A calling to medicine

Do you know someone who “has a calling”? Of course, I’m not referring to vocalizations: this is not a discussion of yodeling techniques. When most hear that phrase, they will assume you are talking about being called to the church or to missionary work. But there are many professions that one can have a certain natural inclination for. Teaching might be an example, or to the practice of law.

Many have a calling to medicine, a deep-seated desire to heal the sick and wounded. I knew from the beginning, or at least from early memories that I did. I had many interests in my formative years, and numerous occupations I thought about, including writing, architecture, photography or playing frisbee professionally (believe it or not, there are people getting paid to play frisbee!). Speaking for myself, none of these ever challenged medicine as a direction in my life. Perhaps an unusual choice since no one in my family or any relatives were in medicine.

Obviously, there are a multitude of reasons people go into the field of medicine. Some of them honorable, and others not so. Being a physician carries a certain social status, or at least it used to. Various studies reveal that it no longer demands the respect it once did. Still, over the years, this has provided an impetus to enter medicine for many.

Greed can be a powerful motivating force. Depending on what field of medicine one enters, income is a significant consideration. The statistics are clear: being a physician is no longer as profitable as it once was, although it remains a lucrative profession. Some individuals value that aspect of medicine more, yet few would say it is of absolutely no consequence.

A critical question to someone driven to practice medicine concerns what kind? There are a plethora of specialties and particular fields comprising modern medicine. Each has its own rewards and demands. Podiatry was an excellent option for me for numerous reasons. One is the importance placed on a good sense of three dimensions and spatial orientation. The functions of the lower leg, including both weight bearing (standing) and gait, are dynamic, with various structures involved in complex relationships. Understanding this complicated process requires an ability think three dimensionally, grasping how all the many structures of the musculoskeletal system perform this intricate “dance”, which results in the body’s capability to move through space, with no conscious thoughts required.

Being a doctor is a hard job and always has been. There are certain challenges and stressors involved in treating people who are in pain or ill. But the demands involved in the practice of medicine are different today than just a few years ago. You didn’t have to be a computer programmer to be a physician in years past. Technology has had a tremendous impact, as you might expect. Every facet of practice is altered, especially in the day to day task of seeing patients. The “simple” act of taking notes about someone’s condition has changed irrevocably since electronic health records became a requirement.

We know so much more about the human body and this also has changed medicine. New discoveries are made almost every day, meaning there is more and more information for each physician to deal with in their particular field. This abundance of information allows modern medicine to successfully treat and resolve conditions heretofore dangerous or even deadly. Illnesses we previously had no answer for are now routinely resolved. It also means a greater of amount and depth of knowledge required to practice medicine in your concern. This explains, in part, why there are so many more specialists and sub-specialists: few can incorporate and retain all the vast amount of information about multiple subjects.

One of the most challenging topics in modern medicine as it is currently structured in the U.S. concerns the insurance industry, specifically in regards to health care. Many recognize that, it’s often not the doctors practicing medicine or, at the very least, we are not the one’s controlling the dispensing of health care. So many recommendations I make to people are not available to them, even if it is the best thing for them. Understandably, some treatment options are unproven, and so shouldn’t be paid for. Cold laser therapy, which I use regularly on my bad ankle as well as providing to patients, hasn’t been around very long, so, naturally, the large scale clinical trials have not yet been performed. Thus, it isn’t going to be a covered service by most insurance plans. That takes years to occur, at least, you would think so. Unfortunately, it generally doesn’t seem to work that way.

Shockwave therapy is a perfect example. This device is a derivative of lithotripsy, a technology used for decades to break up kidney stones. Lithotripsy was covered by many insurances, so shockwave was too, at least initially. But no more: it worked so well, many physicians used it to treat a host of maladies. Apparently too many. So many health care claims were filed that the insurance companies took notice. Shockwave was costing them too much money. The solution was simple: call it experimental! Then they don’t have to pay for it.

What makes someone a good doctor? Definitions will vary. In podiatry, people come in to see me usually because of pain. This is the number one complaint seen by physicians of the lower extremity. Consequently, the ability to relieve their discomfort is critical to being perceived as a good physician. Often that requires time and patience on the part of both the physician and the patient. Those doctors employed by large corporations usually don’t have the time to invest in each patient. Some even have quotas, a certain number of patients they must see per hour, like a worker on an assembly line. An independent doctor is obliged to follow only his own personal guidelines, his own principles.

On a personal note, I would like to take this opportunity to apologize to all those individuals who have had to wait to be seen. I dislike making people wait, but, at times, it can’t be avoided. I see some serious problems, requiring often some extra time. Any delay in seeing the next patient is often reflective of my proclivity to educate. I have taught at both the college and medical school level. In this case, it is my patients and their families who are learning. Often, that can take extra time. I can admit, on occasion, these efforts will put me behind schedule. Guilty!

Delays are especially frequent when dealing with people with diabetes. They often need detailed, thorough information about how to care for their feet. Education has been shown to be of critical importance to those with diabetes. Learning about foot care will help them avoid some of the severe complications of this disease, amputation being one of the most significant. Thus, if you had to wait at my office, some consolation may be taken from the fact your understanding of the delay may have allowed someone to learn more about their problem. A diabetic may have been learning how to keep their feet, not just working, but literally, keeping them attached to their body. From my perspective, this is a calling: keeping people active and walking. Seems like a pretty important role to me.

Editor’s note: Dr. Conway McLean is a physician practicing foot and ankle medicine in the Upper Peninsula, with a move of his Marquette office to the downtown area. McLean has lectured internationally on wound care and surgery, being double board certified in surgery, and also in wound care. He has a sub-specialty in foot-ankle orthotics. Dr. McLean welcomes questions or comments atdrcmclean@outlook.com.