Medical Wisdom and Doctoring (eBook)

Anchor 1 5
Anchor 2 8
Anchor 3 10
Anchor 4 14
1 15
Medical Wisdom in the Twenty-First Century 15
TODAY’S MEDICAL WISDOM, OUR METHODS OF DOCTORING, AND WISE PHYSICIANS 15
Great Doctors 16
Top Doctors 18
Medical Wisdom and the Wise Physician 19
ABOUT DOCTORING, THE ART OF MEDICINE AND SERVICE TO HUMANITY 23
ABOUT MEDICAL WISDOM EXPRESSED AS APHORISMS AND PRECEPTS 25
ABOUT MEDICAL PARADIGMATIC CHANGE IN TWENTY-FIRST CENTURY PRACTICE 27
The Democratization of Medicine 29
The Collectivization of Medicine 30
The Commercialization of Medicine 30
The Computerization of Medicine 32
The Feminization of Medicine 33
The Politicization of Medicine 34
WISE WORDS ABOUT MEDICAL WISDOM IN THE TWENTY-FIRST CENTURY 35
REFERENCES 36
2 38
Caring for the Patient 38
FIRST, BE A HEALER 39
BE SURE TO CARE FOR THE PATIENT AS WELL AS THE DISEASE 40
RECOGNIZE THE DIFFERENCE BETWEEN DISEASE AND ILLNESS 41
TRY TO “FEEL” THE PATIENT’S EXPERIENCE OF THE ILLNESS 42
THINK ABOUT THE IMPACT OF ILLNESS ON THE PATIENT 43
CONSIDER HOW THE INDIVIDUAL PATIENT’S ILLNESS AFFECTS THE FAMILY 45
SOMETIMES, THE KEY TO UNDERSTANDING THE CLINICAL PROBLEM LIES IN THE MEANING OF THE SYMPTOM TO THE PATIENT 46
PART OF CARING FOR THE PATIENT IS “LAYING HANDS” ON THE PATIENT 47
PROCEED CAUTIOUSLY WHEN A PATIENT CRITICIZES HIS OR HER LAST PHYSICIAN 47
DIFFICULT PATIENTS EXIST SO DO “DIFFICULT DOCTORS”
SOME PATIENTS WILL ALSO BE YOUR FRIENDS 50
SOME OF YOUR MOST IMPORTANT LESSONS WILL BE LEARNED FROM PATIENTS 52
DON’T DISMISS LIGHTLY A PATIENT’S RESEARCH ON THE INTERNET AND IN MAGAZINES AND NEWSPAPERS 53
GIVE THE PATIENT THE BEST DIAGNOSIS POSSIBLE AT THE TIME 54
SOMETIMES IT’S APPROPRIATE TO USE HUMOR IN THE EXAM ROOM 54
DURING THE MEDICAL ENCOUNTER, ASK THE PATIENT TO TELL ABOUT SOMETHING NONMEDICAL 56
OCCASIONALLY SHARE A LITTLE ABOUT YOURSELF 56
AVOID LETTING THE PATIENT BELIEVE THAT YOU ARE INFALLIBLE 57
SOMETIMES COMFORT IS ALL YOU HAVE TO OFFER 58
ACCEPT HOW PATIENTS WILL JUDGE YOU 58
BEWARE THE POTENTIAL FOR CARING GONE WRONG 59
BE THERE FOR THE PATIENT 60
WISE WORDS ABOUT CARING FOR THE PATIENT 61
REFERENCES 63
3 65
Clinical Dialogue and Communication 65
ALWAYS GREET THE PATIENT BY NAME 67
SIT WHEN TAKING A MEDICAL HISTORY 68
BE SURE THE PATIENT KNOWS YOUR NAME AND YOUR ROLE IN HIS OR HER CARE 68
MAKE EYE CONTACT APPROPRIATE FOR THE CLINICAL SITUATION 69
RECOGNIZE THE POWER IMPLICATIONS OF RELATIVE EYE LEVELS 70
DECIDE UPON YOUR DEFAULT OPENING QUESTION THAT BEGINS THE CLINICAL INTERVIEW 70
