Wednesday, November 29, 2023
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Most of us have grown up regarding "life, liberty, and the pursuit of happiness" as inalienable rights. But sometimes we don't stop to ask what pursuits will actually lead to happiness. Even when we have an idea of what we want, we don't always know how to pursue it.
This may be especially true of physicians, who often prioritize their patients and careers over their personal goals, according to Dike Drummond, MD, physician coach at TheHappyMD.com. That's why it's important to create a "bucket list"—a set of goals and dreams you want to accomplish during your lifetime.
The term "bucket list" was popularized by the eponymous 2007 movie, in which two men with terminal prognoses decide to actualize their life dreams before "kicking the bucket." But "you don't have to wait until you're in the process of dying to really live," says Dr Drummond, a Seattle, Washington-based coach, trainer, and consultant on burnout prevention for physicians.
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"Your medical career is like an 800-pound gorilla living in your home. To prevent the gorilla from taking over, you need to set boundaries," Dr Drummond advises. This may mean buying tickets now for that trip you've always wanted to take to the Alps, even if you don't actually travel until 2017.
He also recommends breaking down your goals into a series of small steps. "Hang the bucket list on your refrigerator and take a picture of it with your cell phone, so it's right next to your life calendar." This will keep your list items on your radar. And even the smallest step will take you in the direction of your goal.
Medscape asked physicians about their personal and medical bucket lists and how they planned to actualize them. Their responses form a kaleidoscope of colorful goals and dreams. We hope they'll inspire you to paint your own picture of what you want your life to be.
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Practicing medicine demands creativity and insight. Many physicians want to apply these traits to writing books.
Already a published medical author, neurologist Andrew Wilner, MD, wants to try his hand at writing fiction. Unfortunately, he notes, other MD fiction writers "have already used up most of the good villains." He hopes there's "still a villain or two left to be highlighted in a unique medical thriller." Andrew Cronyn, MD, a pediatrician at El Rio Community Health Center, Tucson, Arizona, also wants to write a novel. "I've always used writing and storytelling as a creative outlet."
Others seek to write medical-themed books. Brian Goldman, MD, a psychiatrist in Walnut Creek, California, wants to write about subtypes of Asperger syndrome and the autistic spectrum. Tara Allmen, MD, of the Center for Menopause, Hormonal Disorders and Women's Health in New York City, was invited to write a book about menopause and has submitted her 70-page proposal to publishers. "I'm hopeful that I will get a book deal soon. And if not, I am very happy that I tried."
And Wilfrid Noel Raby, MD, PhD, research psychiatrist at the New York State Psychiatric Institute, wants to write a memoir for his sons.
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Most respondents expressed wanderlust, and many have already traveled widely, to South America, Europe, New Zealand, Australia, Japan, China, Denmark, and Russia. The Galápagos Islands are a desired vacation spot, with several respondents having already visited or planning a trip. Others are drawn to the lions of African safaris or the glaciers of Antarctica. Closer to home, Dr Raby wants to take a car or train through the United States and Canada.
Exploration can be local too. "Bucket lists are often tied to travel, because we are supposed to have already explored what is in our own backyards," observes Thomas Fekete, MD, professor of medicine and chief of infectious diseases at Temple University School of Medicine, Philadelphia. "I seldom see nearby sights unless I have out-of-town visitors, because of the perception that these monuments will always be around." In the past few years, he has enjoyed exploring the buildings of the College of Physicians of Philadelphia. And he still has foreign travel on his radar, perhaps including zip lines or snowmobiles to get around.
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William Osler said, "The young doctor should look about early for an avocation, a pastime, that will take him away from patients, pills, and potions." Of course, this is also true for doctors of all ages.
Martin S. Kane, MD, a psychiatrist in Altamonte Springs, Florida, learned sleight of hand and card tricks under the tutelage of a magician he met while in medical school, and perfected these during study breaks. He created his own card tricks (some even had a medical theme), which were published in magic magazines and books. His goal is to publish his own book of the best of these 177 tricks.
Dr Wilner, an avid underwater photographer, makes short films featuring sea life from Southeast Asia. He has won film contests, and his videos are featured on the Australian Museum's fish identification website. He wants to film and direct a full-length movie about the underwater world.
Kenny Lin, MD, associate professor of family medicine at Georgetown University Medical Center, Washington, DC, wants to further his longtime fascination with Civil War history by visiting all the major battlefields in the North and South that he has not yet visited.
