This is a guest article by Silvio Aladjem MD

Having been a physician for over 40 years I believe I have a good insight of what a physician should be. Only after 4 years of college, 4 years of medical school, followed by 4 years of residency and several more years of subspecialty training, should you choose to become a super specialist, you have the credentials you worked so hard for.

After at least 14 years, or 16 if you plan to be a super-specialist, State Board, Specialty Board and Super-Specialty Board exams, you finally become a doctor.

But are you finally a doctor?

Not really. You have become a technician, in the best sense of the word. You have learned the tools, but not the tricks of the trade. You now have to become a physician. Experience comes with time. The human side of medicine is not something you are taught in medical school. Compassion, understanding the patient, its fears, hopes or expectations, bed side manners, and how you deal with suffering and death, is not something someone can teach you. Yes, you see it around your older colleagues, but you have to be alert and sensitive to assimilate these qualities and use them in your daily interactions with patients. No two patients are alike, even if both have the same medical condition. You have to be the judge and jury and decide how you should approach each one.

How do you tell the parents of a child dying of leukemia, that there is no hope? How do you tell a spouse that his/her lifetime companion has cancer? On the lighter side, how do you tell a hypochondriac that his/her aches and ills are in his/her mind, and what are you going to do about it?

In today’s environment, where medicine has become so impersonal, when the classic family physician has been replaced by Care Centers or Emergency Rooms, where patients really do not care who is taking care of them as long as they do not have to pay with out of pocket money, the task of a real physician becomes monumentally difficult.

A physician is also a human being, with its own feelings, its own concerns, with a wife/husband or a life companion. Most of them have children and probably aging parents. Not any different than patients. Physicians are also subject to potential aches and pains or serious illnesses. Regardless of such common human events, the physician must disengage from all of that and focus on the patient.

It is usually forgotten that a doctor also means a learned or authoritative teacher. Indeed a physician must be a teacher, explaining in plain language the diagnosis, prognosis, and answer all the patient’s questions.

A doctor must master all this and more, before wearing the traditional white coat and become an experienced healer.

Unfortunately, today’s complexities associated with the practice of medicine, the emphasis on the business side of medicine by hospitals and care institutions which employ a large number of physicians, government regulation and more, undermine the very essence of human healing. Some specialties, like geriatrics (the care of the old patient) are not economically self-sufficient, and hospitals tend to close such departments. Dr, A. Gawande, has published a book, “Being Mortal”, where he addresses the difficult issues of caring for the old patient. It should worry us all, as individuals and as a society.

The practice of medicine is really a calling. It is rewarding intellectually and emotionally. Sometimes, however, it is overwhelming, since one can never be completely detached from the ills of the patient. Frustration and anger is not unknown to those that care for extremely sick patients. Physicians that routinely care for such patients, have a high rate of “burning out”.
“Behind the white coat” there is a world unknown to most.

SILVIO ALADJEM MD, an obstetrician/gynecologist and Maternal Fetal Medicine (high risk obstetrics) specialist, is Professor Emeritus in obstetrics and gynecology at Michigan State University, College of Human Medicine, in Lansing, MI. He is the author of “10,000 babies: my life in the delivery room” now available on Amazon, Barnes and Noble and other book stores. Dr. Aladjem published extensively in Scientific Medical Journals and wrote several textbooks in the specialty. He can be reached by email at;

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