OPEN-ENDED QUESTIONS YIELD THE BEST INFORMATION 71
INJECT A LITTLE IMPROVISATION INTO THE MEDICAL INTERVIEW 71
THE MOST EXPERIENCED CLINICIANS WILL MAKE NO CLEAR DISTINCTION BETWEEN TAKING A HISTORY AND PERFORMING A PHYSICAL EXAMINATION 72
IF THE PRESENTING COMPLAINT SEEMS A LITTLE VAGUE, CONSIDER IF IT MIGHT BE A “TICKET OF ADMISSION” 72
LEARN THE SKILL OF ACTIVE LISTENING 73
PAY ATTENTION TO THE PATIENT HE OR SHE IS TELLING YOU THE DIAGNOSIS
LISTEN MORE THAN YOU TALK 74
WHEN DISCUSSING EVENTS IN THE PATIENT’S LIFE, HOW YOU FRAME THE QUESTION DETERMINES THE QUALITY OF THE RESPONSE 75
ASSUME THAT THE PATIENT IS TELLING THE TRUTH 76
MEDICAL WORDS CAN HAVE DIFFERENT MEANINGS FOR PATIENTS AND PHYSICIANS 77
TRY NEVER TO EXPRESS SURPRISE AT SOMETHING A PATIENT TELLS YOU 78
SOMETIMES DOCTOR AND PATIENT ARE SEPARATED BY VALUES, LANGUAGE AND CULTURE 78
DON’T BE AFRAID TO SAY, “I DON’T KNOW” 80
AVOID THE USE OF MEDICAL SLANG 80
BE SURE THE PATIENT HAS HAD A CHANCE TO SAY WHAT NEEDED TO BE SAID 81
LEARN HOW TO PRESENT A PATIENT TO A COLLEAGUE 81
WISE WORDS ABOUT CLINICAL DIALOGUE AND COMMUNICATION 82
REFERENCES 83
4 85
The Art of Clinical Diagnosis 85
THE PROCESS OF DIAGNOSIS BEGINS WITH THE PATIENT’S DECISION TO SEEK MEDICAL HELP 86
THE CIRCUMSTANCES OF THE PATIENT’S PRESENCE IN YOUR OFFICE CAN OFFER DIAGNOSTIC CLUES 87
THE ASTUTE DIAGNOSTICIAN MAKES CASUAL OBSERVATION PART OF THE PHYSICAL EXAMINATION 88
GREET YOUR PATIENT WITH A HANDSHAKE 88
THINK ABOUT WHAT MIGHT BE THE TRUE PURPOSE OF THE MEDICAL ENCOUNTER 89
THE WISE PHYSICIAN DOES NOT READILY ACCEPT THE DIAGNOSIS OF ANOTHER 90
PAY ATTENTION TO VITAL SIGNS 91
ALWAYS EXAMINE THE AREA THAT HURTS 92
USE THE PRACTICAL METHODS THAT CAN ENHANCE YOUR PHYSICAL DIAGNOSIS 92
EXPERIENCED PHYSICIANS HAVE A “STRING” OF DIAGNOSTIC PEARLS THAT HELP THEM FROM TIME TO TIME 94
BEWARE OF “PLASTIC PEARLS” THAT LINGER AS PERSISTENT CLINICAL YARNS 98
KNOW THE PATHOGNOMONIC CLINICAL MANIFESTATIONS YOU MAY ENCOUNTER 99
RECOGNIZE THE CLINICAL RED FLAGS THAT SUGGEST SEVERE DISEASE 101
BE WARY OF OVER-ANALYZING A PROBLEM 102
TRUST YOUR OWN CLINICAL JUDGMENT 103
SYMPTOMS OR SIGNS INCOMPATIBLE WITH YOUR DIAGNOSIS MUST BE EXPLAINED 104
AVOID CARELESSNESS, YOUR OWN OR THAT OF YOUR STAFF 104
TOMORROW’S DIAGNOSTICIANS WILL NEED TO MAINTAIN A HIGH LEVEL OF TECHNICAL COMPETENCE 105
DO NOT OVERLOOK THE “MUST NEVER MISS” DIAGNOSIS – THE POTENTIALLY DISASTROUS BUT TREATABLE DISEASE 105