Image courtesy of Dr Wilner
It's hard to be a doctor in today's healthcare environment. But instead of feeling defeated, many doctors are finding creative ways to defend their profession.
Paul Kempen, MD, an anesthesiologist at Weirton Medical Center, West Virginia, is one of them. Together with several other physicians, he spearheaded "Change Board Recertification," a national movement of physicians committed to reforming the board recertification process. Because physicians are "natural lifelong learners," continuing medical education (CME) and peer-reviewed journal articles should be sufficient to advance their knowledge, he says.
Grant Simons, MD, director of cardiac electrophysiology at Englewood Hospital and Medical Center, Englewood, New Jersey, feels that employed physicians will need some form of labor union dedicated to advocacy. "I want to play a role in the formation of an organized labor entity for doctors, so we'll have a better negotiating position when dividing up bundled payments. I want to be the George Meany for physicians."
(Shown) Abraham Verghese, MD, physician-author, Professor for the Theory and Practice of Medicine at Stanford University Medical School.
Image from Medscape/Darbe Rotach
Being fit is on the bucket list of many physicians, and sports are a great way to keep fit. Water sports are very popular. "I love boating, swimming, and snorkeling—and I want to live on a Caribbean island to enjoy these things", says Paul Doghramji, MD, of Collegeville Family Practice in Pottstown, Pennsylvania. "Maybe I could become a retired pirate," he adds.
Auguste Fortin, MD, associate professor of medicine at Yale University School of Medicine, New Haven, Connecticut, wants to sail his boat across the Atlantic and explore the Mediterranean, whereas Dr Raby hopes to get back to canoeing. Dr Wilner is a divemaster who mentors other divers.
But some physicians prefer dry land. Dr Simons has already climbed Mount Whitney, the tallest mountain in the contiguous United States, and hopes to climb Mount McKinley, the tallest mountain in North America. Jonathan Weiss, MD, of Sullivan Medical Group in Monticello, New York, "would love to do a 100-mile bike ride before they lower the lid on me—maybe even some sort of multiday, multistate bike tour."
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You want what's best for the medical profession, but you probably have an extra-soft spot for your own specialty.
Donald Liss, MD, assistant clinical professor at Columbia-Presbyterian Medical Center in New York City, wants his specialty, physical medicine and rehabilitation, "to gain better respect in the general population." It's been a "slow struggle, but we're gradually gaining prestige."
Shi-Hong Loh, MD, medical director of Dao-Shen Acupuncture, Hoboken, New Jersey, is working toward making acupuncture "more established—notably, the integration of Eastern and Western medicine." He uses the integrative model in his own practice. "I focus most on patients in whom Western medicine can no longer be helpful."
Dr Fekete is on the board of the Infectious Diseases Society of America. "My bucket list includes finding ways to support this organization as a guild, an advocacy group for patients and doctors, and a source of information and support for students and residents considering a career in infectious diseases," he says.
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Although many physicians don't spend as much time with their families as they'd like, their love and pride makes "more family time" a compelling goal.
"I always wanted to be there for my children while they were growing up, and I juggled my career accordingly. Today, I have two outstanding children with traits of humility, knowledge, intellect, and huge personal accomplishments," says Lesley Fein, MD, a rheumatologist based in West Caldwell, New Jersey. She beams as she adds, "My daughter just graduated from medical school."
Cheryl Pegus, MD, MPH, director of the Division of General Internal Medicine and Clinical Innovation at New York University School of Medicine in New York City, wants to see her children "actualize their dreams with enriching experiences and learning." She thinks this "absolutely" will happen, but adds that her "fingers (and toes) are crossed."
And many physicians want to travel with their children. "For my 50th birthday, I took my family to the Galápagos Islands," Dr Allmen reports. "It is my goal to travel with my children every year until they decide they are ready to explore without me. I hope that day never comes!"
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Do you have wisdom to impart? Helping other doctors navigate rough roads or hard decisions would be rewarding for many physicians.
"Teaching is my dream, and I'm living it," says Peter Buch, MD, associate clinical professor at the University of Connecticut School of Medicine, Farmington. "I was a practicing gastroenterologist for 33 years. I wanted to use my experience to benefit others, so I transitioned to teaching. I have a wonderful time and learn a lot from the audience."
But teaching doesn't only take place at a podium. Matt Rosenberg, MD, a family physician at Mid-Michigan Health Centers in Jackson, offers one-on-one time to younger physicians. "It's rare to find doctors going into independent practice these days," he observes. "Most choose the employment model. I sit down with them and talk about my own experiences as a happy doctor in a small group practice—what works and what doesn't work—so they become aware of wider options."
