The Future of Medicine

Seven new doctors talk about their hopes, fears, and dreams for health care in America

Katie O’Brien

O’Brien, 31, from Oakes, North Dakota, is a second-year resident in internal medicine at Hennepin County Medical Center (HCMC). Eventually, she would like to pursue a fellowship in oncology.

Why oncology?
Oncology involves psychiatry: You have to take time to understand how patients process pain, fear, grief, and joy. A cancer diagnosis could mean a death sentence, but you may be able to make their remaining time more meaningful. Challenge: At HCMC, we have a lot of homeless patients and people who can’t afford to come back because they have to make rent, pay bills, and feed a bunch of children. My challenge is to make them want to come see me. Appealing to the thing they value most can help them do what is in the best interest of their health. Concern: Electronic medical records are great, but there’s a risk. If you’re always typing notes and not looking at the patient, are you really hearing them? I just sit and listen. I also allow time for awkward silence, because that’s when people open up.

Photo by David J. Turner

Jess L. Thompson III

Thompson, 35, is in his seventh year of post-graduate training at the Mayo School of Graduate Medical Education. Originally from Tempe, Arizona, he will begin three more years of training in cardiothoracic surgery this spring.

Why medicine? I did a tour of a hospital in the fifth grade. I was fascinated with the big doors that said “Surgery” and “No admittance beyond this point.” Before med school: Studying humanities helped gear my mind to look at problems in a different way—seeing patterns and trends, comparing and contrasting. As a physician, I need to know how things are connected. Concern: There are philosophical issues related to medicine that no one addresses. Should dollars be spent keeping a single pre-term infant alive, whose fate is institutionalization, when the same money could be used to fix multiple kids with cleft lips? In a system with limited resources, escalating costs, and many deserving patients, few are asking the hard ethical questions. Bedside manner: If I have to deliver bad news I always sit down. My hope is to convey that you are the most important thing to me right now.

Photo by David J. Turner

Charles D. Hightower

Hightower, 29, from Anchorage, Alaska, is a first-year University of Minnesota orthopedic resident. Part Cherokee, he plans to create a health-education program for young American Indians after his training is completed.

Why orthopedics? My father is an airline pilot and while helping him build a two-seater, we started casting parts to meet our design specifications. I enjoyed the work and began to wonder: Could I do this for my job? Challenge: Most orthopedic surgeons focus their attention on athletes. It’s like looking under the hood of a sports car. That’s great, but my interest is more in the kid who wasn’t a varsity athlete. Young Native Americans are succumbing to diseases normally seen in people who are middle-aged. I’d like to work with other specialties in developing a health-prevention plan for these kids based on exercise and lifestyle to stop diabetes and limb loss before these kids reach maturity. Concern: Our society sells medicine as this solution for every problem. But believing in a magic pill to cure any disease can affect how you treat your body. Medical care should be considered on a continuum with good health practices.

Photo by David J. Turner

Megha M. Tollefson

Tollefson, 29, is a pediatrician who recently started a second residency in dermatology at the Mayo School of Graduate Medical Education. The San Jose, California, native now calls Rochester home.

Why pediatric dermatology? Almost a quarter of my pediatric patients had skin problems, and I became interested in dermatology. I like the idea of being on the cutting edge of a field that is just now emerging. Challenge: Caring for sick children can take an emotional toll, but it’s also what keeps me in medicine. Even when they’re sick, children are able to act like kids and be happy. Concern: At Mayo, I’m sheltered from the realities of health care in our country. No one is denied care here. I’m not expected to see patients every 10 minutes. We don’t have to deal with the constraints most physicians deal with. Family values: My son has had an ongoing rash for five weeks, and I’ve been more of a mom than a doctor. I lose my objectivity. I like our pediatrician and completely trust her. In fact, we just had his 15-month checkup, and we talked about that rash a lot.

Photo by David J. Turner

Emiro Caicedo-Granados

Caicedo-Granados, 41, a native of Colombia, will finish his otolaryngology residency through the University of Minnesota in June. He plans to continue his training with a fellowship in head and neck surgery.

Challenge: In my field, we still have a lot of questions that we don’t have answers for, specifically for cancer patients. Concern: Medical school should put more emphasis on the patient-physician relationship. Technology is wonderful, but the relationship plays a big role in the outcome, too. Every day patients teach you how to do things better. Physicians learn from books, but also from patients. The downside: Unfortunately, patient care is being harmed at some level because of the way insurance companies are forcing physicians to practice medicine.

Photo by David J. Turner

Amber Erickson

Erickson, 29, is a third-year University of Minnesota resident in neurology. The Duluth native hopes to return to her hometown, after she completes a fellowship in neurology.

Challenge: There aren’t a lot of quick fixes for neurologic problems, so I find myself feeling bad a lot. But there’s a reward, too, because in some way I know I helped that person deal with the disease better. It’s important for the patient to have a good encounter. We cannot always provide a cure, but most of the time, treatment can improve quality of life. Concern: I don’t want the number of patients I’m supposed to see in a day drive my practice. One pressure I already notice is not having enough time. On television medical dramas: ER is the only medical show I’ve ever watched. When I started med school I’d watch and get so nervous. I’d think, “Oh, gosh, is this what I’m getting myself into?” It turns out practicing medicine is nothing like it is on television. It’s much better.

Photo by David J. Turner

Wasira George Bokore

Bokore, 34, from Tanzania, is a second-year University of Minnesota family-practice resident. He plans to continue his training in preventive medicine and someday return to Africa.

Challenge: Some patients tend to be skeptical of doctors in training and aren’t sure they want to trust you. To be able to build that rapport is challenging for those patients who build a wall before you can take care of them. Concern: The system of reimbursement is not playing a fair game to the primary-care doctor. Pay for primary care should move closer to that of specialists. Primary-care physicians prevent diseases or detect them in early stages, before they become expensive to the nation, the insurance company, and the patient. Primary care in the United States, even worldwide, is not valued the way it should be. If you could be a doctor on TV, which show would you choose? House. Dr. House is a little overboard, but he approaches issues in a realistic way. Patients need a character like House to tell them exactly the way things are.