INCLUDE THE PATIENT AS A “CONSULTANT” WHEN DEVELOPING YOUR DIAGNOSTIC IMPRESSION 107
REMEMBER THE WHIM – WHAT HAVE I MISSED? – EXERCISE 108
THE DOCTOR WHO MAKES THE CORRECT DIAGNOSIS IS THE ONE WHO SEES THE PATIENT LAST 111
THINK FIRST OF HORSES, NOT ZEBRAS 112
DON’T FORGET TO THINK ABOUT ZEBRAS 112
WISE WORDS ABOUT THE ART OF CLINICAL DIAGNOSIS 113
References 114
5 118
Disease Management and Prevention 118
RESPECT THE RULES OF SENSIBLE CLINICAL PRACTICE 118
BE A BEDSIDE DOCTOR, NOT A “FOOT OF THE BED” DOCTOR 119
INVOLVE THE PATIENT IN TREATMENT DECISIONS: WHEN REASONABLE AND APPROPRIATE 119
CONSIDER BOTH PATIENT AND PHYSICIAN EXPECTATIONS OF THERAPY 120
BECOME AN EVIDENCE-BASED HEALER: WITH CARE 120
DO NOT ASSUME THAT THE PATIENT HAS JUST ONE DISEASE 121
THINK ABOUT CLINICAL OUTCOMES AND RESOURCE USE IN TERMS OF SYSTEMS 122
ACKNOWLEDGE THAT TODAY’S FAVORED METHOD MAY BE TOMORROW’S CONTRAINDICATION, BLACK BOX WARNING, OR AMUSING ABSURDITY 123
KNOW THE QUIRKY RISKS OF MEDICINES YOU USE IN PRACTICE 125
KEEP UP TO DATE WITH POTENTIALLY DANGEROUS INTERACTIONS WHEN YOUR PATIENT IS TAKING BOTH YOUR PRESCRIBED MEDICATION AND HERBAL 131
CONSIDER THE PATIENT’S HEALTH LITERACY LEVEL 131
THE UNFILLED PRESCRIPTION NEVER HAS A CHANCE TO HELP THE PATIENT 132
THE FOUR CHARACTERISTICS OF THE IDEAL MEDICATION ARE: OLD, SAFE, CHEAP AND EFFECTIVE 133
BEWARE THE MINEFIELD OF POLYPHARMACY 134
ACKNOWLEDGE THE LIMITATIONS OF MEDICATIONS 135
OFTEN THE DOCTOR IS THE “DRUG” 136
SOMETIMES CONSULTATION CAN AN IMPORTANT PART OF THERAPY 137
THINK PREVENTION AS WELL AS CURE 139
INFORM EVERY PATIENT OF WHAT TO DO IF THINGS GO WRONG 140
NEVER END A CLINICAL ENCOUNTER WITHOUT ADVISING THE PATIENT WHEN TO RETURN 140
WISE WORDS ABOUT DISEASE MANAGEMENT AND PREVENTION 141
REFERENCES 143
6 146
Caring for Dying Patients and Their Families 146
DEATH IS REALLY A PART OF LIFE 146
THERE IS A SKILL TO MANAGING A DEATH 147
“PEOPLE DIE FROM VERY REAL THINGS” 148
THERE IS ACTUALLY A “GOOD DEATH” 149
NO DEATH IS TRULY INSIGNIFICANT 150
PATIENTS RECALL FOREVER EVENTS THAT OCCUR AT A TIME OF A DEATH 150
THE AGED OFTEN HAVE A DIFFERENT VIEW OF DEATH THAT OF THEIR DOCTORS 152
WHEN CARING FOR A DYING PERSON, SEEK THE GOLDILOCKS APPROACH TO CARE: NOT TOO LITTLE, BUT NOT TOO MUCH 153
CONSIDER THE POSSIBLE CLINICAL MEANING WHEN A PATIENT TELLS OF A DEATH, EVEN ONE THAT OCCURRED SOME TIME AGO 153
IF AN ELDERLY PATIENT BEGINS TO PREDICT HIS OWN DEATH, TAKE THE PROGNOSTICATION VERY SERIOUSLY 154
NEVER PREDICT DEATH – OR RECOVERY – TOO PRECISELY 154
