With the end of my second year quickly approaching, I took time during my winter break to reflect. One strategy I use in preventing burnout and staying focused is to organize my thoughts and give myself some context: why am I here, and what do I hope to accomplish?
The Merriam-Webster definition for the word medicine is “the science and art dealing with the maintenance of health and the prevention, alleviation, or cure of disease.” A physician would be defined as a person qualified to practice medicine.
For physicians to train and maintain licensure, America has set up a system of required board exams to ensure there is a standard for understanding medical practice that American physicians adhere to. Board exams for practicing physicians focus on the standard of care for managing patients with disease, catered to the particular specialty a physician is practicing.
However, the first board exam focuses on what many would call the basic sciences fundamental to the practice of medicine. The first board exam, Step 1, tests medical students’ knowledge of normal physiology, the mechanisms of pathology, and associations between particular diseases, pharmaceuticals, and demographics. This exam focuses on foundational understanding of how the body works, so that in the next stage of training learning how to manage a variety diseases in diverse populations is able to be grasped. As one UABSOM professor (and board question writer) explained, Step 1 questions are fundamentally designed to differentiate between the marginally informed and the truly knowledgeable.
The Merriam-Webster definition for the word knowledge is “the fact or condition of recognizing something with familiarity gained through experience or association.” Health is an inherent part of life. While optimal health varies between individuals, health in general is what drives life forward. Without health, life ceases to exist.
The same cannot be said for disease; yet, overcoming adversity is also what makes life what it is. The beauty within life is survival. Even what can be perceived as sickness could be adaptive depending on context. An adaptive strategy for one environment could be sickness in another.
Sometimes the priority for a person with a disease becomes finding the best way to survive. Physicians know a lot, but they do not know everything. However, a good physician can know what quality of life looks like if truly attentive. Part of the training of a physician means attaining the knowledge of what can be fixed, and having the wisdom to know what cannot be cured. Furthermore, even though there is not always a cure, physicians can still do so much to help optimize quality of life.
All of these ideas factor into the importance of understanding pathophysiology. In the emergency setting, this understanding helps individuals overcome any of the many environmental factors that immediately threaten their life. In the chronic disease setting, this understanding helps individuals achieve joy despite obstacles and hardships that a chronic disease can impose.
With a high quality of life, everyone is capable of contributing good. If every part of an organism is functioning at optimal capacity, the organism as a whole thrives. On an individual basis, being as healthy as one can tends to make living life so much more joyful. It is important to understand that if one is a living human being, they should be afforded health, simply because that is a part of life.
The Merriam-Webster definition for the word understand is “to be thoroughly familiar with the character and propensities of.” Achieving competency in all of the different cultures in the healthcare setting is extremely difficult, but is crucial to practice medicine as effectively as possible.
Understanding each individual is important because it heightens the level of trust between the physician and patient, allowing for better communication of critical information. Furthermore, there are some cultures where particular therapeutic strategies are not accepted. Respecting a patient’s autonomy should always be the first priority in these cases. Understanding the true mechanisms of disease, therapeutic strategies, and the culture each patient identifies with is the means by which a healthy quality of life can be re-established.
As the lead of the healthcare team, a truly knowledgeable physician will have no fear in handling any situation. Being able to understand multiple perspectives is what brings forth wisdom and understanding of the mechanisms of disease. This is important to put together all the complexity present in a real human-being. The wise physician catches all of the “zebras” because reaching the proper diagnosis requires not only pattern recognition, but also conceptual understanding of human physiology (common disorders can present atypically, and atypical disorders can present commonly).
Ultimately, the wise physician is able to provide peace to the patient by explaining the disease and the therapeutic plan. The ability to explain complicated pathology to all types of patients requires a deep level of understanding. This ability is what differentiates a good doctor from a great doctor, and it helps the patient believe in the doctor for a favorable outcome.
The Merriam-Webster definition for the word believe is “to have a firm conviction as to the goodness, efficacy, or ability of something.” As stewards of science, professionals in the healthcare field are passionate about pursuing truth. And the truth is the that the best economic strategy for any society is for everyone to be healthy.
A culture of health can be achieved through policies that encourage healthy lifestyles (including accessibility to healthy food choices, exercise, and regular doctor visits). Physicians can play their role through good clinical practice. That is why learning the mechanisms of disease the first time around is so important: it lays the groundwork for understanding why another diagnostic test may be more appropriate and knowing the right time to start a specific treatment.
Scientists play their role by identifying novel techniques for diagnosis and treatment. Furthermore, they achieve deeper understanding of disease mechanisms that are not well defined. Not every patient presents the same, and not every patient responds to all treatments the same. Advancing personalized medicine can not only save more lives but also improve the quality of life for patients facing illness.
Lastly, community education is critical. Far too many people are not fully aware of steps they can take to achieve their optimal health. This is where physicians can provide a critical link in the full circle of health promotion and disease prevention. Again, a teacher is only as good as his or her understanding. Professionals in the healthcare field should provide the facts for people to be able to choose healthy lifestyles based on their beliefs and values.
As physician-scientists in training, we have the unique privilege of learning how to preserve the health of the world through medicine. Life is a molecular miracle, so it is important to do everything possible to optimize that.
“This all I’m tryna do, hustle and motivate” -Nipsey Hussle
-Lamario Williams, MS-2