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Reflections after 52 years

I am now 52 years post-medical school graduation and have practiced Allergy in Pittsburgh for 45 years. During my sojourn in this medical career, I have taken the opportunity on three occasions to look back and reflect on where we have been, where we are going and what it all means – a pontification of sort. I now am seeing patients two days a week … when we are not in lockdown … so consider myself still practicing actively. I am living proof that if you live long enough, there is no end to the surprises that life may have in store for us. So, I thought I would make effort number four of philosophizing.

I thought it might be interesting for younger colleagues to see what observations I made in previous writings. In 1991, in an article in the ACMS Bulletin, I listed some of the wrenching changes that were occurring in the practice of medicine but optimistically concluded: “With no conceit intended, let me say that there is nothing more satisfying, more demanding, more important, more emotionally rewarding than the practice of medicine. The one-on-one daily contact with our patients, the intellectual challenges, the demands of constant learning and growth, are unsurpassed in any other field. Ours is still among the noblest callings, and physicians must still work constantly to earn our patients’ trust and confidence. … Our children need not be discouraged from such a rigorous and rewarding calling. The rules of the game have changed and the innovations of the next 20 years will be logarithmically more wrenching, but the physician’s role as a compassionate caregiver should be just as necessary and just as fulfilling.”

Fast forward to 1998, again in the Bulletin, I commented on the advent of managed care and computers in our practices. I then concluded: “As I age, I realize more and more that the practice of medicine is like running a marathon. It is a lot about putting one foot in front of the other, showing up in all kinds of weather and persevering through a lot of adversity. It means pushing oneself daily for the principal, and helping our patients cope with their personal, physical, and psychological needs. It means being there for them, ignoring the pummeling from insurance companies, the media, the myriad of other distractions. It means trudging on through thick and thin, carrying the mantel that was bestowed upon us, and being worthy examples for the next generation of those lucky enough to be called physicians. The rewards are plentiful in personal satisfaction and patient gratitude, in dealing face to face, one on one, with people who need us, who can teach us a lot about life and our own mortality.”

And in 2001, in a somewhat lighter vein, in a personal narrative published in the Medical Economics Journal, I discussed how adding music to my life, learning how to play the cello, provided a “source of inner tranquility, a sense of serenity and harmony … an ideal antidote for the stresses of modern medical practice.”

So now, in 2020, who could have anticipated the stresses brought on by the COVID-19 virus: a pandemic of severe illnesses and deaths, the wearing of masks and face shields in patient encounters? These surpass all of the wrenching challenges that came before … and the astronomical demands being made on young physicians as they strive heroically to go about their work are unparalleled. Additionally, financial pressures on office practices have never been seen like this before. From my perspective, it appears that the new breed of young physicians have risen magnificently to the challenge. They are bright, determined, dedicated. And as I concluded in my remarks in 1998: “This next generation of physicians are the brightest, most talented, worldly, idealistic, and altruistic group. Their patients will treat them with the same trust, respect and love that our patients have given to us. The bottom line is, and will be, that our patients continue to need us and want us to provide compassionate and unfailing support as they navigate the uncertain waters of illness. We must not squander that trust.”

After 52 years, I remain optimistic. We will survive these latest uniquely devastating circumstances. Someday, we will look back on this period as a crisis which was met and successfully overcome! And life will go on.

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