RECOGNIZE THE ISOLATION OFTEN FELT BY A DYING PERSON 155
TRY TO FIND SOME WAY TO BE HOPEFUL 156
WHEN DEATH IS NEAR, YOU SOMETIMES NEED TO DO WHAT NEEDS TO BE DONE 156
AVOID EXPRESSIONS THAT CAN BE MISUNDERSTOOD BY PATIENTS AND FAMILIES 157
RECOGNIZE THAT DEATH IS NOT THE WORST THING IN THE WORLD 158
SOME OF YOUR PATIENTS WILL DIE UNEXPECTEDLY 158
SOME OF YOUR PATIENTS WILL COMMIT SUICIDE 159
BE CAREFUL WHEN INFORMING A FAMILY OF A DEATH 159
CONSIDER THE MEANING OF A DEATH TO VARIOUS FAMILY MEMBERS 160
DYING AND DEATH CAN BRING OUT THE BEST OR THE WORST IN FAMILY MEMBERS 161
REMAIN ALERT TO THE POSSIBILITY OF PATHOLOGIC GRIEF FOLLOWING A DEATH 162
RECOGNIZE THE EMOTIONAL RESPONSES OF PHYSICIANS TO THE DEATHS OF THEIR PATIENTS 163
FROM TIME TO TIME, PHYSICIANS SHOULD REFLECT ON THE BRAVERY OF THE DYING AND THEIR FAMILIES 163
WISE WORDS ABOUT DYING AND DEATH 164
REFERENCES 165
7 167
Making a Living as a Clinician 167
DO YOUR BEST TO UNDERSTAND EVERYTHING THAT GOES ON IN YOUR OFFICE 168
HIRE STAFF MEMBERS WHO HAVE BOTH PROFESSIONAL SKILLS AND A SERVICE ORIENTATION 169
TREAT YOUR PATIENTS WITH RESPECT 170
SEEK WAYS THAT PATIENTS CAN GET TO SEE YOU 171
INVEST IN THE SPACE AND EQUIPMENT YOU NEED FOR EFFICIENT PRACTICE 171
DEVELOP SYSTEMS TO MANAGE THE MOUNTAINS OF DATA 172
SEEK WAYS TO MAKE THE PATIENT’S VISIT JUST A LITTLE MORE PERSONAL AND INFORMATIVE 173
SUPPORT YOUR OFFICE STAFF MEMBERS IN THEIR DEALINGS WITH PATIENTS 173
BE WILLING TO LEARN FROM THE CUSTOMER SERVICE EXPERTS 174
LEARN TO MANAGE TIME EFFECTIVELY 175
BE AWARE WHEN YOU ARE LOSING TIME CONTROL OF AN ENCOUNTER AND THUS YOUR SCHEDULE 176
AVOID CREATING TIME PROBLEMS FOR YOURSELF 177
COMPLETE TODAY’S CHARTING TODAY 178
NOT ALL YOUR DAILY TIME WILL BE SPENT PRODUCTIVELY: AT LEAST AS WE TEND TO DEFINE PRODUCTIVELY 178
PARETO 80/20 PRINCIPLE WILL BE EVIDENT IN MANY FACETS OF YOUR PRACTICE 178
DO YOUR MOST IMPORTANT WORK AT YOUR PERSONAL BEST TIME 179
RESPECT YOUR PATIENT’S TIME AS VALUABLE 181
RESPECT THE PERSONAL TIME OF YOUR STAFF 182
ACKNOWLEDGE STAFF ACHIEVEMENTS 182
SEEK FEEDBACK FROM YOUR PATIENTS ABOUT HOW WELL YOU MEET THEIR NEEDS 183
WISE WORDS ABOUT MAKING A LIVING AS A CLINICIAN 183
REFERENCES 184
8 186
Staying Up To Date 186
AVOID PROFESSIONAL ISOLATION 187
MAINTAIN YOUR CLINICAL SKILLS 187
DO NOT COUNT TOO HEAVILY ON YOUR EXPERIENCE 188
RECOGNIZE YOUR BEST LEARNING STYLE 188
READ, READ, AND READ SOME MORE 189
LEARN TO APPROACH THE MEDICAL LITERATURE EFFICIENTLY 191
