Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

Challenges, Choices, and Changes


CHALLENGE yourself to be a lifelong learner—make CHOICES in your career that make you HAPPY, and use the CHANGES in your personal life to inform and enrich your work.



There are lots of challenges in clinical medicine each day—difficult patients, time constraints—but arguably the biggest is the hurdle of becoming a lifelong learner and keeping up-to-date as your career progresses.


At first

Early in one’s career the learning process is easy—there’s SO MUCH you don’t know—every day there’s a new disease to read up on, a treatment modality you haven’t tried. Your training gives you a solid fund of knowledge, but learning the art of practice consumes your early years.


15 years later

As time goes by, you turn to journals and conferences, and then one day you’ve been busy practicing for 15 years, and all of a sudden it’s a lot harder to remember things you haven’t seen in a while—that’s when it becomes a challenge to continue to learn and stay at the top of your game .


Two tips

I’ve utilized two things to help my memory and ongoing learning in practice. The first isn’t medical at all—I do the NY Times Crossword Puzzle every day. The puzzle has taught me how to think outside the box. This has been an invaluable skill when I’m presented with a tough clinical case—like a diagnostic dilemma referred by a colleague or another patient. Often when that happens I ask the patient to re-tell me the story of their illness, but to leave out what other doctors thought was wrong, or what consultants tried, so that I can bring a fresh look to a new problem.


The other technique I learned from one of my mentors—the great Dr. Fred Heldrich.  Dr. Heldrich was a big believer in being an astute examiner and learner. He told me to write down bullet points. When he first shared this with me I didn’t really understand it—but years later started applying his method at conferences and lectures. The basic idea is after hearing a lecture, or sitting through a whole day’s worth of CME at a conference, to take a few minutes to write down just three take home points, or things to look at later. To this day I have a copy book of pointers on my desk that I refer back to from recent conferences. It keeps me on my toes and always gives me something new to share with my patients or learn about.



In a medical career we’re all confronted with lots of choices—whether to be a surgeon, or not; whether to work with children, adults, or both; whether to do research, or not; whether to be an administrator or a clinician. These are all important choices, but I’d like to suggest you choose to be HAPPY.

Happy doctors are successful doctors. After all is said and done, we spend more time at work than we do with our families, or on vacation, or for that matter on a hobby you enjoy. So pick things to do at work that make you happy. I love talking to people—it makes my day to walk into a room, see patients I know, and catch up with them on how their lives are going and find out how I can help them that day. So I’ve chosen to do primary care where I spend my days with my very large extended family of patients.

I also love to teach—and so over the course of my career I’ve had the opportunity to teach residents, med students, nursing students, NP students, triage nurses, and in my later years I’ve taken to mentoring the younger clinicians in our office. These choices have made me happy in my work and helped me practice quality medicine.

So—choose things to do at work that make you HAPPY.



So much has changed in the 31 years I’ve been practicing. When I started practicing we had three vaccines—whole cell DPT, oral polio, and MMR—now we have more than twenty. There were no cephalosporins. We had a new inhaled medicine for asthma—Albuterol—that had just replaced the standard of using epinephrine, susphrine (long acting epi), and Theophyllin —unimaginable. There was no MRSA and there was a new virus killing gay men—the HTLV3 virus—we did not yet know it was a retrovirus, and had not yet named it HIV. We could talk about the changes in medicine for days—but instead I’d like to talk about the changes in my own life that made me a better doctor.


Becoming a parent

The first change was becoming a parent. I remember walking into an exam room shortly after returning to work after the birth of the first of my four children. It was a well-baby visit. I looked at the young child on the examining table and said, “Hi honey,” and stopped cold in my tracks. I realized that I’d never spoken to a baby that way before—but that I was addressing her the way I talked to my own Sarah. I decided that was a good thing and went on with the visit. Being a parent taught me how to talk to children. Residency taught me the pediatric diagnoses but my own children taught me many lessons on child development and behavior.


Knowing loss

The next change in my life came twelve years later, when I was widowed. That was a very sad time in my life, but it taught me many things that I used as a clinician. I had new empathy for single parents, and for patients dealing with death and dying. I also learned to help families deal with sadness.

Everyone deals with sadness—whether it’s caring for a chronically ill child, or dealing with divorce and separation, dealing with an aging parent, or with an alcoholic spouse. It’s a gift to be able to help people through their darkest times and I’m grateful to have learned how to be empathic and sensitive to patients when they’re sad.


It’s a team sport

In the last 15 years I’ve been blessed to work with a really great group of folks who have taught me that medicine really is a team sport—not a solo marathon. I have a manager and clinical lead who’ve involved me in hiring and training our staff. We care for my practice as a team—from the front desk, to the nursing staff, and finally to me the doc. It’s made my work easier, more rewarding, and provided really great care to my patients.


CHALLENGE yourself to be a lifelong learner—make CHOICES in your career that make you HAPPY, and use the CHANGES in your personal life to inform and enrich your work. These ingredients will surely make you a wiser doctor.