I wanted to be a doctor ever since I could remember. My father was a kidney specialist. I admired everything about the way he practiced his profession: the intellect, the seriousness, the nobility of sacrifice for others, his unrelenting work ethic, and the respect and deference afforded him. Did he “pressure” me into medicine? He had a very strong personality. He knew I had the academic aptitude to succeed in medicine. Perhaps he might have leaned on me if I had not already been so enthralled by his example. He would have been pushing on an open door. I wanted to be just like him.
Medical and Business Degrees
In my younger years it was always about achievement: president of my high school, magna cum laude at an ivy league college, acceptance to an elite med school. But even that wasn’t enough. In addition to being a dedicated physician, my father had also become a brilliant businessman. In fact, he became a transformative figure in American healthcare. He urged me to enroll in the Penn Med/Wharton School combined MD/MBA program. So I did that too.
Choosing to Become a Pediatrician
I assumed that when it came time to choose a specialty I would end up in Internal Medicine like my Dad. That seemed to be where all the smart, serious minds were. But I was in for a surprise when I left the classroom and entered the hospital in my third year of med school. My first rotation was in Pediatrics. I fell in love with it. All of it. The patients, the families, the medicine. I had naively thought that doctors for kids must somehow be less serious and more childish. Of course I was completely wrong. The clinical interactions were often light-hearted and fun. But the medical decision-making was high-stakes and deadly serious. I have never regretted my decision. I’ve heard it said that you don’t choose to become a pediatrician. You realize that you are one.
But upon completing my pediatric residency training in Philadelphia, I still felt constrained by the boundaries of specialty training in the US. I longed for the old days when intrepid doctors (like my Dad) did rotating internships before they chose their specialties. I identified a mission hospital in Kenya and pledged the following year of my professional life to them.
My Year as a Physician in Kenya
That African experience was both overwhelming and exhilarating. Of course I was assigned to the pediatric ward. Yet, even there, the local diseases and conditions made me feel as if my prior American training was useless. But when I was on call nights and weekends, I was expected to manage all the patients in a 400-bed hospital. I was called for difficult deliveries and even learned to do Cesarean sections. My qualifications were strained even further in the management of orthopedic and other trauma surgeries.
Initially, my unfamiliarity and incompetence flooded me with feelings of regret and inadequacy. But over several months, I regained some footing and began to learn to manage the patients under my care with increasing degrees of confidence. Frantically searching for an IV and successfully giving a life-saving blood transfusion to a toddler ravaged by malaria was a profound, almost spiritual experience. Paradoxically, the fact that death was so common made every life saved feel so much more meaningful. Despite my subsequent 20 years of medical practice in the US, I don’t believe I have ever accomplished as much (or felt as rewarded) as I did during that single year in Kenya.
But I always knew that I was an American doctor with an American life and an American family. So I returned to the US (Chicago) for additional training in Emergency Pediatrics. While I loved interacting with children, I knew that primary care pediatrics was not my strength. I liked the excitement and quick decisions in the ER.
Fellowship Training in Chicago
Pediatric ER requires fellowship training in an academic medical center. It was there that I was given first-hand exposure to medical research. I loved the process. Thinking of a research question, designing and implementing a study, analyzing and interpreting the results, and publishing a manuscript.
When I worked in Africa, very few of my patients spoke English. I relied heavily on interpreters. I often wondered how much my medical care was being compromised by the language barrier. On the north side of Chicago, I decided to make this my primary research focus. Of course there were important differences. The primary language creating a barrier for me (and many other doctors I worked with) was Spanish. And the medicine practiced in the US was very different from Africa. But a common question remained, “How was medical decision-making affected when a language barrier introduced additional uncertainty to the visit.” I discovered that the effect was even greater than I expected. Doctors ordered more tests, gave more IV fluids, and even admitted patients to the hospital more often when a language barrier existed. This work was used by administrators and policymakers nationwide to prioritize the inclusion of medical interpreters into every encounter where they could help.
Fellowship training in Chicago also prepared me for another component of academic medicine: teaching. Clinical medicine and research each provided different forms of gratification. But teaching was different still. My own practice was shaped by bedside encounters with attending physicians that I respected and admired. Of course a good teacher will provide pearls of wisdom that a trainee will incorporate into their own approach. Really great teachers also help their students develop their own intuitions, practice styles, and confidence. While a detailed lecture or PowerPoint presentation might convey the same information, there was no substitute for time in a clinical setting, with actual patients.
When I took a position in Denver in 1999, I intended to round out my academic career as a clinician, researcher, and teacher. But my MBA also positioned me to add the “quadruple threat” of a significant administrative role. This began as Medical Direction of a few satellite urgent care centers. Eventually, I also moved into the position of Medical Director of the main hospital ER.
Those were all places on the hospital’s organizational chart. But an even greater academic responsibility resided in the position of Section Head of Pediatric Emergency Medicine in the Medical School. At the time of my appointment, I became one of the youngest faculty members leading an academic section in the Department of Pediatrics.
Moving Forward Now
My addiction ended that rather accomplished and promising academic medical career. But it has not ended my love of clinical medicine. And it certainly has not diminished my desire to take care of kids. The criminal and regulatory consequences of my prescription writing have been severe. But returning to active practice has remained my goal.
At the onset of the COVID epidemic, I donated my time and training to a general urgent care clinic. After several years on the sidelines, it felt great to be contributing again. The work was overwhelming at times. But to hear families say, “Thank you for your service,” was as satisfying as any moment in my entire medical career. I will probably never resume that academic career. And I’m totally OK with that. My recovery has taught me how to simplify and enjoy what I have always liked most about my work.