HONE YOUR INFORMATION MASTERY SKILLS 192
MAINTAIN YOUR PERSONAL REFERENCE LIBRARY, WHETHER PAPER OR WEB-BASED 195
BECOME AN INTERNET “POWER USER” 195
KEEP A NOTEBOOK (OR NOW A COMPUTER FILE) OF WHAT’S NEW IN MEDICINE 196
PERHAPS ADD SOME “GEE-WHIZ FACTS” TO YOUR “WHAT’S-NEW” NOTEBOOK OR FILE 197
CONSIDER EACH CONSULTATION AS A LEARNING OPPORTUNITY 198
THINK ABOUT WHAT YOU DO EACH DAY AND PERHAPS WRITE ABOUT IT 199
KEEP YOUR MIND ACTIVE BY THINKING ABOUT THE POSSIBLY UNRECOGNIZED CONNECTIONS IN WHAT IS SEEN EACH DAY 200
TEACH 202
WISE WORDS ABOUT STAYING UP TO DATE 203
REFERENCES 204
9 207
Mentoring Tomorrow’s Physicians 207
ADVISE THOSE YOU MENTOR TO CONSIDER OUR PROFESSIONAL INHERITANCE AND THEIR OWN EVENTUAL LEGACY 208
REMIND THE ASPIRING DOCTOR TO BEHAVE LIKE A PHYSICIAN 210
ENCOURAGE THOSE YOU MENTOR TO RECOGNIZE THE PRIVILEGES AND POWERS ACCORDED THE PHYSICIAN, AND TO USE THEM WISELY FOR THE BENEF 210
REMIND THE ASPIRING PHYSICIAN THAT MEDICINE IS ABOUT HELPING OTHERS 212
WARN MEDICAL STUDENTS AND RESIDENTS NEVER TO THINK OF MEDICINE AS A PATHWAY TO WEALTH 212
ENCOURAGE LEARNING ABOUT THE WORDS OF MEDICINE, AS VITAL TOOLS OF THE PROFESSION 213
ENCOURAGE THOSE YOU MENTOR TO READ ABOUT THE HISTORY OF MEDICINE 217
SUGGEST READING SOME BOOKS ABOUT PHYSICIANS IN LITERATURE 220
ALERT ASPIRING PHYSICIANS TO BE AWARE OF THE HIDDEN CURRICULUM OF MEDICAL SCHOOL AND RESIDENCY TRAINING 222
HELP THOSE YOU ADVISE TO SELECT A SPECIALTY FOR THE RIGHT REASONS 222
RECOMMEND THAT THE YOUNG PHYSICIAN NOT SUBSPECIALIZE TOO EARLY 226
ADVISE YOUNG PHYSICIANS OF THE RISKS OF PREMATURELY LIMITING THEIR CAREER OPTIONS 227
ALERT YOUNG DOCTORS TO BEGIN EARLY TO RESPECT PERSONAL HEALTH AS PRECIOUS 229
REMIND THOSE YOU ADVISE TO RESPECT AND HONE THEIR PHYSICAL EXAMINATION SKILLS 230
SUGGEST THAT THERE IS NO MERIT IN BEING THE SMARTEST PERSON IN THE ROOM 231
ALERT THOSE YOU MENTOR NOT TO STRAY FROM THE PATH OF SCIENCE 232
SHARE WITH YOUR ADVISEES THE TRUISM THAT WE ALL SPEND OUR PROFESSIONAL CAREERS LIVING WITH UNCERTAINTY AND GOVERNED BY THE LA 235
SUGGEST CATALOGING THE THINGS THAT OCCUR MOST COMMONLY 235
HERE IS A CHALLENGE FOR THOSE YOU MENTOR: MAKE SOCIETY GRATEFUL FOR ITS INVESTMENT IN YOU 236
THE YOUNG PHYSICIAN, AND INDEED, EVERY PHYSICIAN, SHOULD BE A PROFESSIONAL: IN THE CLASSIC SENSE OF THE WORD 237
WISE WORDS TO SHARE WITH THOSE YOU MENTOR 238
REFERENCES 240
10 243
About Your Family and Community 243
BE A GOOD LIFE PARTNER 244
NURTURE YOUR CLOSEST RELATIONSHIPS 244
