The "Hit By The Bus" Perspective

September 14, 2010

This week my toddler is into Mommy. My toddler wants to be by my side constantly and will strain to get out of my husband's arms in order to get to me. This reminds me of a lesson I learned about the time I finished residency and one that I try to teach to our resident physicians. I call it the "hit by the bus" perspective. The basic argument is that none of us, no matter how amazingly wonderful we are as physicians, are irreplaceable in the lives of our patients.

This week my toddler is into Mommy. It's hard to predict when one of your kids will go through the stage when you are the only parent they want. I admit, it's a bit of an ego boost. But, payback will come during the next Daddy phase. My toddler wants to be by my side constantly and will strain to get out of my husband's arms in order to get to me. "Mamamamama," he says as he toddles around the house. My arms are getting tired, but I love it. It feels good to be wanted, needed, and adored.

This reminds me of a lesson I learned about the time I finished residency and one that I try to teach to our resident physicians. I call it the "hit by the bus" perspective. The basic argument is that none of us, no matter how amazingly wonderful we are as physicians, are irreplaceable in the lives of our patients.

Now, some patients will stroke your ego with ardent praise. "You are the best doctor I've ever had." "No other doctor ever took the time you've spent with me." "I really depend on you and don't feel comfortable seeing anyone else when I am sick." All nice thoughts, but the truth is that if any one of us were hit by a bus tomorrow, life would go on for our patients and our colleagues. Within a suprisingly short period of time, another physician would step into the gap, take over care of your patients, and chances are the patients would do just fine (or continue to be stably unstable).

This insight was quite revolutionary to me as I finished my family medicine residency. I spent three years being the doctor for my panel of patients. They had my e-mail, voicemail, and pager number. I was on call for them even when I wasn't on call. It was exhausting and unsustainable. Fortunately, as I was ready to have my first child, I was also discovering that I was not the only physician my patients needed, regardless of what they may think at times.

Despite the enormous sacrifices we all make to be physicians - in terms of emotional energy, money, time, and our 20s - we are not essential to an office, hospital, health plan, university, or a patient. That is both comforting (the world doesn't rest on our shoulders) and humbling (we are not gods).

This realization allows us to properly focus our attention on those things that matter and turn away from those things that don't. For me personally, this realization allowed me to turn off my pager when I'm not on call, transfer responsibility to a colleague when I am out of the office, and not feel guilty when one of my patients has to see someone else on occasion.

Despite my expendability as my patients' physician, I am completely essential to my family. I am the only Mommy and that role cannot be filled by anyone else. So, despite the imbalance of hours that I devote to being a physician each day versus being Mommy, my roles as wife and mother are the ones that only I can do. It is essential that I do these roles well.