In the Business of Medicine, Be Your Own Boss

As medical students, we exist between two worlds. On the one hand, we’re tasked with learning as much as we can about the practice of medicine from our preceptors, many of whom have decades of experience. On the other hand, we’re always thinking about our place in the future of medicine and fantasizing about what our unique style of practice will look like. While I feel indebted to the seasoned physicians who graciously give of their time to teach us, a recent interaction reminded me that I am the boss of my own practice of medicine.

It started out as a morning just like any other. I needed to finish rounding on my patients before a noontime meeting where I was slated to give a small presentation. The last patient on my roster had been particularly troublesome for our service. She had been admitted for worsening congestive heart failure and although she was relatively young, and had a very supportive family, she did not seem willing to make any of the lifestyle changes that would improve and possibly prolong her quality of life. Nurses, doctors, and respiratory therapists had been trying to get her to wear her CPAP mask during this hospitalization, but for reasons that we didn’t completely understand, she had been refusing to wear it for the past two months.

After a quick exam and what seemed like a futile imploration to try her CPAP again that night, she started telling me a bit about her life prior to becoming ill. I knew the time was coming closer and closer to my meeting, but I couldn’t leave while she in the middle of divulging such personal information. Our conversation dwindled, and I stepped toward the door, when she tearfully mentioned that her dog had recently died. Again, my thoughts drifted toward the upcoming meeting, but I also wanted to be sensitive to this very meaningful event in my patient’s life. Trying to be polite, I asked when her dog had died.

“Oh, about two months ago,” she replied.

I paused. “Is that about the time when you stopped wearing your CPAP mask at home,” I asked.

She stopped to think. “Yes, I think it was exactly around that time.”

Thinking that the timing of her dog’s death coinciding with when she stopped using CPAP might be more than coincidental, I offered my condolences for her loss, and assured her that I wanted to come back later in the day to talk more about her dearly departed pet. I felt relieved to see that I had only run a minute late, so I hightailed it to the meeting. As I stopped to pick up the materials for my presentation, I heard my attending calling my name from the hallway. I couldn’t wait to tell him that I had stumbled upon a very useful piece of information to help us understand why she stopped using her CPAP machine.

“I know I’m a minute late-I got stuck with our patient,” I explained. “I couldn’t just couldn’t leave when she started talking about her dog who recently died, but I may have a clue as to why she won’t wear her sleep mask.”

He looked dismayed. “You have to figure out how to get out of those conversations,” he told me curtly. “That’s just the business that we’re in.”

His last words “the business that we’re in” struck me so profoundly that I can still replay them in my head as clearly as if he was standing right across from me. I have not had a temper tantrum since childhood, and yet, in that moment, everything inside me wanted to shake my head and bang my fists in passionate disagreement. I understood immediately that whatever business this physician is in is not the same business I’m planning to go into. As a student, I still have a lot to learn, but one thing I know for certain is that patients should always take precedence over meetings. After all, without fostering the relationships we have with our patients, medicine would be a business in bankruptcy.

Medicine has a rich history of being passed down from generation to generation, but like anything else, aspects of medical practice may become antiquated. As the next generation of physicians, it’s up to us to hone our judgment and decide whether we will accept the status quo or make a new path forward. We get to decide what the business of medicine means to us. Whether we work for a large corporation or go into private practice, each one of us is a boss-in-training of our own future practice. It took some not so sage advice from a preceptor to remind me that meaningful and collaborative relationships with my patients are the cornerstones of my business of medicine.


Photo credit: Christophe BENOIT

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