TAKE GOOD CARE OF YOUR FAMILY 245
SEEK THE RIGHT BALANCE BETWEEN WORK AND FAMILY 246
WHEN HOME WITH FAMILY, BE A PERSON, NOT “THE DOCTOR” 247
ESTABLISH EARLY HABITS OF FINDING FAMILY TIME 248
SPEND TIME WITH YOUR CHILDREN 248
HELP YOUR CHILDREN LEARN TO APPRECIATE THE VALUE OF HARD WORK AND INDEPENDENT THINKING 248
TEACH YOUR CHILDREN TO BE CHARITABLE 250
CONSIDER INVOLVING YOUR FAMILY – SPOUSE AND CHILDREN – IN YOUR WORK 250
YOU WILL INEVITABLY BE INVOLVED IN THE CARE OF YOUR OWN FAMILY MEMBERS 251
LIVE IN THE COMMUNITY WHERE YOUR PATIENTS LIVE 251
SERVE YOUR COMMUNITY 252
WISE WORDS ABOUT YOUR FAMILY AND COMMUNITY 254
REFERENCES 256
11 257
Caring for You, the Physician 257
TAKE YOUR OWN PULSE FROM TIME TO TIME 258
THERE IS MORE TO LIFE THAN WORK 258
AVOID THE “GROUND-DOWN,” BURNOUT SITUATION 259
DON’T SUCCUMB TO THE DELUSION OF INDISPENSABILITY 260
BALANCE YOUR PERSONAL AND PROFESSIONAL LIFE 260
DON’T OVERUSE ALCOHOL OR TAKE SELF-PRESCRIBED DRUGS 261
AVOID PATIENTHOOD 262
EXERCISE REGULARLY 263
KEEP YOUR MIND ALIVE 263
LEARN A NEW SKILL, PROCEDURE OR FOCUS OF MEDICINE 264
READ SOMETHING NONMEDICAL FOR PLEASURE EVERY DAY 264
READ SOME OF THE GREAT PHYSICIAN–AUTHORS 266
KEEP A JOURNAL 268
CREATE SOMETHING 269
JUST FOR FUN, LEARN A LITTLE ABOUT SOME OF THE CURIOUS EVENTS IN MEDICAL HISTORY 269
FIND TIME FOR PERSONAL REFLECTION 271
CELEBRATE YOUR SUCCESSES 271
NURTURE YOUR PERSONAL SENSE OF HUMOR, YOUR “INNER CHILD” 272
SAVOR A FEW OF MURPHY’S LAWS OF MEDICINE 273
AVOID HURTFUL HUMOR 274
DON’T BLAME YOURSELF WHEN GOOD DECISIONS GO WRONG 275
LIVE LIFE TO THE FULLEST 275
WISE WORDS ABOUT CARING FOR YOU, THE PHYSICIAN 275
REFERENCES 276
12 278
Ethics, Credibility, and Trust 278
OUR CURRENT ETHICAL CODE IS ROOTED IN THE HIPPOCRATIC OATH 279
RECOGNIZE THE UNDERPINNINGS OF TODAY’S MEDICAL ETHICS 282
Beneficence 282
Non-malfeasance 283
Autonomy 283
Confidentiality 284
Truth-Telling 284
Justice 285
RECOGNIZE THE GENESIS OF ETHICAL DISAGREEMENTS IN MEDICINE 285
ACKNOWLEDGE THE ETHICAL ISSUES IN DAILY PRACTICE 286
Deciding What to Tell to Whom 286
Easing Pain but Perhaps Doing More 287
Flying the Risky Skies 287
SOME EVERYDAY ETHICAL ISSUES ARE COMPLEX AND MAY EVEN CALL FOR COURAGE 288
BE AWARE OF HOW PATIENT CARE DECISIONS ARE MADE IN YOUR DAILY PRACTICE 290
DO IN PRACTICE ONLY THAT WHICH YOU CAN BE PROUD OF DOING 291
MAINTAIN CONFIDENTIALITY EVERYWHERE 291
KEEP PERSONAL POLITICS OUT OF YOUR PRACTICE 292
HOW WE DEAL WITH ERRORS IS AN ETHICAL ISSUE 293