Dr Doghramji also wants to do more teaching. When he presents at CME conferences and in other educational settings, he draws on his background of acting, which he studied in high school and college, to make dry material engaging and entertaining.
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Many people played a musical instrument or danced when they were children. But as they grew older, the guitar and the dance shoes were put away. Maybe it's time to dust them off, some respondents suggest.
Sandra Fryhofer, MD (pictured above), adjunct associate professor at Emory University School of Medicine in Atlanta, has returned to dancing—a passion that began when she was 3 years old. In 1976, her tap dance routine won her the title of Miss Georgia. More recently, she danced at a benefit for the Georgia chapter of the Alzheimer's Society and won the Judges' Choice as Dancing Star of Atlanta, bringing in $130,000 toward the cause.
Her current dream: "To tap dance on Broadway in a musical (perhaps 42nd Street) or on Dancing With the Stars." She wants the proceeds to go to an Alzheimer disease research charity, noting that she has a very personal connection: Her mother has Alzheimer's.
Ira Kirschenbaum, MD, chairman of orthopedics at Bronx-Lebanon Hospital Center in New York, wants to "play guitar like Stevie Ray Vaughan—specifically, all the tracks on the Blues at Sunrise album." He adds, "We know Stevie Ray Vaughan played music that affected the soul, but only an orthopedic surgeon can attest that this music flows through the bones."
Image courtesy of Sandra Fryhofer, MD
As patient visits become shorter, fewer physicians find time to get to know their patients. But several respondents emphasized that they want to learn what's in their patients' hearts and minds.
Part of every doctor's bucket list should be to find out what's on their patients' bucket lists, according to Joseph Smith, MD, PhD, chief science and medical officer, West Health Institute, La Jolla, California. That way, you can help your patient attain their goals through better health.
Although physicians are typically advised not to share their personal lives with patients, appropriate mutual sharing can open doors.
Charles Vega, MD, clinical professor of family medicine, UC Irvine Health Family Health Center, Santa Ana, California, enjoys an "increasing bond" with his patients as he gets older and experiences some of the same symptoms they have. "I also identify with them on a personal level. Pictures of my kids have become a routine demand from my patients—and of course, as a proud papa, I'm happy to share them." This "leads to stories about my patients' kids. And their grandkids. And their funny aunt." Dr Vega wants these relationships to continue to grow in depth and quality. "I know that if we can do this together, we will look back and realize what a profound effect we've had on one another."
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Being a doctor is about alleviating suffering. Some physicians feel drawn to doing so in third-world areas.
Inspired by the work of Albert Schweitzer, Dr Loh went to Santo Domingo under the aegis of the Tzu Chi Foundation, a Buddhist humanitarian organization. "I treated Haitian refugees who lived in utmost poverty, in shacks built on top of a garbage dump," he recalls. He brought his wife and daughters with him on one trip. "I wanted them to see what poverty really is."
Jamila Rasouli Arsala, MD, an ob/gyn at the Asklepios Clinic North, Hamburg, Germany, plans to volunteer in a refugee camp. Herself a former refugee whose family fled Afghanistan and emigrated to Germany, she knows what it's like to live in a refugee camp. And when she was in medical school, she completed an ob/gyn rotation at the Hayat Shaheed Teaching Hospital, which serviced a refugee camp in Pakistan.
You can also volunteer your nonmedical skills. Barry Bialek, MD, a family medicine physician in Boulder, Colorado, volunteers in Nepal with Engineers Without Borders. He wants to "see Nepal recover from this latest tragedy, the earthquake, and be a significant part of the sustainable nation-building."
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Dr Kirschenbaum emphasizes that medical talents should also be volunteered at home. "You can travel to Africa, South America, or Asia, but you don't need to look further than down the block. Consistently spending time ensuring that the most socially deprived people within the United States, and within your own community, have access to you is something every doctor should do in his or her lifetime."
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It's easy to focus only on treating disease. But it's equally important to focus on building good health in your patients. "I want to help my patients achieve their fullest potential in body, mind, heart, and spirit," says Dr Bialek.
