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What's the most rewarding aspect of being a doctor? We can have an impact with everything we do in cardiology -- we are able to really change the outcome of patients, says Kim A. Williams Sr., MD, president-elect of the American College of Cardiology, in response to one of the 10 questions MedPage Today is asking healthcare professionals.
Williams is chief of cardiology and the James B. Herrick Professor of Medicine at Rush University in Chicago. He is board certified in internal medicine, cardiovascular diseases, nuclear medicine, nuclear cardiology, and cardiovascular CT.
1. What's the biggest barrier to practicing medicine today?
The administrative burden. And that comes in a variety of silos. It's worrying about payment, both the billing aspects and the coding aspects. It's worrying about the electronic health records and doing a good job of that to support the billing while making a comprehensive, understandable note that can actually help patient care.
2. What is your most vivid memory involving a patient who could not afford to pay for healthcare (or meds or tests, etc.) and how did you respond?
The issue of the ability to pay is very important to me, having grown up poor on the South Side of Chicago with little access to healthcare myself. My solution was to grow up to be a practitioner on the South Side of Chicago. I did that for decades in an academic setting, until we were told that we could no longer take care of patients who had difficulty with ability to pay. It was actually the patients in the coronary care unit with acute infarction and low ejection fraction where I fought the hardest to be able to follow, because they were at such high risk. The appeal process did not work for those patients. So I had to leave that job. Fortunately, that policy was reversed after I and several others left the institution.
3. What do you most often wish you could say to patients, but don't?
I pretty much say everything to my patients. Clinic visits with me can be brutally frank. I'm a stickler for prevention. If I had to pick out one very difficult conversation, it's one with a diabetic smoker. I actually look at their feet when I'm talking to them and I tell them why I'm looking at their feet: because the amputation rate is so high in that population, as well as heart attack and stroke. It really seems to get their attention.
4. If you could change or eliminate something about the healthcare system, what would it be?
Profiteering. That has a lot of different aspects, from some industry or insurance folks all the way down to individuals practicing law or medicine. They end up in the news, but it still seems to continue. But profiteering, wherever it's found, is driving the cost of medicine so high that regulators and some insurers, patients, and physicians are all put under stress trying to maintain this financial burden.
5. What is the most important piece of advice for med students or doctors just starting out today?
To continue to study hard, evaluate every aspect of medicine that you can during your training with an open mind, and while you're learning medicine, also learn about yourself. Find out what really excites you. What you would really be able to do at 2 o' clock in the morning because you enjoy it so much? To the best of your ability go into that specialty.
6. What is your "elevator" pitch to persuade someone to pursue a career in medicine?
Probably my worst line ever was with my youngest daughter, who was clearly one of the brightest people, doing her undergrad work in psychology at Yale. I was having trouble convincing her to go to medical school like her older brother and older sister. So the line I used was, "I just feel bad for all the patients who won't be alive because you chose not to go into medicine." And she went into medicine. Just a bit unfair in retrospect, but she enjoys what she does, and so do her patients.
7. What is the most rewarding aspect of being a doctor?
The most important aspect has to be the interaction with patients, the opportunity to do what we do best in cardiology, a 50% decrease in mortality over the last several decades. We actually can have an impact with everything that we do -- whether it's guideline-driven medications, diagnostic testing, revascularization, primary or secondary prevention -- we are able to really change the outcome of patients.
8. What is the most memorable research published since you became a physician and why?
I think that a landmark publication was the COURAGE trial. It was roundly criticized, but it still got physicians to think that there are more ways to improve outcome in patients than just mechanical revascularization and that secondary prevention has a very large role to play in our management strategies.
9. Do you have a favorite medical-themed book, movie, or TV show?
That's a tough one, because I don't get to watch much television, typically only on airplanes on my iPad. So if I had to pick one, it was probably "House," just because they attempted to make it realistic in terms of diagnostic dilemmas, but certainly not how House would behave!
10. What is your advice to other physicians on how to avoid burnout?
Take care of yourself -- eat, sleep and take time off. But you have to love your work. It's hard to burn out doing something that you love. So love what you do, and it will love you back.