A doctor’s standard career path – and the path I chose | Christi Hay | TEDxFoggyBottom

By Adem Lewis / in , , , , , , , , , , /

Translator: Vivian Chen
Reviewer: Denise RQ I’m a doctor. We doctors are not typically
considered risk takers. Our path is pretty safe. We go to college,
take pre-med school courses, some would go to graduate school
and get a master’s degree, and then complete
four years of medical school. After medical school, there is residency fellowship
for three to seven years. Once all that training is done, most of us go and work in a hospital
for a provider, like Kaiser, or in private practice. Like I said, pretty safe path. But I left this path
for something different. And I would like to share
that journey with you today. I followed this blueprint
with every intention on being a lifelong
employee of a hospital. I love to teach. I have a master’s in public health,
in health behavior, health education. I love my specialty – pediatrics. So, I thought the best fit for me would be a physician
in a pediatric teaching hospital. But after eight years,
something was missing. So I made the switch to private practice. In private practice, I love the families, but the business of medicine, not so much. Honestly, medical school
and residency did not prepare me for the business of medicine. I can diagnose and treat
diseases; no problem. Give me a sick kid coughing,
difficulty breathing, the parents in the corner about to faint
because they don’t know what to do, I’m all over that. My brain clicks on, I’m diagnosing the problem,
determining the best course of action, but private practice was more than that. There were office policies and procedures
that just didn’t make sense to me. Insurance policies with
different formularies and benefits, office personnel that just didn’t know
what they were doing. It ultimately made my workday a nightmare. Imagine waking up everyday
to start a nightmare. Who does that? I did for three years. To make matters worse,
I was always getting in trouble. And I have to say,
I am not a troublemaker. But, I became that person over the years that was asking questions about things
that just didn’t make sense to me. Like, why did it take four weeks
to return a school form when I can complete it
in four minutes during the visit? Or why did it take 20 minutes to bring
a family back to an empty exam room when I could do it in two? Or why did a mother, calling to find out
what food to feed her child with diarrhea, need to come into the office for a visit? And why was a medical assistant who could not properly count
respiratory rate and heart rate not fired? And why was the schedule done in a way
that I must enter every room and say, “I’m so sorry for your wait.” Trouble. I stayed in it and it just added
to my nightmare experience at work. Then one of my girlfriends
gave me my aha moment. We were chatting on the phone
about work when she simply said: “You were not listening to
the voice in your head. The voice is telling you
to pick up and move, but you are comfortable
where are, but miserable, so you need to make a choice. No one is making you
stay there but yourself.” And with that, I knew I needed to start
my own pediatrics practice. I was choosing to stay in the nightmare. Who does that? Most of us. My husband had been encouraging me to start my own practice
since medical school, but that wasn’t my intention at first. But now, I believed that
I could create a pediatrics practice that was a pleasant experience
for the child, the family, and me. The process of creating
Palisades Pediatrics forced me to think about
what is medicine to me? How can I fully express myself
as a physician and a health educator? How could I be my authentic self at work? I had never asked myself
these questions before. So in 2011, I started
my own pediatrics practice. I made it small and intimate. My families have direct access to me. They call, text, email me
when they need me. I visit my families at their home. I focused on comprehensive
and preventive care. I’m in. I’m the doctor, the nurse,
the lab tech, and the receptionist. Some call it old-fashion.
I just call it different. To me, medicine is more
than diagnosing and treating illness. For me, a doctor, a good doctor,
is about three things: relationships,
accountability,and passion. Medicine is about
doctor-patient relationships. And in the case of pediatrics,
the doctor-family relationship. Listening to and communicating with
the patient builds that relationship. I believe that it is important
for my families to know who I am, where I was raised, where I was educated,
what my interests are, and what my treatment
philosophy looks like. Does my personality and medical
philosophy fit for this family? Communication is the foundation of the doctor-patient relationship
and ultimately, the care of the child. Parents bring a lot
to the medical decision-making table. Doctors need to know the family’s
health beliefs and preferences. When I’m creating
a treatment plan I need to know: Is this a family
that can take a medication three times a day
versus twice or once a day? I need to understand
the child’s tolerance. Is this a kid that can sit
for a nebulizer treatment? Or should I use an inhaler? Relationships matter when creating
plans for the family to execute, so the child will thrive. Accountability. Families want one person,
an easily accessible person, to be accountable
for the well-being of their child. One of my favorite cases was
an 11-year-old boy with abdominal pain. Abdominal pain is
a very common pediatric complaint. The mom called me in the morning and said her son had
a stomachache and was lethargic. She thought he was coming down with a cold
and was just giving me a heads up, but this didn’t sit right with me. I went to the home, evaluated the patient,
and diagnose him with appendicitis. He was taken to the hospital,
the diagnosis was confirmed, he had surgery that evening,
and was back home within 24 hours. Appendicitis is a medical
emergency and can be fatal, so the early diagnosis and appropriate
treatment made this a sweet case. It’s easy to be accountable
when there is good outcome. It’s more challenging for doctors
to admit to a mistake. In my practice,
I do not have a receptionist. My families call me directly,
and I answer the phone. So if I do not return
a voicemail, it is my fault. If I forget to call a prescription
to the pharmacy, it is my fault. If I do not complete a school form, or I do not follow up the family
about a lab result, it is my fault. These are all tasks
that most doctors delegate to staff, but I wanted to be responsible for the entire healthcare
process of my families. The “but” starts and stops here,
and I like it that way. I believe it is a privilege to
take care of children and their families, and that families expect
and deserve their doctors to be attentive, accessible, and responsive to their needs. An intimate practice like mine requires the doctor
to come from behind the curtain, stand alone on the stage,
and say, “How may I help you?” Passion. I love being a pediatrician. When I was a resident, I remember having a conversation
with one of the nurses about how us residents, we have this awesome responsibility
to take care of the children of our city, and she looked at me, and said she had never heard
anyone say that before. I love the health issues
that span from birth to adolescence. I believe one of the greatest gifts that
I have been given is the care of children. I think about my families all the time. I worry about my sick patients
until they are well, and I celebrate the successes
of my well patients by attending birthday parties,
graduations, and plays. It is never a chore
to go to a medical conference, read the medical literature,
or remain current on medical topics. When I am at work, I am happy. My families expect me to be the expert, which is a constant process
of learning and teaching. Pediatrics is my passion. Once I was able to identify
these three core values, I was able to write
a business plan rather quickly. I knew I needed to step outside
the traditional model in order to be my authentic self at work. I needed a small practice,
not a lot of support staff, a lot of time to engage
the family and the child in the office or at home. Time for professional development and time to create health education
materials for my families. And when I think about it,
these three core values, relationships,
accountability, and passion, can apply to any new business venture
you may be undertaken. Along the way, support is helpful,
doesn’t matter how big or small. When taking a risk, it may be really hard
to find external validation. I was really fortunate to have
a small group that encouraged me to make my dream practice a reality. Honestly, I thought my ideas
were too out there. Home visits? Those are things of the past. The families really want
that in the 21st century? The families really want
their doctor in their kitchen? Were there enough families in the area
to make my startup a viable business? Ultimately, you have to believe
in yourself and in your ideas. I had to realize
that I was getting in trouble, not because I was a bad employee,
but it was a bad fit. I had to reconcile
my core values with work. I had to believe
in my idea and in my ability to execute on that idea. I had to take a risk. I had to. In order to create
an authentic workspace for myself. And today, I am so grateful
and happy I did. Thank you. (Applause)