Allan Magaziner, DO, founder and director of the Magaziner Center for Wellness, Cherry Hill, New Jersey, coordinates public seminars to "teach people how to live with health and vitality instead of spending their final decades in steady decline, dependent on prescription medications to control their multiple symptoms." He hopes to "develop a community-wide program to show that chronic degenerative diseases can be diminished by a change in consciousness, nutrition, lifestyle, exercise, eating wholesome foods, and reducing exposure to toxic chemicals." His bucket list goal is to expand this model to other communities throughout the United States.
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No matter how old you are or how proficient in your career or specialty, there's no end to how much knowledge you can acquire. In fact, says Dr Kempen, doctors are natural lifetime learners. And passion for learning goes beyond CME courses and journal articles.
Tony Francis, MD, JD, director of Legal Medicine Research and author of advisory reports for US federal judges, told Medscape that he wants to "become a more intellectual person" and study classical Latin. He also wants to study Greek philosophy, mainly Aristotle and Plato.
Dr Smith advises learning new computer programming. "It can do wonders for helping understand how computers think, and gaining an appreciation for what they are good and bad at. You'll never look at those little check boxes in your electronic health record (EHR) the same way again after you've written some if-then statements in LISP or another BASIC programming language."
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Sometimes, you should make time to kick back, put your feet up, and do whatever you enjoy, even if it's just counting air molecules. Dr Weiss wants to "see as much live music, especially as much live jazz, in as many cool venues as possible; read, read, read; bike, bike, bike; see every great movie ever; and find a great place to stare at the ocean, and then stare at it for a long time."
Dr Gloria Bachmann, MD, associate dean for women's health, Robert Wood Johnson Medical School, New Brunswick, New Jersey, also has a list of activities that she'd like to engage in. "Who wouldn't prefer spending more time with family and friends, and having more time to keep up on all of the latest clinical and research advances in medicine? More awake hours would also include staying up into the wee hours of the morning watching favorite movies, reading best-seller books, and debating politics with friends—to name just a few activities that there's never enough time for."
You don't have to wait for retirement, vacation, or sleep-banking to begin relaxing. With creative time management, you can integrate some relaxing activities into your ordinary week, while keeping longer stretches of relaxation time on your bucket list.
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Being on the cutting edge of advancing science and medicine is extremely gratifying. Several physicians described their passion for research and innovation.
George Lundberg, MD, is one of them. Still working full time at age 82 years, he is an editor-at-large for Medscape, the editor-in-chief and chief medical officer for CollabRx, and president/chair of the Board of Directors of the Lundberg Institute. Dr Lundberg has always been at the forefront of innovation—for example, using the Delphi process to inform administrative decisions or introducing the brain-to-brain loop concept of medical testing. He says, "Transformative movements and branding have always been my thing."
Jacques Barth, MD, PhD, a Dutch endocrinologist and cardiologist and professor of family health at the Keck School of Medicine, University of Southern California, Los Angeles, has been an innovator in use of ultrasonography in atherosclerotic disease. Now back in The Netherlands, he is the principal investigator on the Trauma and Resilience Initiative—an international research project studying intergenerational transmission of trauma and resilience patterns in descendants of Holocaust survivors. But his interest extends beyond Holocaust survivors. "I would like to get humanitarian research funded to help promote peace, satisfaction, and resilience in all people."
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Today's physicians face an unprecedented number of clinical and administrative tasks, and many doctors would become professional heroes by solving some of these problems.
The EHR is a huge and frustrating problem for many, if not most, physicians. Dr Weiss wants to "build a new and improved EHR from the ground up, eliminating all the stupid things that have tortured me in all the EHRs I have been forced to use and replacing them with a truly doctor-friendly, spectacularly elegant EHR." He plans to eventually segue out of clinical practice into a role as an EHR physician-consultant.
Dr Raby is interested in implementing an office-based brain mapping technique that is more practical and less expensive than functional MRI.
Andrea Fagiolini, MD, professor and chairman of the Department of Mental Health and the University of Siena Medical Center, Siena, Italy, wants "to develop easy algorithms to identify and code disease subtypes, with the goal of individualizing treatment by immediately identifying which therapy is most appropriate for the patient."
Dr Goldman has a similar vision. He's working on an artificial intelligence program that predicts which medications will or won't work in each patient. "For the clinician, this creates an extremely efficient treatment protocol, allowing more time for the deep caring contact that promotes health and quality of life," he explains.
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Physicians leave medical school with a wealth of clinical information, but a dearth of training about business issues. Arlen Myers, MD, MBA, professor in the departments of otolaryngology, dentistry, and engineering at the University of Colorado, and president and CEO of the Society of Physician Entrepreneurs, wants to change this by introducing an "entrepreneurial mindset" to fellow physicians.
