The 50 Things I Believe in Medicine

Inspired by a recent post by John Mandrola, I thought I would share the 50 things I believe in medicine, as a family medicine doctor and health coach. Check out his article below:

These are my 50 beliefs in medicine:

1. Healing can’t happen if you and the patient haven’t built a bond.
2. A treatment is only as good as the patient’s belief in it. That’s why placebos work.
3. Using placebos in medicine is ethical and it can be done with amazing results. I can be 100% upfront about it with my patient.
4. Just because it’s medicine it doesn’t have to be macabre. My patient and I can have amazing conversations, even about the most serious topics.
5. Humor is my antidote to the traditional stale doctor’s appointment. You’ll know about my cooking and rock climbing escapades and I want to see the silliest photo you took of your cat.
6. I don’t patients come to me because I have the answers. They come to me to help them make the best decision given the many good options they have.
7. Medications only work when they are given to people who have the adequate pre-test probability to benefit from them.
8. The best way to lose a patient’s trust is to give an answer before really understanding what their fears are.
9. AI is great. I use it every day. Kind of like the Google searches before it. And the library index cards before that. And the librarian before that.
10. Reading more journal articles won’t make me a better doctor. In fact, more clinical knowledge makes makes me less connected to my patient. It’s understanding my patient that’s so powerful.
11. I don’t have a physical practice. I’m all virtual. For some people virtual medicine is like fake fruit in basket – just decorative. For others it’s the best invention in medicine.
12. I love technology. Not robotics surgery or the latest wearable. I love texting, sending audio and video messages to my patients. Sharing fun presentations with them about their labs.
13. Preventing a disease is not the same as screening for it. Even when I say this, the penny usually doesn’t drop, even for physician colleagues.
14. I went to UCLA for medical school. There, you learn all the latest and greatest research. If you couldn’t recite the most important studies on a topic, you got scolded. But you know what, that doesn’t help patients feel better.
15. Patients come to us not for drugs or a blood test, even if that’s what they request. They come to us to feel better or ease a fear.
16. I practice 20 hours a week of clinical medicine and I practice being a better doctor the other 20 hours.
17. Arguing with other doctors about clinical facts is an easy way to waste an afternoon. Sharing what we’ve learned from our patients in the past week is amazing.
18. Speaking of alcohol, it isn’t “bad.” Studies and beliefs about it change all the time, and it remains part of our culture. My job is to help the wine aficionado find the healthiest way to keep it in their life.
19. Car accident death risk in any given year: 12:100,000. Influenza death risk in any given year: 1.5:100,000.
20. It’s very rare that a CT or MRI will give me valuable insight into my patient’s medical condition. It’s even more rare that it will change their health trajectory.
21. 90% of my patients don’t know that the same lab test, prescription, and MRI could be had 8x cheaper if they didn’t use insurance.
22. People often worry about health problems that rarely cause real harm, yet they are unaware of the risks that matter most for them.
23. A good diet and gym membership is a far, far, far better investment for health than health insurance.
24. Health insurance is not health. This often is a late, unfortunate realization for many once they are already admitted to the hospital.
25. I can prescribe a medication in about 3.5 minutes. Teaching someone the nuances of lifestyle change takes 90 minutes. The second approach is far more effective, and the first one is more lucrative.
26. I can’t sell health to anyone. Least of all to someone who doesn’t believe they can be healthy.
27. Defensive medicine is at the heart of poor patient care. In my own cash-based online practice, defensive medicine takes up very little space.
28. What I love about my primary care doctor is that she listens. It took me 2 decades to realize that’s what I need to do.
29. I work best with patients who share a similar approach to health as I do. A better doctor could probably handle anyone with any perspective.
30. I don’t take health insurance because I want to be richer. I took a 50% pay cut because I don’t believe I could make much of a difference in the health insurance world.
31. If most Americans are dissatisfied with US healthcare, then I probably need to do things in a different way to get a better result.
32. Health is rarely a priority until it can’t be ignored. Just as wealth is rarely a priority until it’s desperately needed.
33. I take most of my patient calls as I go for a stroll. Takes more focus but is better for my body. And now my patients do the same.
34. The perfect medical practice doesn’t exist. But if my patients are for the most part feeling better and taking fewer meds, that’s success.
35. The less seriously I take myself the closer I feel to my patients.
36. My patients rarely come in with their apoB or Lp(a) levels, even though that’s the standard of care. That means that the standards are perhaps really low.
37. When I get the question, is keto better or mediterranean, I usually ask for what. The answer then is, for better health. Then we start defining what health is. That’s when it gets really juicy.
38. I have a network of colleagues who practice medicine all over the world. And I’ve collected patients who live all over. This has made me a much better doctor.
39. I don’t know how some of my colleagues juggle a patient panel of 2,500. I can’t genuinely know more than 250 people.
40. I used to refer to specialists and have them manage my patient’s special condition. Now I use specialists as a way to guide our care. Same thing, but just better results.
41. In a 10-minute appointment time with a doctor you have only enough time to get a script for a medication and a lab test. That’s not what I want for my own health.
42. Surgeries are miracles in medicine. It’s knowing when to avoid them that makes all the difference.
43. My patient’s health preference is more more important to me than knowing their name. It’s the biggest identity and the biggest driver of how well or poorly they’ll do.
44. The hardest part of being a primary care doctor is knowing when to just step back and not do anything.
45. The best gift I can give patients is hope and optimism.
46. Peptides, PRP, stem cells, and IV vitamins are tools. For the right job, they are likely game changing. I’ve yet to meet a patient in my practice whose health was transformed because of it.
47. If a surgery costs too much in the US, there is always Mexico. Canada. Spain. Germany. Netherlands. Turkey. Thailand. Indonesia. Australia. Iran.
48. Many of my patients came to me after they unsuccessfully tried to be their own doctor.
49. Doctors are my favorite patients because they know better than anyone that you can’t be your own patient.
50. Nutrition is like clothing. We all need it, and there are endless ways to make it work. But the GAP will tell you that this season you must have the fire red crop top.

Happy Thanksgiving.

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