Lunch is for losers

Medicine is changing,” said my general surgeon father. “Medicare is not what it used to be and private insurance companies respond with three letters when I submit a bill for surgery: 1) payment pending, 2) payment pending, and 3) payment denied. This was his response in 1975 when I told him that I wanted to go to medical school. The more things change the more they stay the same.

Nearly every medical student has a little Albert Schweitzer in him or her. Like Schweitzer, they think they can learn it all and take care of everyone.  All medical students slowly realize that they need to narrow their focus and, thus, specialization occurs. Even family practice physicians are considered to represent a specialty like cardiology or radiology. Gone are the days of the true general practitioner or general surgeon who took care of everything.

I chose to become a pediatric urologist. I know, many of you do not even know that roughly 350 full-time pediatric urologists practice in the United States. In the course of becoming a surgical specialist for pediatric genitourinary issues (seven post-medical school years of training), I met all kinds of mentors along the way.  

As a third-year medical student on my first rotation, I met the chief resident, Steve. Tall and confident, he taught the other residents, medical students and me the trials and tribulations of obstetrics and gynecology.

During our first hours with him, we watched him answer pages and phone calls every two to three minutes with the ability of a master bookie. It was incredible how he could juggle it all with aplomb and control. Several times, he uttered five magic words, “Send the patient right over!” “Reisman,” he also said, “Lunch is for losers.” I quickly learned to keep cheese crackers and candy bars in my white coat pocket for the entire two months of my first rotation, and, throughout my career.

During my medical school general surgery rotations, another remarkable mentor came into my life. Ed was just three years older than me and was like John Carter of the television show ER. He was from a wealthy family that could not imagine why he would want to touch people, let alone blood, pus or feces for a living. “Reisman, (here we go again, they never called you by your first name) the highest honor anyone in this world can bestow upon you is to sign a piece of paper and ask you to cut them open with a knife and fix them. Don’t ever forget that and don’t ever complain about working too hard … you chose this.”

Getting this advice early in my medical career proved to be fortuitous.  While others complained about working hard, I never did.  Not that I liked being up for days at a time or missing family events (birthday parties, weddings, bar mitzvahs, even the funeral of my best friend’s father who was like my own father). 

Next: it is our job and our honor to give patients what they need 

But if forewarned is forearmed, then that is what I was.  I also found a very smart, very independent and very beautiful woman (if I may say so myself) to marry me. She understood me and my chosen profession and in the 33 years we have been together in medicine, she never complained once about my schedule. This relieved a lot of guilt on my part. One can see how so many marriages end when this is not mutually understood.

It took me many years to realize that my very first supervising resident’s straightforward words would set the tone of my own private practice. Steve’s perspective was clear, “Our job is to take care of the patient.” I quickly realized that taking care of the patient included taking care of their families and the referring providers’ (customers). 

My grandmother was in the chicken business for 40 years.  She always said, “You have got to know your customers.” Not every person wanted the same thing from you and it was up to you to figure out what they needed and give it to them to be successful.

I took this wisdom and applied it to medicine.  What did the customer need or want?  In pediatric specialty practice the customer was usually the referring physician/practitioner or the child’s parents, not the child.

Once I realized this, I adopted his mantra of, “Send the kid right over” and made sure my staff supported that mantra. I wasn’t like many doctors who have “gatekeepers” that restrict access. My nurse, Joanie, and the team knew that I would not be happy unless our “customers” were happy. We missed a lot of lunches, but were sustained by remarks such as “Thanks for seeing us right away. You have no idea how much this meant to us.” If I was in the operating room and none of my partners were available, Joanie, the world’s best office nurse, would “walk them over” and I would see the child in a treatment room between operations.

Perhaps, others would say that they need the down time over lunch to recharge or do administrative work. For me, it was more stressful knowing there was a patient (or customer) that needed attention. 

As physicians, it is our job and our honor to give patients and our customers what they need and what they want. Adopting this perspective will help lead to success and a feeling of satisfaction. The alternative is unacceptable.