you hoping to do a fellowship, become a hospitalist, or do the most rewarding thing of all: primary care?
Hi Dr. Bates! Hematology/oncology fellowship is the hope.
Good luck to you! Please remember to look critically at what you're taught, and even what you read in esteemed journals. There are conflicting agendas in medicine, as in life. Thank you for the walk down memory lane; be appreciative that IM did away with every third night call. Ha! :)
Well, good luck to you! I hope you get exactly the fellowship you're hoping for.