Today’s Masterpiece

From a dozen years ago

“Make every day your masterpiece.”

        — Coach John Wooden

“…to do the day’s work well and not to bother about tomorrow. You may say that is not a satisfactory ideal. It is; and there is not one which the student can carry with him into practice with greater effect. To it more than anything else I owe whatever success I have had — to this power of settling down to the day’s work and trying to do it well to the best of my ability, and letting the future take care of itself.” 

— William Osler

Whether you are America’s most legendary basketball coach, the father of modern medicine or a busy primary care doctor in a remote rural area, there is only one right way to get through each day. In the practice of medicine with its daily ration of two dozen fellow human beings in some sort of need, we often only have one chance to get it right.

As a young man and newly trained physician, I spent a lot of time thinking about the future. I know I sometimes devoted less attention to the here and now than I should have.

Today I carry with me all kinds of memories of the past; some are useful clinical impressions and life experiences that help me be a better doctor, others are sentimental distractions I need to manage in order to be effective in the present moment.

I am also distracted by the future. The changes in health care we all face have me thinking about how things will be different tomorrow, what new skills I will need and which old ones will be obsolete. I also find myself spending too much time thinking about what’s wrong with health care today and imagining how things ought to be.

Most days we primary care physicians don’t diagnose any rare diseases, and we don’t usually know right away if our efforts will produce any lasting results. We know we are constantly being measured and evaluated by insurance companies, employers and many others – even the pharmaceutical companies track our prescription habits. We strive for quality certificates and worry about satisfaction surveys. We devote increasing time and energy to mastering the new technologies of health care delivery and documentation.

Today I spend more time e-prescribing a new medication for my patient with inoperable sciatica than I do choosing the drug and the dose in the first place. If I don’t specify capsules or tablets, or if I should neglect to put in “by oral route”, which I always thought was obvious with both capsules and tablets, the script won’t go through. I start thinking about what I would like to say to the IT people or how I would change the technology if somebody would just give me the opportunity.

Tonight over dinner my wife asked me one of those questions only she can ask me:

“In your work as a doctor, are you striving to meet your patients’ needs or your own?”

Before I had time to swallow and clear my throat, she continued:

“Because if you’re in it to fill your own needs, you’ll never be happy, since health care is not run by you or any other doctor anymore. If you focus on how things ought to be instead of doing the best for your patient in the reality of the moment, you’ll never be satisfied. If it’s not enough for you to know you did your best for that patient, then you’re in it for the wrong reasons.”

There are days when I clearly see that I made a difference in the life and welfare of a fellow human being because I saw what needed to be done and put my abilities to use. Those are the days I come home and tell my wife that I feel good about being a doctor.

Then there are those days when I talk about what kinds of things stood in my way of being a good doctor – excuses, really, when I think about them. My patients certainly aren’t interested in what my obstacles are. All they want from me is my best effort under the circumstances:

The lab closed early, the computer is malfunctioning, the specialist’s report is missing, the insurance doesn’t cover the medication and the road to the hospital is icy and snow-covered, but the patient is still sick. I am his doctor. Today’s work is today’s work. What more can I do besides make it my masterpiece for today? Isn’t that all I set out to do from the beginning?