One of the beauties of being a physician is that not only does your world encompasses the clinical aspects of health, but also involves many other disciplines as well. Often people assume that a doctor’s influence ends at the clinic or hospital door, however that is far from the truth. Promoting health is a very comprehensive idea and much of what we can do for people has nothing to do with seeing them face to face.

The thing that has me jazzed the most right now is work that I’m assisting with in northern Haiti. Haiti is the poorest country in the western hemisphere and one of the poorest in the world. I visited there last year with a medical mission and we conducted a clinic in one of the rural areas close to the Dominican border. No medical professional had been to this area of Haiti in 20 years! Needless to say we encountered people with very significant health issues. This next week I return to the same part of the country with a group associated with the children’s hospital of Port-au-Prince and the goal of establishing a sustainable clinic in the area, potentially continually staffing the clinic with doctors and residents. Going into these needy areas of the world and being able to use the influence and knowledge that comes with being a physician is incredibly rewarding. Even if I never see a patient in Haiti again, the infrastructure we create will help people for years to come.

Another area outside the mainstream of clinical medicine is medical research which really boils down to determining the causes and treatments of disease. This has not been a large part of my career up until this point, but I am now actively working on a few projects. The prospect of figuring out something new, or finding the answer to some problem, is a very gratifying endeavor which many physicians end up spending all or a significant part of their careers pursuing.

Public health, advocacy, medical informatics, drug & device design and medical education are all other avenues which a physician can influence the world beyond their clinical duties. Each doctor seems to find his or her passion in something, hopefully something great!

This is a question that I’m often asked when talking to future physicians or people in general. Medicine has gone through some impressive, dynamic changes in the last ten to twenty years, even more since I started down this road. I truly believe that the next ten to twenty years will be even more incredible. From my experience the age of genetics, stem cell therapy, nanotechnology, robotics and information technology is quickly approaching and will forever change how physicians work with and treat their patients.

Genetics and Stem cell therapies have the potential in the next two decades to change the natural history of diseases that we have accepted since the beginning of medical care. I would be very surprised if in twenty years Cystic fibrosis, Type 1 Diabetes, Sickle Cell and other disease like them, are not just treatable, but curable. Nanotechnology is at such an early stage that it’s nearly impossible to imagine what wonders it may bring about. Two intriguing ones already being planned are artificial oxygen transport vessels that may replace the need for blood transfusion and artificial bacteria that search out and destroy germs invading our bodies. Robotics are already making their way into surgical centers around the world where doctors hand movements are being translated with millimeter accuracy through a robot that actually does the cutting in the operating room in front of the surgeon (or through links thousands of miles away). But what excites me the most is the use of information technology and artificial intelligence in medicine. At its heart medicine really is an IT technology and the possibilities of complex algorithms finding patterns in the vastness of available data may be the single most dynamic change in the care of patients in the next few decades?

So then what will be the role of physicians in the future? Well, the day of the solo community physician really is coming to a close. The sheer complexity and diverse nature of medical knowledge and it’s delivery in the 21st century cannot be easily done by one person alone. Specialization has become more and more commonplace even within specialties themselves. I ran into a pediatrician the other day who lists his title “General Pediatrician with special expertise in pervasive developmental delay in Asian children”. More and more surgeons specialize in just one or a few surgeries. That all being said, the core parts of what defines a physician are not going to change. A compassion for humans and a desire to heal. So the physician of the future will likely face a world filled with complex medical therapies which he or she will act as a partner with patients (and computer systems) in making decisions about possible pathways to choose. This is much different than the patriarchal doctor of the past, with the emphasis on science, outcomes and support rather than intuition, hierarchy and god-like power.

When people have asked me what it takes to be a physician, I usually tell them that there are three things that every doctor must have. And no, being scared of blood is not a deal breaker. Three out of the six people who did their surgery rotation with me in medical school fainted at one point or another. They’re all physicians today! One turned out to be a surgeon himself!

The first thing you have to have to become a great physician is a love of learning. If I go back and count all of my years of formal education it comes to a total of twenty-three. But that number is deceiving because when you decide to become a physician, your education never stops. This may sound trite, but it’s actually required by all the specialties of medicine under Continuing Medical Education (CME). So nearly every day as a doctor is spent learning new things. If that’s something you don’t love, it won’t come easy.

