Robert Hogue, MD, TAFP President

Words of Wisdom
Weighing the frustrations against the joys of practicing medicine

Over the last three months, I have had the privilege of teaching a third-year medical student from UTMB in Galveston. He is doing a primary care rotation, sharing the time with a local internist and pediatrician. This time has served to remind me of the great opportunity we have as physicians to influence the future of medicine. Hopefully, he will look strongly at choosing family medicine as his career field. Even if he decides to go into some other specialty, I believe he will have a greater appreciation of what family medicine offers to the quality as well as the continuity of our patients’ medical care.

As we spend time together, it is often hard not to discuss the problems that we face as physicians in these uncertain times. Everywhere I go, I am engaged in conversations about Medicare fee reductions, harassment from insurance companies and issues regarding the complexities of managed care. The continuing rise of malpractice insurance premiums or even its availability seems to, at times, consume our daily energy. The HIPAA implementation and fear of not complying with its rules causes all of us anxiety. So what are we to say when these young, innocent and excited students ask us how we like our work?

Perhaps we should be more like the optimist who fell out of a 10-story building. As he passed the second floor he was heard to say, “Safe so far.” While I don’t believe we are doomed, I do believe our outlook makes a major difference in our outcome. I believe it is true that our perception becomes our focus, and our focus then becomes our reality. So as we go forth in our daily lives, let us remember that the longer we dwell on our adversities, the greater is their power to control us. Thus our focus is important in every area of life. It determines whether we reach our goals or if we crash land in disaster. When we have a tendency to be discouraging or gloomy about the future of medicine, we should be like the student in the science class.

During a lecture on science, the instructor asked the student, “This gas contains poison. What steps would you take if it should by chance escape?”

“Long ones,” came the reply.

So from a practical aspect, what can we do about all the outside influences that seem to hinder us from delivering compassionate, high-quality care for our patients? Perhaps we should be more like the cook from the elite neighborhood.

She was said to make the best hash ever. It was a culinary gem. She managed to raise hash from the lackluster dish it is to one of gourmet brilliance. The cooking editor of a local daily paper approached her for the secret. She smiled with appropriate Irish modesty and gave this analysis, “Beef ain’t nuthin’. Seasonin’ ain’t nuthin’. Onions, them ain’t nuthin’, too. But when I throw myself into the hash, that’s what makes it what it is.”

Now is the time to throw ourselves, individually and collectively, into creating our destiny. We can no longer afford the luxury of hoping that others will look out for our best interest. We must understand that time must be spent, letters must be written, phone calls must be made, and yes, even some money must be spent if we are to validate our claim for our future. It will take a commitment of action, not just of words. As opportunities arise, please make yourself available to be a part of the team that will be making the difference.

The new legislative session is upon us. It is imperative that we communicate with each other and with our legislators. If you personally know your representative, senator, or both, please contact Tom Banning or Greg Herzog at the TAFP office to inform them. You can serve as a TAFP Legislative Ambassador. Perhaps you can spend a day at the Capitol being the “Physician of the Day.” It is an excellent opportunity to demonstrate our willingness to serve as well as speak to many key legislators. The AAFP Web page has a legislative link that makes it easy to contact your national senators and representatives. As can be clearly seen by the recent election, grass roots activity can make all the difference in the outcome. Albert Einstein said, “The world is a dangerous place to live not because of the people who are evil but because of the people who don’t do anything about it.”

So, what would I say to the young medical student? There are challenges in any field of work. In few other life endeavors, however, can there be the challenge of managing a complicated medical problem, the excitement of bringing new life into this world, the satisfaction of helping the quality of life of an elderly patient, or the fulfillment of the gratitude shown by the family for whom you now care for five generations. Let us be the ones who will make life better for someone. We will then be like Harry Truman who said, “I come to the office each morning and stay for long hours doing what has to be done to the best of my ability. And when you’ve done the best you can, you can’t do any better. So when I go to sleep I turn everything over to the Lord and forget it.” Let us just be sure that we have actually done the very best that we can.