Shhhh it's a secret

Here are 10 things doctors think (and will never tell you).

10. You are going to die, and probably at age 76. One of the intriguing things about being a physician is that every illness has a beginning, a middle and an end. To patients, they have symptoms, they come in, they either get fixed or get worse. To us, the beginning holds the clues, the middle is where we meddle and the end is hopefully a successful remission of the illness, if not complete eradication. But in the end, something is going to begin that we can't stop. The middle may be a day or less, or months to years. But there will always be an end. This is apparent to us on the first day of anatomy when we meet our cadavers. And this is what makes doctors able to deliver terminal diagnoses with some regularity. It's not an easy fact. But it's life, and your doctor knows this and thinks about this more than most patients. For what it's worth, the average age of death in the US is 72 for males, 80 for females averaging 76.

9. We like it when you show that you care about yourself. This may seem like a no-brainer, but it is inevitably easier to take care of people who are making efforts to take care of themselves. We live in an interesting era- where malpractice lawyers eat doctors for lunch and patients read internet material and consider themselves experts. It's tough to be a doctor today, trust me, but nothing is more rewarding than the patient who shows up on time, and has made an effort to get better. I cannot tell you how many of my patients in my continuity clinics during residency skipped appointments, showed up 30 minutes late for a 30 minute appointment, stopped taking their medications-those who tried earned my internal respect. All were treated respectfully externally.

8. We're tired! I've written about the work hours before- but docs are beat. By the end of a day delivering health care we're emotionally exhausted and standing and bending and running around all day is tough. The good doctors will not try to hide this.

7. We are grossed out sometimes. So in my 2nd year of med school I rounded one night in the emergency room and a woman came in carrying her eye with the nerve dangling from her socket- I had to leave the room to avoid throwing up. Ever since then- many eye-related diseases weaken my knees- but this is one thing I can get over when I think from the patient's point of view.

6. MANY narcotics users are abusers. With the exception of patients with documented causes of their chronic pain, or patients with debilitating illness (cancers, etc) that require oxycontin, oxycodone, dilauded, morphine, fentanyl patches, or any others in the family of the most abused drugs in history- most patients prescribed these medications for unclear causes are abusing them and should be off of them. Almost all of my colleagues believe this to be so. Unfortunately, many of them prescribe them anyway.

5. We would do it again. I have asked many of my colleagues if, knowing what they know now about how tedious a path medicine is, from the start, they would pursue this path again. Most say a resounding yes. The truth is, we love our patients, our knowledge and our work. If we didn't, we'd never do this!

4. HOWEVER, we'd like to retire young and have second lives. The truth is, medicine takes a lot out of doctors, and most of us would love to pursue other passions as well. The problem is, the job takes up a LOT of time and energy- and there is a wave of young retirement among 50-60 year old docs and second careers which has left some hospitals with very young staffs and few senior physicians.

3. We hate malpractice lawyers. This may seem obvious, but every time I see an add from an ambulance chaser soliciting that "bad doctor" who "needs to be punished" I want to scream: 'you went to school for 3 years, did no residency or fellowship, made $150,000 the year you graduated (I am still making less than $60,000 4 years out), and don't have to deal with vomit and feces and blood and death all day!!'

2. We love to hear about patients' lives. The pleasure in my day, besides meeting amazing people and helping them feel better, is hearing their stories, and learning from them. Every time a patient recommends a book or a website I check it out. Most of my physician colleagues also embrace the chance to learn from our patients. You are our connection to the world at-large, and we are grateful.

1. We are afraid that health care in America is in BIG trouble. It's not just the uninsured, the insurance companies, politicians and CEOs who are worried about the crisis that is upon us, we docs worry about not being able to take care of all of you. We talk about it, read about it, vote according to it, keep up with it- we know that at the end of the day we are going to be in high demand, and that you may not have the means to pay for the services required to keep you healthy. These are scary times- and your doctors are equally scared.