- I've realized I shared
the beginning of my medical journey with you,
my journey through med school, my journey through residency,
but I never completed the cycle.
I've been attending physician for four years now.
I'm a board certified family medicine doctor.
And I wanna share with you
what's been my attending life journey.
(air whooshing)
Well, an attending is essentially
a supervising doctor, if you will.
In medical training, we have medical school,
which is usually four years.
Then you have a residency and/or fellowship
where you specialize
in the type of doctor you're gonna become.
I became a family medicine physician,
so my residency was three years.
And then once you finish residency and/or fellowship,
you then move on and become
a licensed professional supervising attending physician.
(air whooshing)
You are under your own license,
you have your own medical license.
When I was practicing medicine as a resident,
as a family medicine resident,
I was training under my supervisors,
under my attendings license.
Not only am I seeing patients completely on my own,
I have my own malpractice insurance,
but I'm also precepting.
Precepting means taking on students,
taking on residents and training,
and either seeing patients alongside with them
or having them shadow me into my patient's visits
to see what it's like to be a doctor.
For me, that's like one of my favorite parts
of being an attending, because I love teaching.
And I think there's so much value
that you can give as an attending physician
as well as receive.
When you're teaching someone,
you have to know the information cold.
And if I sense that I don't know something,
that there's a gap in my knowledge, I admit it.
And we get together with the student or resident
and we look it up.
Now you get a whole different set of paperwork.
You get stuff from the insurance company,
from the patient's insurance companies
asking for changes in their medication,
asking for information about you as a provider,
filling out disability paperwork prior authorizations.
Oh my God, that's the bane of my existence.
So instead of spending half an hour with the patient
explaining to them all these things,
I'm arguing with the insurance company
whether or not this test should be paid and covered.
(metals clanking)
One or the other most demanding things
about being an attending is having to say no.
Sometimes you have to put your foot down
and say something is unacceptable,
or speak to your staff about scheduling mistakes
and really make sure that your patients
aren't being put in harm's way
and really bearing that burden.
So that's not easy.
The last thing I want
is for my patient who needs 30 minutes with me
in order to adequately address their mental health needs
to be getting 15 minutes appointments scheduled for them,
because it's not about
just seeing a patient, signing a chart, moving on.
It's about making sure that patients
are adequately taken care of.
And if you can't do that,
because there's not enough time,
because the paperwork wasn't set up correctly,
they're seeing the wrong provider,
you have to be unafraid to speak up.
And while that's not always easy, it's mandatory.
Going to seniors for help is still something I do.
I know some people, when they become attendings,
they want to be like in charge and the boss and all that.
And I that's fine, and that works for some personalities,
but I feel like a team approach is always best.
So if I see a rash
or some kind of new presentation in a patient,
and I'm not quite sure between two specific diagnoses,
I'll bring in a senior doctor,
I'll bring in Dr. Joseph Tribune or one of my colleagues,
say, "What do you think about this?"
We even discuss it with the patient, because again,
it's a team approach.
That's when you get the best outcomes
for not only the patients, but also for us as physicians,
'cause we wanna do right by the patient.
The tricky part is when you're alone
and you're either on call or it's late at night
and you're doing a night shift
or you're doing a weekend shift
and you have to make a decision, getting them 911 called,
or sending them to the ER yourself,
or completely doing something different.
My one piece of advice, if you're going onto your first day
of being an attending tomorrow is, trust your education.
Know that you've gone to medical school, you've done well.
You've gone to residency, you've done well.
You've treated thousands of patients up until this point.
You have hundreds if not thousands of hours
invested into this.
You know what to do and there's always a plan.
Even if you don't see it right away, think about it,
talk to your staff, talk to another doctor,
a senior doctor, junior doctor, what have you.
Bounce ideas off each other.
I feel like I see a lot of the residents get worried
that someone might judge them if they ask a question.
No one should judge you for asking a question.
In fact, they should be encouraging you to ask questions,
because if you're afraid to ask questions,
that's where mistakes get made.
I see a lot of the same mistakes repeated
and it affects how I teach moving forward
and the questions I ask moving forward.
I oftentimes see the residents
because they're early in their training,
get overly focused on lab values,
or test results, or imaging,
instead of thinking about what's in front of them,
the patient, the human.
What are their subjective feelings?
How aggressive do they want to be in their care?
Do they want to go down this route?
Do they understand the treatment that you're giving them?
You're practicing like a human
and you're treating the human in front of you.
The second thing that I see them repeat is not thinking
about putting themselves in the patient's shoes.
Like they'll give them an explanation
of what they think now, of their current diagnosis,
of the treatment plan, et cetera,
but they never tell them what to do
in case something changes.
If there is no improvement, how soon should I come back?
If something changes for the worse,
should I come back earlier?
Should I go to you?
Should I see a specialist?
Should I call 911?
It makes them feel more confident in the treatment plan.
The third thing that I see residents
consistently do differently than I would do as an attending
is think that they need to know all the answers.
