Personal Financial Considerations for Physicians

It is often difficult for medical students to understand the extent of the educational debt that they may incur. They often struggle with managing their finances during training and after they begin to practice medicine. Students make their choice of specialty without fully considering how their decision may affect their lifestyle and their ability to pay off their loans. This has led to a serious shortage in primary-care physicians. In addition, because physicians undergo an extensive training period, they are often late in planning for and funding for their retirement. Understanding the time-value of money and being able to make informed decisions regarding repaying loans versus meeting other financial obligations are important factors to addressing this problem. Financial literacy is not being taught in medical schools and residency programs, although there is a perceived need. Developing a financial plan that involves both paying off debt and saving for retirement is usually the best course of action.

Lifestyle Medicine

This chapter addresses the rise of lifestyle medicine. The impact of chronic diseases on health and quality of life are well-known within the medical community. Preventive medicine has only been partially successful in addressing these problems. For physicians to advocate healthy lifestyle choices for their patients, they must first understand what a healthy lifestyle entails. The Six Pillars of Lifestyle Medicine outline the six main lifestyle changes—healthful eating, increasing physical activity, improving sleep, managing stress, avoiding risky substances, forming and maintaining relationships—that physicians should promote to their patients. The global public health burden of diabetes, obesity, and other lifestyle diseases is increasing at an astounding rate. However, very few training programs have robust educational offerings for physicians on nonpharmacological treatment of obesity and diabetes.

Teams in Medicine

To effectively diagnose and treat patients, physicians must often cooperate, coordinate, and problem-solve with other healthcare workers. Successful teams in medicine define and work toward shared goals, employ the pertinent and appropriate qualifications of each member, and establish trust in other team members. Task-shifting passes certain roles onto other team members so that physicians can focus on their key areas of responsibility. A number of medical schools have adopted interprofessional education to train today’s physicians, but there are other strategies that are also being explored. Training modules such as Crew Resource Management and TeamSTEPPSTM are being adapted to the needs of the healthcare field. High-fidelity patient simulations are being used to replicate common situations encountered by healthcare workers. Also, many medical schools are using problem-based or team-based learning practices through which students work with one another to tackle and reason through clinical scenarios.

A Roadmap to Medical Professionalism

Medical professionalism is more than a demonstration of individual competencies. Becoming a member of the medical profession is not only about passing a set of milestones but also about embodying the values, behaviors, and identity of a physician through a process of professional identity formation. The major frameworks for medical professionalism, the process of professionalization, and the importance of socialization in medicine are discussed. The reader is encouraged to reflect on who they are and who they want to become. Thus, this chapter provides a roadmap to medical professionalism. Physicians have a fiduciary duty to act in the best interest of their patients and embrace lifelong learning.

The Aging Physician

After decades of working in the medical field, physicians have gathered an extensive knowledge of human pathology as well as effective courses of treatment for illnesses. However, aging may also bring about cognitive deterioration, which may compromise the quality of care physicians provide to their patients. In 2015, 23 percent of physicians were above the age of 65. An estimated 25,000 to 50,000 active physicians are expected to suffer from mild cognitive impairment and up to 25,000 from dementia. Currently, physicians are not held to a mandatory retirement age and are not subject to oversight of their cognitive abilities and physical health as they age. However, the current system of self-regulation for cognitive impairment is insufficient for protecting patient safety; on the other hand, mandatory retirement or screening of aging physicians may be ethically or legally problematic. An optimal solution would balance the safety of patients and the dignity of aging physicians. It is likely to be multipronged and multifactorial, involving multiple screening steps and continued development to assess the quality of validation. Adoption of healthy lifestyle practices and financial literacy, as well as providing opportunities for retired physicians to stay involved with the medical profession, may encourage successful aging among physicians and ease the transition to retirement.

The Reflective Process

The term “reflection” is often used informally with different meanings. This chapter lays out the core components of the reflective process that can be used as a tool for professional identity formation and lifelong learning and why and how reflection ought to be incorporated into daily practice. Reflective practice in healthcare education is an emerging topic with a substantial theoretical basis. Various theoretical frameworks of reflection are introduced, such as Schon’s concepts of reflection-in-action and reflection-on-action and Brookfield’s concept of critical reflection. These are used to question hegemonic assumptions in the field. Practical models for the reflective process are presented, including the Gibbs framework and the Kolb’s cycle of experiential learning. Team reflection supports bases for continued learning, problem-solving, improved patient outcome, and quality improvement initiatives. Narrative medicine focuses on treating patients as individuals with their own unique stories, and reflective writing is an important part of developing narrative competency.

Professional Boundaries and Digital Professionalism

The relationship between physicians and patients is unlike any other personal or working relationship in modern society. The patients must put their utmost trust in the abilities and intentions of their physicians, and in return, physicians must put the needs of patients above their own (described as a physician’s fiduciary duty). Often, the physician-–patient relationship crosses over boundaries that are present in other aspects of our lives. These so-called professional boundaries must be observed to avoid potential ethical or legal problems. Physicians ought to abide by the most conservative guidelines for professional boundaries established by their institution, state, and medical organization. Increased use of digital technology in medicine is blurring the lines of these boundaries. Physicians’ use of social media, email, and telemedicine all offer potential benefits as well drawbacks that should be considered before social media is incorporated into their practice.

Artificial Intelligence in Medicine

Disruptive forces are challenging the future of medicine. One of the key forces bringing change is the development of artificial intelligence (AI). AI is a technological system designed to perform tasks that are commonly associated with human intelligence and ability. Machine learning is a subset of AI, and deep learning is an aspect of machine learning. AI can be categorized as either applied or generalized. Machine learning is key to applied AI; it is dynamic and can become more accurate through processing different results. Other new technologies include blockchain, which allows for the storage of all of patients’ records to create a connected health ecosystem. Medical professionals ought to be willing to accept new technology, while also developing the skills that technology will not be able to replicate.

Communication, Empathy, and Compassion

The state of modern healthcare is often not conducive to empathy or effective communication because physicians are pressured to see as many patients as they possibly can, sometimes forcing them to forsake emotional connection. However, empathy and communication are among the most vital skills for providing excellent care to patients. Incorporation of empathy and communication have been found to result in fewer malpractice suits, better adherence to treatment plans, fewer errors, and improved outcomes. The components of effective communication include active listening, offering feedback, and being able to apologize for past errors or miscommunication. The challenges associated with patients that are labelled “difficult” are discussed. The neurological processes of empathy are highlighted including the regions of the brain that are implicated. The chapter also frames empathy as a broad concept with emotive, moral, cognitive, and behavioral components, and that compassion is an empathic response that may facilitate feelings of engagement and protect against burnout. Increasingly, medical schools are incorporating training in building empathy and compassion into their curricula.

Substance Use Disorders and the Impaired Physician

Patient safety is jeopardized when healthcare services are provided by physicians who suffer from substance use disorders (SUDs). When focusing on the problem of substance abuse and dependence among physicians, certain factors inherent in the medical field, such as long hours, the high-stress nature of the work, and the ease of access to drugs, make physicians more susceptible to abusing or becoming dependent on prescription drugs and alcohol. SUDs may differ in severity. The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (Washington, DC: American Psychiatric Association, 2013) provides three severity specifiers: mild, moderate, and severe. Severe SUDs are also known as addictive disorders. To make matters worse, a culture of silence exists among colleagues, who often seek to protect the compromised physician from the legal consequences of abusing drugs. Luckily, the compromised physician can be provided with an intense and individualized treatment regime through physician health programs that aim for rehabilitation over termination of employment.