The second thing a doctor must have is a love of science. Medicine today is not based nearly as much on personal experience as it once was. Health care revolves around evidence-based practices that have been developed from scientific studies. This is a good thing because the outcomes for patients have dramatically improved by using scientific reasoning. Not only this, but much of the understanding of how the human body works is based in anatomy and physiology which is of course one of the disciplines of hard core science. Most of a student’s time is spent in these and other scientific courses such as physics, math and chemistry so if you don’t have a grasp and enjoyment of science from the outset, imagine how hard it will be to force yourself into something that doesn’t come naturally.

The third and probably most important thing that you should ask yourself prior to going down the path towards an MD degree is “Can I commit my life to caring about others?” This sounds like an easy yes or no question, but behind it are issues that will shape your life forever. To become a physician is to put other’s interests before yours. That means that you might end up working long, strenuous hours sacrificing parts of life that others take for granted. You will be put into situations where you have to choose: Am I going to be lazy, scared, intolerant or distant from my patient or am I going to do everything in my power to help them live the life they want. Obviously, putting the patient first means putting your life second. Before you start down this path, you should ask yourself honestly: “Am I capable of giving up what I want for what others need?”

Every doctor has a story of how they ended up in medicine. Mine goes like this. My parents instilled two things that looking back now were probably the reason I was drawn to become a physician. From my father I inherited the love of problem solving. A lot of the clinical part of medicine depends upon applying scientific reasoning to problems and then finding patterns within information to arrive at a plan.

From my mother I inherited the love of helping other people. There are a lot of things in life that can make someone feel good about themselves, but I am yet to find something that trumps the high that I get by making someone else’s life better.

Technically what got me into medicine were hours of studying and a little luck. In my college 1000 students started as pre-med freshman year and around 40 actually went. It’s just not worth it unless it’s a burning desire in your heart. There is the classic joke though “What do you call the person who graduates last in his or her class from medical school…? Doctor of course!” And although the strain of residency has abated somewhat in the last 5 years or so do to changes in work hours, becoming a doctor is just the beginning. I did my residency at Stanford and although I loved my program there were definitely times when everyone sat back and said to themselves “Is this really worth it?” The answer for me was always yes, but sometimes it was difficult to say that out loud. And I surely don’t underestimate how much luck had to play in the process. I happened to choose great schools, meet great mentors and avoid any horrible life tragedies. Luck did seem to come much more frequently the harder I worked though. It still does. [I love this sentiment. It’s so true and often forgotten!]

First of all you might be wondering what a pediatric hospitalist does. Prior to about 10 years ago, when a child became ill enough to require hospital admission, their pediatrician would place them in a hospital and then manage their inpatient care accordingly. However, both the pressures of increasingly complex inpatient medicine as well as financial changes in how pedestrians are reimbursed have opened up an emerging specialty of general pediatricians who only take care of patients in the hospital. That’s me. Thus, when a pediatrician or emergency room doctor has a sick patient, they call me to accept this patient to be managed under my care in the hospital.

Now what kind of life does that mean for me? A great one. I have the wonderful job of helping take care of very sick babies and children and through my team of medical students, residents and consultants hopefully making them better again. At Lucile Packard Children’s Hospital at Stanford, we have a very diverse group of patients which means that I get to take care of extremely complex cases as well has patients from all walks of life (ethnicity, socioeconomic status, culture or education). What makes my job so amazing is that no matter where the patient comes from or what problems they have had in the past, when they reach me; we do everything we can to get them back to where they need to be.

My job really consists of three parts. The first is daytime service where my team and I round each morning on our group of patients and make decisions about what course of action we are going to take to improve their care. The second is night time call, where I serve to supervise the overnight issues of the hospital’s patients and deal with acute issues that invariably arise. The third part is education of the medical students and residents which is actually a lot of fun, helping people move along their chosen career. I work between 40 to 60 hours a week depending on what is happening — although that doesn’t account for most of the extra things that we do such as administration and education. When you find a job you like, you end up spending a lot of time on it even after work. It’s fun after all!