A Physician Valentine

Lisa Sanders, MD, got a call from an editor and friend at The New York Times who was looking for a way to cover more medical issues. Sanders knew just what to suggest: herself.

Since September 2002, Sanders, an internist and clinician-educator at Yale University School of Medicine, has been writing "Diagnosis," a column in The New York Times Magazine that explores possible causes for curious symptoms via real-life case studies.

In one case, an obese patient was eventually diagnosed with Pickwickian Syndrome. In another, a female patient's masculine appearance -- male pattern baldness, thick facial hair -- were discovered to have been caused, most likely, by insulin resistance.

The columns invite readers to play doctor, and solve the mystery as they read along.

Two things become clear about Sanders upon reading her columns: first, she obviously revels in the investigative process of medical diagnosis, and second, she truly cares for, and empathizes with, her patients. In short, she loves being a doctor --  and in reading "Diagnosis," it's easy see why. (Read some samples at www.nytimes.com/pages/magazine/columns/index.html. Scroll down to the Diagnosis header.)

"It's the most interesting thing I've ever known," she says of the diagnostic process.

The column titles read like a medical student's notes: "Back Pain, Mottled Vertebrae, Anxiety" or "Hip and Buttock Pain, Difficulty Walking, Normal X-Rays." Sanders explains that she tries to use ordinary language --  or at least explain medical jargon --  but that readers have proven surprisingly astute in picking up the medical concepts.

"Since the days of Dr. Kildare ... doctors' stories have been interesting to patients ... . It's the kind of conversation you hear at dinner parties; people are fascinated by this kind of stuff. They are real-life, actual mysteries."

In other words, readers like to be doctors. It's ironic, because so many doctors don't like to be doctors anymore. A big part of Sanders' objective with her column is to send "a Valentine to my own profession" --  to remind fellow primary-care physicians of how wonderful it is to be a physician.

Sanders used to work in television journalism; the control rooms had a cartoon reminding everyone that television isn't brain surgery. "In television, being a doctor is the highest level of achievement. In medicine, people just don't recognize how glorious this is. ... I think it's easy to forget."

And no wonder. "The way primary-care doctors are paid and the difficulties they have negotiating the system so they can get paid is appalling," Sanders says. "Really, primary-care doctors do the heavy lifting of medicine. So my secret agenda is to remind everybody of how important internists are."

This Valentine's Day, set aside the claim denials, refill requests, and internecine disputes and think for a moment about what made you fall in love with medicine in the first place.

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This article originally appeared in the February 2004 issue of Physicians Practice.