Simon Murray, MD: On Being a Doctor

I am truly saddened that 48% of my fellow physicians want to retire early and that more than 30% of internal medicine residents are clinically depressed after a year of training. Medicine is such a noble profession and its practitioners deserve better. Over the past 35 years, I never lost my awe for the practice of medicine, despite my disdain for the business of medicine.

Medicine and business do not mix. That’s the root of most of our profession’s unhappiness. I am a terrible business man which is why I never saved nearly enough money, and why I will never be wealthy. Not even close. Yet the practice of medicine has made me wealthy beyond belief ways in other ways that I could never have imagined growing up.

I was born in rural West Virginia, the oldest of 5 siblings. Being the family hero made it important that I get out of West Virginia and do something worthwhile which was a task that gave me pride and trepidation. My father said, “It doesn’t matter who you are inside, it matters what you do. That’s what defines you as a man.” I never forgot that, and today I think I am still struggling with figuring out who I am.

After moving to a small town in New Jersey I was put in Catholic school. I did fairly well in high school, stayed under the radar for the most part and got a scholarship to a small liberal arts college. Sadly, both my parents died before my 25^th birthday. It was never mentioned but they died from their own vulnerability to tobacco and alcohol.

For some time, I had secretly harbored the idea of becoming a doctor. My role model was our family doctor, an Irish man who was kind and funny. He did magic tricks in the office to distract us from getting shots. He loved practicing medicine and it showed—and I wanted to be like him.

(Amazingly, 30 years later after he had retired, I became his doctor. As I learned more about him, I learned he had flaws. He’d been sued for malpractice, had an extramarital affair, and had a child with alcohol addiction. The more I got to know him, the more I loved him because I saw him not as a godlike figure, but rather as someone like me, a mere mortal. The essence of real friendship is our shared vulnerabilities, another lesson I have never forgotten.)

I got through college as a pre-med with better than average grades. I had several medical school interviews, but no acceptances. I was grateful when I was accepted at a foreign medical school of good reputation. It was a wonderful experience because it gave me a leg up on my fellow American medical students when I returned since I’d had to develop clinical skills rather than rely on modern tests and procedures common in American medical schools. We had to learn to do more with less and work amongst the poorest of the poor with no resources. My total medical education cost less than $900 and when I transferred into Rutgers, I came with a deep sense of gratitude to be there. Another lesson learned: gratitude gives a person serenity in the face of adversity.

When I graduated, I managed to get into the best residency program in our state. Naturally I chose internal medicine following in the footsteps of my old family doctor. Internal medicine, I reasoned, offered the most diverse opportunity to practice many styles of medicine, almost anywhere in the world.

Residency was a daily challenge, never boring, and exhausting. We were on call for 36 hours every fourth day for 3 years with 2 weeks of vacation a year. The best times were in the middle of the night camped out in a patient’s room, ministering to the IVs, insulin, blood draws, vital signs, talking about nothing with the patient and nurses. There was nothing better than seeing the sun rise with the patient still alive and smiling. The thanks our patients gave us was worth everything.

I married a beautiful and classy European nurse during residency, someone way out of my league, and had a daughter. When I finished, I lucked into a private practice in one of the most prestigious communities in NJ. Princeton, NJ, is a place like no other, and oasis from a forgotten era in the middle of central NJ. Princeton was filled with its share of oddballs, world class academics, scientists, government agents, students, dissidents, and farmers. Its location kept it isolated from the rest of New Jersey and I often felt I was still in the South.

My dream was to become a busy practitioner with a large and affluent practice. For the first half of my medical career I worked hard to make a name for myself in the medical community. I stayed late, worked weekends, took on more and more patients. Every year my income increased, my house got bigger and I bought nicer cars. My family could take European vacations, but I always had to leave after one week to return back to work. I worked in psychiatric hospitals, nursing homes, and rehab centers and consulted for IBM, Johnson and Johnson, and Princeton University, and was the principal investigator for several novel drugs in development all while practicing full time.

The more I earned, the more debt I acquired and the lower my credit score dropped. Gradually work responsibility kept me from showing up for family events, and then I stopped seeing new patients, and I quit going to the hospital. There were too many missed school plays, girl scout trips, vacations never taken, and phone calls never returned. Although my intentions were good, I had stopped showing up and that’s how others began to judge me.

I became physically sick, tired, and patients became adversaries, a necessary evil to make a living. I stopped feeling joy in getting to know and become part of the lives of the people I served. The daily interactions with patients was what I really used to enjoy, but it became too much trouble.

Quite by happenstance—or divine intervention—I was recruited by a group of physicians who had started a new way of practicing. They called it personalized health care or concierge medicine (a term I don’t like). In return for downsizing the practice to a reasonable number, patients agreed to pay a fee ($5/day) outside of the insurance system. In return they got a whole host of otherwise non-covered services. Physicians didn’t have to practice volume medicine and be at the whim of insurance companies to earn a living. If the care is good, the patients stay, if not they leave. What a concept. It was a scary thought to change, but I was as willing as only the dying can be and changed the way I practiced. It has turned out to be the best thing I ever did, and 92% of the original patients agreed, because they have stayed with me for the past 12 years.

I began to enjoy the interactions with patients again. I stopped giving orders to patients and started listening to their stories. I began to show up prepared to practice and the feeling of dread melted away. I started to attend their birthday parties, bar mitzvah, sit shiva, attend weddings, visit nursing homes, rehabs, and their apartments. I learned that people still use rotary phones, and don’t have cable TV. Sadly, I’ve been to far too many of their funerals.

I started back at the hospital because that’s when the patients need you the most. I spent more time at home and became expert at home repair. I took up running every day and joined a squash league at the university. In short, I just started to show up in life when and where I was needed.

Am I bragging? That’s not my intention. The point is that by being a physician, doors opened for me that I would have never imagined. The relationships I have forged with thousands of patients by sharing our vulnerabilities and listening to their stories will never be forgotten. Like me, no one escapes without blemishes. We are flawed at times, inspiring at times, accomplished but fearful that our inadequacies will keep others from accepting us.

In fact, the opposite is true, our weaknesses bring us closer.

I will never be wealthy but am financially stable. More importantly I have been blessed with having the best job I could ever imagine because it never feels like a job. I was delighted when my daughter mentioned medicine as a career. I hope she finds her way.

The final lesson I want to share: don’t lose sight of the great profession you were given. Forget the endless pursuit of wealth and keep in perspective that there are support people to deal with the endless interference of government, malpractice, and insurance companies. Simplify your life, be grateful, show up and realize that our patients are our most valuable asset. My father got it wrong, it does matter who you are inside, it’s not what you do that in the end defines you.

Simon Murray, MD, is an internist based in Princeton, NJ. The piece reflects his views, not necessarily those of the publication.Healthcare professionals and researchers interested in responding to this piece or contributing to MD Magazine® can reach the editorial staff here.