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Dear W:

I am so glad to hear that you want to become a physician. I really am surprised at how happy I am about that. I recently have been guilty of saying that I would not do it again if I had it to do all over, but of course that isn't true. I love what I do, despite the drudgery and frustration of dealing with managed care and other obstacles regarding patient care.

You asked my opinion and advice, and I am pleased to be asked. I have to respond with some hesitation and humility, though, because I am not really a senior voice yet (middle-aged, maybe, but not senior!). I have been a physician for most of your life, but truth be told, that isn't really very long! You were a child during my residency, and your mother was my best friend and colleague. Your father faithfully brought you to the hospital for visits every time he was on call. You grew up with the sound of beepers and the smell of alcohol wipes, playing or sleeping through codes and sometimes chaos. You actually seemed to like Pediasure milkshakes for snacks!

W, I am sorry that you and other youths are coming into a world with such hatred as was shown on September 11. I guess you now know the worst about mankind, but you must try to remember there are more "good guys" than bad ones. Just look at how people have pulled together, shown patriotism, and helped each other during these unnerving times. You know, it is at a time like this that people turn for guidance to their traditional leaders and comforters: clergy, teachers, firemen, police, military, doctors, and nurses. Even more than others,these professions are called on now to play old-fashioned roles of community leadership by volunteering, comforting others, and setting good examples. A perceptive Charlotte policeman, Officer Edwin Carlton, wrote recently in Dilworth Quarterly, a neighborhood newsletter, that some people are more sensitive to stress than others and their neighbors may notice signs of depression or anxiety. Everyone needs a little support right now, and physicians are often privileged to know their patients' innermost concerns.We are in an excellent position to help recognize the more troubled folks Officer Carlton described.

You should have heard some of the heartbreaking comments from some of my pediatric patients after the September 11 attacks. On September 12, one young boy leaning against my window and looking toward uptown Charlotte said, "Excuse me, ma'am, is that New York?" The little girl after him said, "Are we too high here? Is someone going to see us?" Now, W, you may think I am rambling and I don't have a point, but it is this. I want to show you there must be time in your day as a physician to offer comfort to people. I didn't accomplish much by refilling those children's prescriptions, maybe a little, but not much. I think I did more by just talking with them about their fears and reassuring them with our shared beliefs and unity. After "Do No Harm," I think the next principle of being a good physician is "Take Time to Comfort."

During your busy clinic, try to remember to sincerely ask patients how and what they are doing. Take brief notes on what your patient says, and next time ask about his aging parents about whom he was concerned. Ask if she is still taking music lessons and how her job application turned out. This recommendation is found nowhere on the managed care documentation guidelines for "level of service," which really is just an insurance measure of billing rates. But this is the only "level of service" worth providing. You could be technically the best physician around, but if you don't take time to comfort your patients, your competence may help little.

When you go out, look around you for your patients' faces. Unless you are a psychiatrist and need to be careful not to betray confidences, nod and smile to your patients. Don't worry, they usually won't ask you medical questions (and if they do, handle it gently with a suggestion to call your office so you or your assistant can consult the chart properly). Also you won't have to remember their names; they will just be touched that you recognized and acknowledged them.

In modern times, we might underestimate it, but a physician is still very much a guidepost for his or her patients. Try to always behave in a balanced way that would allow your patients, whether you saw them in a restaurant or not, to say affectionately, "That is my doctor."

W, I know you will be a great physician. You were a compassionate and smart child and will be such a man. I am honored to share in advising you and will write again soon with more ideas.

Fondly,
Carolyn