64 thoughts on “A doctor’s standard career path – and the path I chose | Christi Hay | TEDxFoggyBottom

  1. good job mam…  keep  the  good  work  goinng,,,,  a thousand likes and  appreciation,,,…

  2. I liked the idea, but its not feasible. You cant have just doctors and not nurses, no rad-techs, RT's and no MA's. There arent even enough nurses to care for patients, and nurses make up 1% of the workforce in America. How could we have the man power to meet the needs everyone in this country. I LOVE the idea of home visits, love everything she is saying about knowing the family, accountability etc. but one has to understand…. There is a reason that its not just one person that does everything. You just cant be an expert nurse and expert doctor, as a nurse I can tell you that there are seasoned nurses that will school any doctor when it comes to certain skills and abilities in nursing and of course vice versa. Ive been amazed by all types of healthcare professionals right down to the CNA's. People must learn to trust each other and work together, one person cant do it all, not for the country or the world as a whole. I completely understand the dissatisfaction with the current state of the system, and I myself ask those same questions on a daily basis… I too hate walking into a room and instantly apologizing for not being there sooner. Nothing makes me hate myself more.

  3. Outstanding doc, a great first step in reinventing/returning medicine to being about the patient and healing again. I wonder where health in this country would be if more doctors had such passion for excellence. Yes we need doctors in the home, in the kitchen because in the kitchen is where chronic illness begins and thrives. I would bet the old fashion doctors could diagnose patients from the call and walking in the livingroom by what they saw. I suspect the future will be this or a similar model as quality of care, access and specialized care are paramount with all the modern chronic plague illnesses. It's a crime that doctors have maximum time limits they can spend with a patient, especially a sick child. There is healthcare and then there is highly profitable efficient meatcare.

