What's the biggest barrier to your practicing medicine today? That's just the first of 10 questions the MedPage Today staff is asking leading clinicians and researchers to get their personal views on their chosen profession. In this series we share their uncensored responses. Here, answers from Cy Stein, MD, PhD, of the City of Hope in Duarte, Calif.
Stein has degrees from Brown University (BA) in Providence, R.I., Stanford University (PhD), and Albert Einstein College of Medicine (MD). He completed his internal medicine internship and residency at New York Hospital-Cornell Medical Center in New York City before joining the National Cancer Institute as a Senior Staff Fellow. Stein subsequently had clinical and faculty appointments at Columbia University in New York City, Montefiore Medical Center in Bronx, N.Y., and Albert Einstein College of Medicine, also in the Bronx. He joined City of Hope in 2012 as chair of medical oncology and therapeutics research. Stein has just finished writing a novel; he also collects ancient coins and dotes on his 15-month-old granddaughter.
1. What's the biggest barrier to your practicing medicine today?
This is a difficult question. The biggest barrier is that there are a large number of small barriers that add up. But if I had to choose one, it would be the crazy system of insurance and payments that we have in this country that is making things difficult for everyone.
2. What is your most vivid memory involving a patient who could not afford to pay for healthcare (or meds or tests, etc.) and how did you respond?
I once tried to treat a 22-year-old Mexican kid with testicular cancer who was an illegal alien. We did the best we could but there was no money to pay for him. Not only that, but his treatment was intensive, he was often ill, and we had no way to contact him. He also did not understand his condition very well. The situation was impossible, and he was lost to follow-up. I'm sure he died, and I have often thought about this kid with great sadness.
3. What do you most often wish you could say to patients, but don't?
I really do care about you, but right at the moment you're driving me crazy.
4. If you could change or eliminate something about the healthcare system, what would it be?
Bureaucracy, red tape, and the perverse financial incentives that compel certain doctors to inappropriately treat patients to make a buck.
5. What is the most important piece of advice for med students or doctors just starting out today?
Love your patients as yourself, be intellectually honest to a fault, don't compromise your standards, and don't let your life be directed only by money.
6. What is your "elevator" pitch to persuade someone to pursue a career in medicine?
The relief of human suffering and anxiety may be the most satisfying long-term thing a human being can do.
7. What is the most rewarding aspect of being a doctor?
The true appreciation you receive when patients know they are in good hands and you have helped them.
8. What is the most memorable research published since you became a physician and why?
My own research, of course.
9. Do you have a favorite hospital-based TV show?
Nope. Never watch them. I think they're all Hollywood soaps that bear no relationship to the real world as I know it.
10. What is your advice to other physicians on how to avoid burnout?
Have a passion outside of medicine. Don't be a workaholic, and don't take your work home with you. Rest your brain by doing something else you love doing. And when dealing with patients, never think about yourself. It's only about the patient. It's amazing how refreshing that thought can be.