DO NOT BECOME THE “SECOND VICTIM” OF A MEDICAL ERROR 295
A CLINICAL ERROR CAN BRING PROMPT USEFUL CHANGE 296
DO NOT LIGHTLY CRITICIZE JUDGMENT DECISIONS MADE BY ANOTHER PHYSICIAN 297
PROTECT YOUR CREDIBILITY AS A PROFESSIONAL 297
RESOLVE TO AVOID THE CLINICIAN’S DUMBER ETHICAL MISADVENTURES 298
NEVER CLAIM KNOWLEDGE AND SKILLS BEYOND YOUR TRAINING AND EXPERTISE 299
NEVER JEOPARDIZE CREDIBILITY AND TRUST BY ENGAGING IN ANY TYPE OF PROFESSIONAL MISCONDUCT 300
Alcohol and Drug Misuse 302
Sexual Abuse of Patients 303
Dishonesty and Dishonorable Behavior 305
ALWAYS PRACTICE IN WAYS THAT INSPIRE TRUST 307
BE WORTHY OF THE TRUST PATIENTS PLACE IN YOU 309
WISE WORDS ABOUT ETHICS, CREDIBILITY, AND TRUST 310
REFERENCES 311
13 315
Planning for Tomorrow 315
TOMORROW CAN BE DIFFICULT TO PREDICT 315
RECOGNIZE THE LIFE CHANGES THAT LIE AHEAD 316
RECOGNIZE THE STAGES AND THE TRANSITIONS IN YOUR OWN PROFESSIONAL LIFE 317
PREPARE TODAY FOR TOMORROW’S PRACTICE OF MEDICINE 319
LEARN THE INFORMATION TECHNOLOGY SKILLS YOU WILL NEED IN YOUR FUTURE PRACTICE YEARS AND IN RETIREMENT 321
PIONEER TOMORROW’S PRACTICE 323
PREPARE FOR THE FUTURE BY ASSURING THAT YOU CAN AFFORD THE OPTION OF RETIREMENT 324
Here Are the Answers to the Questions Above 326
MAKE PEACE WITH THE LIMITATIONS THAT COME WITH AGING 327
ADJUST YOUR PRACTICE TO YOUR TOLERANCE AT EACH STAGE OF LIFE 328
DON’T CONTINUE PRACTICE AFTER YOUR SKILLS HAVE WANED 330
LEARN THE ART OF RETIREMENT 331
RESOLVE TO LEAVE MEDICINE WHEN THE TIME IS RIGHT FOR YOU 332
PLAN WHAT YOU WILL DO WHEN YOU AREN’T PRACTICING AT ALL 333
STAY INVOLVED WITH MEDICINE AND OTHER PHYSICIANS IN RETIREMENT 334
DON’T SPEND SOME OF YOUR BEST YEARS WAITING FOR DEATH 335
WISE WORDS ABOUT PLANNING FOR THE FUTURE 335
REFERENCES 337
14 339
Wise Physicians, Twenty-First Century Challenges, and Doctoring 339
RECOGNIZE THE CHALLENGES OF TWENTY-FIRST CENTURY PRACTICE 340
Managing the Evolution of Technology in Medicine 340
Being Sensitive to the Pervasive Influence of Financial Considerations in Healthcare Delivery 341
Recognizing Your Epiphanous Moments When They Occur 342
Seeking Personal Simplicity in an Increasingly Complex World 343
Remembering That, Even in the Most Troubled Times, We Are Privileged to Practice Medicine 344
SOME MUSINGS UPON COMPLETING THE MANUSCRIPT FOR THIS BOOK 345
WISE WORDS ABOUT WISE PHYSICIANS AND DOCTORING 345
REFERENCES 348
15 349
Epilogue 349
TO REALIZE ONE’S DESTINY IS A PERSON’S ONLY OBLIGATION 349
REFERENCES 351