A lot of times patients are complex.
They have multiple chronic illnesses.
They have unique lifestyles.
And when you're putting this puzzle together,
you're not always gonna have the right answer,
especially in one visit.
And a lot of times that's all we have.
So I urge all of my residents and students
to take their time.
Talk to the patient like a human,
explain the few things that you're thinking it could be,
or the route that you wanna take,
and then give your reasons as to why.
And then see how the patient feels about it.
What if one of the things you were thinking about,
potential diagnoses, was something that the patient knows
they definitely do not have?
It would have saved you a lot of time.
What if one of the treatment options you were considering
is one that the patient absolutely cannot afford
or doesn't want.
It would save you a lot of time.
So that constant communication of,
here's what I'm thinking,
what do you think about what I'm thinking,
is really important.
The medical journey is long.
You go to high school, then college, then med school,
then residency, potentially fellowship,
and then you become an attending.
If you're not enjoying the entire process,
you're not gonna be happy when you become an attending.
'Cause there's no light switch that flicks on for happiness
once you become an attending
and you get your license in the mail,
you're still the same person you were two weeks before that,
two years before that, 10 years before that.
So you really got to find joy within yourself,
within your everyday life.
And obviously be happy that you become an attending.
You can celebrate those things,
but do not think that once you reach that moment,
everything changes.
Yes, things change.
In fact, something's changed for the worst:
More responsibility, more paperwork, licensing,
continuing medical education credits.
Becoming an attending is almost like becoming an adult.
You know when you're a kid and you're so excited
about finally getting some responsibilities
and becoming an adult, and you're like,
"Oh, look how cool it is to be mom and dad."
And then you become an adult and you're like,
"Oh my God, it's not as cool as I thought it was gonna be."
Becoming an attending is a wonderful thing,
it's an amazing accomplishment.
But at the same time,
do not wait for that check box to be filled
in order to be happy.
Be happy now, choose to be happy now.
Do not get lazy and do not get over-confident.
You've made the correct diagnosis,
and you know what a patient has,
and you're ready to prescribe them a medication,
and you're pretty confident you know the dosage
or you're pretty confident there's no interactions
with the medicines that they're taking
and you don't double check.
Double check!
You will learn from your mistakes,
you will learn from your near misses
that didn't become mistakes.
And those are so much more valuable to learn from
because no one gets hurt there.
For me, I always go on up to date and check
about a patient's condition, about the medication,
the options, the most up-to-date info because things change.
Research articles come out like every minute,
if not more so.
So you have to not be afraid to challenge your knowledge,
to constantly look things up
and make sure you're doing the right thing.
Now that we have such a great community on YouTube,
on Facebook, on Instagram, Twitter, what have you,
TikTok now, patients do recognize,
and sometimes they are very surprised
'cause they came in for an urgent care appointment,
they're looking down and they're like,
"Wait, wait, wait, I was just watching one of your videos
about this or that, and now you're my doctor.
This is so cool."
I think that's a great jumping off point
to develop a healthy doctor-patient relationship,
because now there's familiarity.
Now we can be on the same page.
Now I know their level of interest
when it comes to medicine.
And sometimes, and I'll admit,
sometimes the conversation can go off the rails a little bit
where the patient only wants to talk about that,
or they're so excited that they're seeing me
that they completely forget about their problem
or about the important things that they need to learn
on their visit today about their medications,
or they wanna take a picture so bad.
So I do at times have to redirect the conversation
away from social media and back to them and their health.
This isn't a bad thing, this is just excitement,
this is part of it.
In fact, I've heard several times from patients
that told me they were afraid to see a doctor
and hearing my videos,
learning what it means to be a family medicine physician,
they got excited
and they went to see a doctor for the first time.
Maybe it wasn't me.
Maybe it was someone else in my practice,
but they were motivated because of this channel.
And when I hear stories like that, I get excited,
'cause right now, it's just me and you,
I'm just sitting here talking to a camera
and I don't know the impact that I have on you.
And hearing patients tell me that it's changed their life,
they feel more empowered,
they wanna take control of their health,
that gets me hyped.
There's no other way to put it.
No matter of my financial success
on social media, on YouTube,
if I get a show on television or whatever it is,
I will never leave clinical medicine.
Being able to treat patients makes me better on YouTube.
Being a YouTuber
and constantly looking up medical conditions
and learning new things,
makes me a better doctor for my patients.
It's such an amazing symbiotic relationship
that I never expected to happen.
So right now I'm currently practicing about half the week,
seeing patients in an outpatient center
in two separate offices,
and then the rest of the time I'm spending
creating content, filming, planning for the future.
We have some amazing projects coming up.
And that's my life right now.
It allows me to have the best of both worlds
and at the same time deliver the best results
for both worlds.
Check out "A Day in My Life" videos right here,
where I spent full days in the hospital.
And you get to learn exactly what I do
as an attending physician.
As always stay happy and healthy.
(upbeat music)