Physicians, Heal Thyself:  Confronting the Inconsistencies in Your Life and Practice

by The Darwinian Doctor

Discover how I addressed the inconsistencies I found between my day-to-day reality and my ideal vision for my life and practice.

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The case of the missing foley

I walked into the wrong patient’s room last week while on morning rounds.  In retrospect, it was the perfect setup.  As I hit the alcohol hand scrub before I walked into the room, the patient’s nurse stopped me for a chat.  I waved my hands around to dry them faster as she said, “He might seem with it, but he has pretty severe dementia.  Just FYI.”

I thanked her for the warning, walked in, and greeted the patient by name.  He said hello, and then I started asking him about his voiding.  He said he was “peeing just fine,” but the consult was for urinary retention, so I probed deeper. 

After a few seconds, I started noticing a few inconsistencies in the patient’s history and exam.  As I glanced down at his exposed lower extremities, I thought to myself, “Wait, I didn’t know he was missing a leg?”  As I kept on asking him questions, I wondered if he had a history of severe peripheral artery disease or trauma.

He continued to deny any issues with his urination as I thought back to his history that I’d read before rounds.  “It really didn’t mention anything about a BKA in the past… you’d think the hospitalists would have noted something like that.”

After another few seconds, it hit me that he didn’t have foley catheter snaking from his groin to a urine bag.  I rearranged his white blankets, looking for tubing as I said “Wait, where’s your foley catheter?  Did they take it out already?” 

It was only then that I had the thunderclap realization that I must be in the wrong room.  I asked the patient his name again, only to be met with a pleasant smile of incomprehension. 

Luckily, his nurse came in to administer some medications and she confirmed I was in the wrong room.  We both laughed and I apologized to the patient.  I then retreated from the room, noticing that I had misread the room number from my patient list as I walked onto the ward. 

Ignoring inconsistencies

Not everything is a profound event deserving of analysis, but as I thought about the encounter later that day, it started to bother me. 

Why did it take so many inconsistencies for me to realize that something wasn’t right?  The BKA should have tipped me off immediately, just like the dementia.  Neither one was mentioned in the patient’s history.   

But then as I thought about it some more, I concluded that it’s not surprising at all. 

After all — both doctors and humans in general are masters at ignoring the inconsistencies in our lives that offer mounting evidence that we’re on the wrong track. 

Systems versus insight

I’m sure you’ve run into a similar situation, where it was about five steps down the diagnostic pathway that you discovered you were on the entirely wrong track.  Hopefully you figured it out before you ran into as disastrous consequence!

Because in clinical practice, the stakes are dire when we ignore inconsistencies with our patients.  Someone could get the wrong medication or even the wrong procedure, leading to illness or death.  It’s only with hindsight that we can see how we were led astray, down a diagnostic or treatment path that was clearly wrong. 

But still, this happens in hospitals every day.  To catch these errors and inconsistencies, hospitals have developed safety checks and systemic redundancies, which help us catch these errors before they lead to harm.

But in our own lives, we don’t have the benefit of these systems to tell us when we’re on the wrong track.  We have to rely on our own insight.

The inconsistencies in my own life

For me, the inconsistencies started to mount a couple of years into my attending career as a urologic surgeon. 

After about 15 years of higher education and training, I was finally employed by a large medical group and making a decent starting salary.  I had a wife, two kids, and a large house in Los Angeles.  I would have had a dog too, but my elder son was allergic.  My wife and I worked hard during the week and spent our weekends enjoying the beauty of SoCal (when I wasn’t on call). 

But during the week, I was commuting an hour each way in traffic.  I was also working about 10-20 hours more each week than I ideally wanted.  My weight had started to creep up because I didn’t have time to work out and I was eating poorly.  Most nights, I’d be leaving after dinnertime, so I’d grab a burrito from the drive through and eat it one-handed as I drove home. 

My kids were happy and healthy, but I left for work before they awoke in the mornings and barely saw them when I got home at night.  Usually, they were already in their PJs and in bed by the time I pulled into the driveway. 

The model employee

At work, I was the model employee.  I had great productivity, stellar patient reviews, a low complication rate, and got along great with my colleagues.  But after 10 hours of clinic, I would struggle to review my patient emails, in-basket test results, and close my charts before my drive home.  I was often so tired that I’d lay on the floor of my office for a few minutes to catch my breath before diving back into the EMR for another hour or two before heading home.

In many ways, I had gotten a lot of the things that I’d wanted to achieve when I set out to become a physician.  I was so fortunate in all the important areas: financially, professionally, and with my family.  But something just felt off. 

Somewhere, I had gotten subtly off track from the vision I had for my life.  Now, my life was full of these glaring inconsistencies: 

On most days, I would just ignore these inconsistencies, forging on with my routine.  But as the inconsistencies grew, so did that uncomfortable feeling that something was wrong. 

The turning point

One day, I was commuting home on the 405 freeway from Irvine to Los Angeles, a drive that would routinely take me about 2 hours in rush hour traffic.  It was the kind of traffic that even having a Tesla didn’t fix. As I gripped the steering wheel in frustration, the realization hit me as surely as I knew I was in the wrong patient’s room last week: “I can’t do this for another 30 years.”

Correcting the inconsistencies

I then started the journey to correct all the inconsistencies in my life.  First, I started with the financial inconsistencies and figured out where my money was going.  I then started investing in stocks then real estate, working towards replacing my clinical income within 10 years.

Read more:

Next, I started tinkering with my work life, successively striking back against the inconsistencies of my work hours and lack of autonomy.  I was able to reduce my clinic hours by 20% and eventually became a department chief to try to optimize our work experience as much as possible.

Finally, in the biggest transformation of all, I tackled the lack of time with my family. 

I recorded my adventures on my blog, The Darwinian Doctor, for others to follow my journey.  But the cliff notes of this transformation would include these major points:

Now I’m now just a few years away from financial freedom and happily working in medicine just one week a month.  It’s almost the perfect balance of business and medicine for me, and I finally get to have breakfast with my sons most mornings. 

Your life’s inconsistencies

Are there mounting inconsistencies in the story of your life?  Are you just ignoring these inconsistencies and the voice in your head that keeps telling you that something’s not right? 

You’d never do this with your patients, so why would you do it in your own life?  The stakes are just as dire. 

Over time, the misalignment of your day-to-day life with your desired life will lead frustration and burnout.  Even worse, you may never realize your true potential in this one precious chance we get at life in this world. 

Time to get to work

I won’t say that I’ve got it all figured out.  It’s only been about half a decade since I started to noticing the mounting inconsistencies in my life and started working to correct them.  There are still things in my life that need to change.

But I’m in the fight and I’m winning. 

I also don’t want to give you the impression that you need to quit your job or start a real estate investment company like me. Everyone is different. But my message to all physicians is this: Don’t ignore the inconsistencies in your life

When you notice that you’re in the wrong patient’s room, you don’t just keep on treating them and acting like nothing is wrong.  That would be absurd. 

It’s the same thing with your life.  If you feel that something is off, it probably is.  Lean into that feeling and put some thought into why you might be feeling that way. 

Then take some action:

  • Think about alternative ways to structure your work life
  • Consider talking to a mental health professional or life coach
  • Sign up for a blog or podcast that will expand your knowledge
  • Start investing your capital to buy back your time

Just don’t ignore the inconsistencies in your life.  The stakes are too high. 

Daniel Shin, MD

The Darwinian Doctor

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Since everyone is different, it may not be appropriate to generalize my doctorly advice to your own situation. Please run all medical, life, and financial advice by your own physician or financial professionals before applying it to your own life! Consider all information for your entertainment only!

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