  4. giving your patients that kind of access to you, don't you sleep about 2 hours a night? All the patients I've ever encountered would totally take advantage of this and not respect the doctor's time.

  5. Good .
    THIS is what we call as comprehensive medical care which the west has lost way back decades ago. Good that you are rediscovering the charm of it. But I warn you, it is more addictive than marijuana as you 'll be loathing in in unconditional love n respect. ofcourse the price you got to pay is fatigue, is nothing compared to the dividends. Good luck doctor.
    I'm an Indian rural Internist.

  6. I really need to contact her,, how will I get this chance, I want to learn more about the way she was able to mange all this respinsiblities

  7. I agree every doctor follows the safe path. They go to college then go back to graduate school. I have heard a lot of people switching to private practice. Medical school didn't prepare Dr. Hay for the business for medicine. This is something that needs to be taught. She says it was a nightmare working and she was always getting into trouble. No one wants to do something that is dreadful and like a nightmare. She makes a good point when she asks why a mother needs to come into the office when she just wants to know what to feed her baby when the child has diarrhea.I feel like many people are always making unnecessary visits. I like that Dr. Hay questions this. This video shows us when you have a voice inside your head telling you to leave, then do it and go after what makes you actually love working. I agree that we need more personal care. I like how she texts, calls and emails her patients and says its more than just healing people. I agree that there are three things when your a good doctor are relationships, accountability, and passion. listening to patients really builds the relationship between them.

  8. Thank you for such wonderful talk, inspiring but I have to say health care cannot be provided nowadays by just one care provider, it needs a group of comprehensive professionals in order to deliver the most efficient care possible. This type of patient interaction resembles the past and if taking a look at historical facts the percent of errors was way higher than today. The past had that nice patient doctor interaction I really wish came back but unfortunately we have a screwed up healthcare system ( which is also another source of problem) that hopefully would be fixed by the upcoming generations. You're initiative is brilliant but I sincerely doubt it to be applicable at a broader scale under our current system.

  9. 1. This is an unusual approach to practice medicine. Off the beaten path. 2. This pediatrician tread the beaten path for many decades, found her feet, got her bearings and got a good handle on the points of reference and THEN she ventured out to confront the reality. 3. When you venture out on any uncharted trail, you either perish or you thrive. You never just survive. This pediatrician appears to be thriving. God bless her. 4. I saw some comments from young medical students and young doctors expressing their keenness to follow her path right from the beginning. My advice (unsolicited, I agree): DON'T…….WATCHOUT! It's a dangerour world out there !!!! P.S. : I'm a senior physician, (Cardiologist) in early sixties.

  10. I love her dress 🙂 Damn she must be paid A LARGE SUM OF $'s. How does she have time and … She can't be at two places at once so how does this work? Can anyone tell me? Does she send out another dr. to that location while she is with someone else?

  11. I love her!!! More doctors need to take note, and step of their high horses. I hate the doctors I have, they don't listen and they are ice cold like when u are meeting a patient that is in pain it doesn't help that you don't believe them or try to understand them and also an hour late as if only your time is important

  12. She is an amazing doctor, she is someone that went into medicine to truly help and care for patients. That’s how I want to be as a doctor and I feel all doctors should be. She is truly a remarkable and respectable person!!

  13. What a huge waste of time… She talks fluff. Basically she didn't do anything other than not hire a receptionist

  14. Medicine is about co-operation and teamwork with the interdisciplinary medical team members. Simply stating everyone else at an unacceptable standard and then going at it alone is not a feasible solution by any stretch of the imagination.

  15. Super huge risk for her. But, if we don't Gamble, we can never win. Two thumbs up to this Brave woman who has found her happy life!

  16. This woman (Christi Hay) is really naive. The way that professional/graduate school education is systemically designed in the Western world… Universities historically DO NOT train their graduates how to effectively operate businesses. (It sounds like her current private practice setup has some good components, but it does not sound efficient. Most physicians are not well trained in Clinical Laboratory medicine – testing & analyzing blood, stool, body fluids, & other specimens. Additionally… It's a waste of time for the physician to be doing excessive clerical tasks & other clinical items that could be handled by a competent nurse &/or physicians' assistant).

  17. Yep, sounds like a doctor alright. Because all patients have super deluxe insurance and all have severe issues that can't just be handled by a nurse. And there isn't a shortage of doctors to patients that was intentionally created by doctor associations and lobbying. And there certainly are never cases nurses saving patients from oversights by inattentive doctors. If you REALLY want to cut out all the support staff and silly protocols why not just go straight to Medicare fraud?

  18. This is what Naturopathic Doctors do all the time! I am glad you are discovering the wonders of the Naturopathic business model. Enjoy!

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