The Marriage of Idealism and Realism for a Young Physician

June 8, 2011

Our newest Practice Notes blogger, Dushyant Viswanathan, discusses his experience moving from medical education into residency and the emotions that developed within him.

The practice of medicine is an art, not a trade; a calling, not a business; a calling in which your heart will be exercised equally with your head.
-William Osler 

Like many young physicians, I was inspired by the anticipatory idealism implicit in premedical and medical education, and the prospect of a life as a healer. Quality education, pre-eminent standing in the community, opportunities to distinguish oneself in academics, the excitement of clinical research, job security, and the opportunity to be intimately connected to the lives of thousands of people all are idealistic undercurrents that fueled the more than sixteen years of education and training I've undergone. A successful life of action and doing something great have always been goals of mine, although admittedly I have entertained several different definitions of "success" over the years.

It was only after my internal medicine residency that this idealism was tempered with a healthy dose of realism. The world I, as a young physician, encountered after residency was fraught with difficulties and dangers. After the bureaucratic issues of licensing and certification were addressed, I approached my first application for liability insurance with a bit of naiveté. Liability. An issue I had previously viewed as unnecessarily excessively present in the immediate awareness of my teaching attendings during residency suddenly loomed on my consciousness like the specter of a long-suppressed insecurity. I realized I needed to know what I was doing. So I tightened up my documentation and carefully read what the federal medical boards specifically required of licensed physicians. I stopped taking new outpatients (to the detriment of my income) and spent time orienting myself to an EHR and crossing my t's and dotting my i's on the charts of all my patients.

The middle men of medicine - insurance companies, HMOs, hospital administrators, pharmaceutical companies, recruiters - were an added irritant. They, in addition to all the subtle difficulties of evidence-based medicine (such difficulties include guidelines based on expert opinion and not on trials; results of trials one year contradicting the results of similar trials the next; the constant changes, updates, and the general overabundance of information) served to complicate my early experiences working with patients. I was introduced in a visceral way to the perils of the real world of the physician, and I had to search deeply within myself to remember my innate idealism.

I became constantly reminded of my own limitations: the complexity of the human experience of my patients, of their suffering and struggles, far surpassed the rather superficial perspectives afforded by medical school and residency. I began to draw from my own experience, understanding, and compassion as much as drawing from my scientific medical background. True humility was born within me. As my ego calmed down from the growth it experienced through medical school and residency, kindness in my heart burgeoned, and became an hourly practice-in-action. I was beginning to experience what Osler was talking about in the above quote.

In this blog I will write about what I know and what interests me. Besides being a hospitalist and internist, I also have a decade of experience working as a physical trainer, also having studied yoga, pranayama, and meditation for many years. My vision for the coming years is to develop a house call practice and continue to growing into an excellent practitioner.

I am off to a good start, let me say. I say so because my patients tell me so. They seem to do well overall, and perhaps we can attribute clinical improvement, aka healing, to a plethora of factors. The process of healing, the unending learning process as a doctor, expostulations on comprehensive therapeutics, and the central role of communication in the practice of medicine are all topics about which I am passionate, and about which I enjoy writing.

To learn more about Dushyant Viswanathan and our other Practice Notes bloggers, click here.