"I want my legacy to be a change in the culture of medicine through entrepreneurship," he says. Dr Myers describes many different entrepreneurial models for physicians. One is managing a private practice, which he regards as a "small- to medium-sized professional service business." Another is being a "technopreneur" and trying to get a drug or device to market, or being an "intropreneur"—an employed physician who acts like an entrepreneur within his or her organization. Other possibilities are being a "social entrepreneur"—a physician "who tries to improve the human condition with profit as a secondary motive"; a physician consultant, who helps other physician entrepreneurs; or a "physician investor," who provides money to early-stage companies.
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Ralph Waldo Emerson said, "Do not go where the path may lead; go instead where there is no path and leave a trail." Sometimes, you need to step in and address a gap that no one has tackled before.
Dr Cronyn wants to create a comprehensive primary care center for transgendered youth in his area. "Transgendered kids face many hurdles," he says, sharing disturbing stories of discrimination against children as young as 6 years old. He knows he might face formidable barriers. "To really do this, we have to convince the public and private insurance carriers to provide full coverage for the medications, procedures, and interventions that these kids need. But I believe that will come in the next few years."
Fortunately, his organization is giving full backing to create a safe space for transgendered youth. "I am so glad," he says.
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Most doctors cringe when they hear such words as "quality metrics" and "reduced readmissions." Measuring what does and doesn't work in healthcare shouldn't come from "administrative rooms in the bowels of Congress," says Dr Rosenberg.
Dr Cronyn says, "I want to find new ways to measure quality in the primary care setting, with true scores that are correlated with better health outcomes and reduced mortality, rather than meaningless metrics invented by 'quality experts' who have never seen a patient or worked in a hospital or health center."
Marrick Kukin, MD, director of the Heart Failure Program at Mount Sinai St. Luke's/Roosevelt in New York City, wants to see hospital-level changes. "I would love to get my hands around the success of my hospital system in reducing heart failure readmission rates into the low teens, and use a better metric than the 30-day readmission rate to measure success."
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Many, if not most, people feel that there's more to us than our physical being.
Several respondents said they want to enhance their spiritual growth. Study was the most popular approach. Dr Francis plans to study the Scriptures. Dr Liss sets his sights on completing the entire Talmud.
Dr Loh, who has been studying Taoism since his teens, plans to increase his learning. "These days, I'm focusing on the I-Ching, one of the oldest Chinese classics, although it's difficult to understand—even harder than it was to learn Chinese medicine," he adds.
Spirituality isn't confined to literature. Dr Fagiolini wants "to spend more time in nature to improve communication with my soul." In addition, "I want to play a role in eliminating religious hatred and intolerance and helping people realize the common core of compassion and tolerance in all religions."
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"Physician, heal thyself" is an old adage that few doctors take to heart. Beginning with medical school, the message is to attend to the health of your patients while neglecting your own.
Some Medscape respondents are recognizing that they serve their patients best by modeling healthy behaviors. For Craig Wax, DO, of Mullica Hill, New Jersey, that passion is creating optimal health. "It is incumbent upon us as individuals to take care of our own health better," he says. "Personally, I want to be an outstanding example of this concept by exercising daily, eating a nutritious diet, drinking water, getting sleep, not poisoning myself with toxins, and trying to lead the healthiest life I can. Because, how can I advocate the proper things for others to do if I don't do them myself?"
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Even the most accomplished people sometimes get hung up on what they haven't yet achieved, or fail to give themselves enough credit for what they have done.
Henry Black, MD, clinical professor of internal medicine and director of hypertension research, New York University School of Medicine, New York City, says he's achieved his dream to be acknowledged internationally as an expert in hypertension and preventive cardiology. He is also fulfilled and happy in his family life. The only thing lacking: "I wish some allergist would develop a way to enable me to have dogs or cats in my apartment."
Dr Fryhofer writes, "I have had so many dreams come true, and so many unexpected joys." Among her accomplishments, she has served as president of the American College of Physicians (the second woman to be elected to that position). Like Dr Black, she feels joy in her family life and pride in her children.
But the biggest achievement of being a doctor is making a difference in the lives of your patients. "I'm greedy, and I don't desire a single thing on my bucket list," says Dr Vega. His most important wish is for his relationships with his patients to "grow in depth and quality."
So take a moment to congratulate yourself, and enjoy what you've made of your life.
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