A Glimpse Into My Future

Shadowing a pulmonologist (and one of my medical school instructors) today was very much like watching the 1993 NBA playoffs: I stood in awe of greatness. While I have described and hear others describe “great physicians,” I don’t find it customary to refer to “greatness” in any physician which seems more like an act of hubris than a compliment. However, the greatness in which I could find grounds for hero worship is less related to the pulmonologist’s considerable skill and sharp mind than it is to the large combination of factors that come together to create great patient care. Never in any of my many hours shadowing physicians have I found such a convincing endorsement of a particular field than in shadowing this physician.

There are many things in the doctor’s approach that are admirable. She works in multiple clinical settings and is acutely aware of small but important details in the workings of each setting that can be improved upon. The patients really like her: similar to the cardiologist I shadowed during my first year of medical school, this doctor’s patients readily volunteered their admiration and appreciation for her excellent rapport and successful outcomes. She pays close attention to details and seemingly unrelated mysteries: one patient had unexplained hypotension that was being treated with three diuretics (including a new one added on by the patient’s primary care physician recently), but the pulmonologist discovered that she had recently changed the face mask for her CPAP (continuous positive airway pressure) machine for her sleep apnea.

The patient had been using an old, broken mask that may not have been functioning properly, resulting in hypertension (high blood pressure) seemingly resistant to her previous treatments. Thus, it’s possible that she was being overtreated, and her blood pressure was now alarmingly low.

The patients themselves and the diseases they experience greatly affect the doctor-patient interaction. Unlike the common heart diseases I saw in the cardiology clinic last year, the pulmonary diseases these patients experienced (primarily asthma and COPD) are very symptomatic and very noticeably reduce quality of life. Being an asthmatic myself, I understand what it is like to not be able to breathe, and so I have great amounts of sympathy and empathy for these patients. Aware of their disability and suffering, these patients are a lot more focused on treating and fixing the problems so that they can live normal lives again. Furthermore, the action plans given by asthma specialists to their asthmatic patients seems to truly empower the patients into monitoring the status of their lungs and to prevent severe exacerbations. I had the opportunity to interview one patient alone, and for the first time, I actually enjoyed and was intellectually stimulated by “office-based” practice.

I learned a lot from this physician today, giving me a glimpse of my future career. I will be shadowing and working with more pulmonologists over the next few months in my (sparse) spare time, but as time goes on, I am leaning more towards this field over others (including cardiology, the other main contestant, and infectious diseases, neurology, etc.). A few other gems:

• I do want to work in academic medicine, especially for the teaching aspect. Additionally, I am interested in research, possibly of the clinical outcomes variety (to which the pulmonologist helped me find the right words) and trials of new therapies. My research interests are less in basic science and the etiology of diseases and is more towards the action-oriented nature of discovering new therapeutics, new diagnostic methods, and improving clinical practice.

• It’s a relief to discover that I don’t need to be doing basic science research to be in academic medicine, and that at least in Pulmonary and Critical Care Medicine, the clinical service can bring in more money for the institution than basic science research might. If I chose between an M.D. and a Ph.D., I would always choose the M.D. It’s really all about bringing money to the institution in which one is employed, and for the types of research I am interested in, I will have to make sure that I go to institutions that share those interests (e.g. clinical trials, clinical outcomes, health care delivery improvement, drug trials, etc.).

• After seeing both healthy and sick patients in the clinic today, it’s remarkable how much the quality of life improves with pulmonary care. And the patients are very aware of this fact, and their approach and relationships with their physicians adjust accordingly.

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