Is the notion that your physician is a salesman inherently disturbing? It is a question I have asked myself over the more than 35 years that I have been in practice.  I come from a family of salesmen.  My father and son are in fields traditionally viewed as sales. 

Yet I had never viewed what I did as sales–until I thought about it.  The truth is that we all salesmen but hopefully in the best sense of the word. In any field of endeavor, from businessman to artist to physician we are continuously “selling” ourselves to our clients, our colleagues, our patrons, our social contacts.

I am not talking about the stereotypical ” used car”  guy who uses high pressure, fast talk and disengenuous techniques to push you into a choice which may not be in your best interest. To my way of thinking sales is essentially demonstrating your best self.  It is about educating the client/patient about a product or service which will cost them financial resources but which will benefit them in someway (or not)  in the future. 

We all need to be good communicators, educators in effect.  A good salesman can explain the risks/benefits of that product/ssrvice is such a way as to make the decision easier.  If it is not a mutual consensus on what to do the, quite frankly, it should not be done. And yet there remains a strong element of uncertainty in any sales situation. Will the product or service be beneficial in the long run? Is there risk in consummating the sale or in not doing so? Of course.

 Is there an element of trust involved in such an interaction? Certainly.  The salesman almost always has the advantage in knowledge and experience regarding the product/service that are being negotiated. But that has been true and will always be true.  Ultimately, the leap of faith will prove to be mutually beneficial or not.  There will always be the element of uncertainty and risk that is inherent in any human interaction.Time will be the ultimate arbiter.

A “good” salesman, whether selling a dishwasher, car, insurance product or the need for a colonoscopy, will be vindicated in the long run.  Their client/patient will return to them, time and again.  They will recommend them to their friends and neighbors. It is as simple and complex as that.


American Psychological Association (APA). “Falling off the wagon with Facebook.” ScienceDaily. ScienceDaily, 6 August 2015. <>.

The American Psychological Association’s piece cited above points to an important phenomenon of which we should all be aware–namely technology has its limits. Of course this is not to demean or diminish the incredible benefits that computers and access to instantaneous information and communication has brought to society as we know it.  It is virtually impossible to recall just a few years back when we did not possess smart phones, or any portable means of communication for that matter.

The point of this study is to remind us that technology still has its limitations.  We are still inherently social beings who have evolved to interact with each other in close proximity. Body language, facial expressions, subtle emotional responses to close in dialogue represent a dance between who individuals. The give and take often occurs on a subliminal level. Our ability to “read” others is a gift that some of us possess to a higher degree than others.  Face to face encounters are different from computer based and I will openly  risk the wrath of my more technologically savvy colleagues to propose that they always will be so.

So will telemedicine ever replace the office visit? Will it be used as a less satisfying but potentially helpful supplement to the patient-doctor encounter?

 Perhaps I only fantasize that my personal encounter with patients within the sanctity of the closed exam room cannot be adequately duplicated by technology. Perhaps it is only withful thinking that some of my success in the practice of medicine is related as much to those interpersonal skills as to raw medical knowledge.

Perhaps I remain the Luddite in the white coat.  Or at least I remain skeptical of its ability to replace the personal encounter.  Only time will tell.

Doctor On Call — Past/Present/Future

This will be a short version of the story, of an aspect of being a physician that most readers are aware of but which has an enormous impact on their own health care, the personal lives of their own doctors and the future of health care in this country.

Being “on call” begins with a young physician’s first clinical experience as an intern/resident and ends when their either retire or arrange for another physician to assume that responsibility.  It reflects the 24/7 nature of what we do.  As I begin to wind down my medical practice, the first element to jettison is, you guessed it, the on call.

I cannot enumerate the numerous times that I would be awakened by a blaring phone call at 3AM, or a vibrating smart phone in later years to bring my attention from some deep, undisturbed REM state to immediate awareness. The “Service” would be calling. The adrenaline rush became instantaneous and that mili second a barage of thoughts filled my sleep deprived brain.  As a gastroenterologist I knew that the problem I would be facing as I responded would center around a few specific disease states. Had they swallowed a piece of meat, now lodged in their esophagus. Or was it a relatively minor issue– Mrs Jones was ‘bloated’ or called at 3 AM to report her two week history of diarrhea.  Even those minor calls were quite frankly major to me.  I had to shake loose the cobwebs of my cognitive self and make a decision– to come in to the hospital, to defer for a few hours or have the patient call the office in the AM.  At least these calls and decisions could be made over the phone.  I could be half-asleep, grubby and disheveled.  I could be wearing pjs or nothing at all. The consequence of such a call is the inability to quickly fall back to sleep.  The adrenaline is still flowing.  The self-questioning begins.  Did I make the correct decision? Should I call back and change my opinion?

But it is 2015 and it is the dawn of a new era in medicine–Telemedicine.  We are told that the future is rushing up to great us regardless of how we feel. The future will mandate a visual exchange between physician and ER, physician and patient. Telemedicine will require a Skype kind of communication.  After all it will be far cheaper to connect patient with physician this way. And it won’t just be for the emergency on call interaction. Why go to the trouble of having a “hands on” visit when it is so much more convenient to do it via a computer screen.

 So I do not envy my younger colleagues one bit.  They will not have to sound competent at 3 AM, they may have to look the part as well.


Now don’t be alarmed by the title of this piece. The term ambivert is not in anyway connected with the term pervert.

In fact I first became aware of the term via The Wall Street Journal article on the subject by Elizabeth Bernstein. It described a combination of personality traits that did not fit the definition of either an extrovert nor an introvert but something of a hybrid.  

In truth this description sounds very much like me.  Like most of us I often embarked on the journey towards self-discovery.  Who am I, really? How do I relate to the world, really? I have come to the conclusion that I am not a “people person”.  On occasion, when the discussion arises, I will confess this quality to others.  Those who have witnessed me in the course of performing my professional duties as a physician/gastroenterologist are often baffled by my confession.  “No way” they might state.” You can be charming and warm with your patients, particularly the nervous ones.” Of course I thank them for that assessment but admit that this is an act I put on.

 I am always been around extroverts.  My Father was comfortable speaking with anyone and everyone. My wife and daughter-in-law are very comfortable engaging in conversation with total strangers. My Mother was quieter.  I must have inherited her genetic makeup when it comes to speaking with strangers. 

I have always wondered if my approach to dealing with patients is an act, a bit of a charade.  Am I just faking my outward persona?  I know many of my patients would be shocked by my admission.  I often observe myself in the role I play.  But am I being inauthentic? I don’t think so.  I believe we are all capable of being different people under different circumstances.  Years ago I learned the behavior that allowed me to relate better to my patients, to win their trust and to maximize the therapeutic encounter I have with them. I am now comfortable in that role.  I don the white coat of the physician and become that doctor. I believe it contributes to the healing process itself.

 I have observed that I do actually relate well to one individual at a time.  I value time spent with one person in which I can cut through the superficial banter that passes for being “social”.   I am comfortable discussing the deepest metaphysical issues with anyone.  I find those topics holds my interest and I lose any sense of being self-conscious.  I find that actually quite rewarding.  On the other hand, I find “small talk” about personal preferences, other people’s families whom I don’t actually know, rather boring.

 But at least I now know what I am— an ambivert.  I just need to explain the term to anyone who hears it for the first time.