Transitions in Medicine – One Doctor’s Perspective

MedizinBy Tia Will

Today, I was asked to write about transitions as they occur in medicine by a fellow poster on the thread regarding the reaction to the national election. This request comes at a particularly poignant time for me as I prepare to make my last transition within the group with which I have worked for the last 30 years. But I would like to start by addressing some other issues of transition in medicine.

So that we are all starting on the same page I am going to use the following definition of “transition” :

The process or a period of changing from one state or condition to another.

In the field of medicine, transition can refer to many different processes. For the patient, it may mean change from one state of health to another. It may mean the change from a state of complete independence , full mobility and bright prospects for the future to one of devastating loss up to and including near complete loss of movement and/or speech. It may mean the need to transition to the awareness of a very brief life span when the assumption had been of a long life. These changes may occur in the blink of an eye as in a collision, gunshot wound, or stroke. Or they may be prolonged over a period of months to years.

  For the family it may entail the change from one state of membership to another as in a death or a birth. These changes are likely to have different meanings for different family members. I had been unable convince my 2 ½ year old daughter that the baby in my tummy was a boy. She was insistent that it was a baby sister. She was much less ecstatic than I was when she realized I was right. Smooth sailing for me. A much harder transition for her.  It may involve necessary changes in the roles of some or all family members as one family member may become either more or less capable of self care or the care of others. It may mean that someone who is used to being in control can no longer fulfill this role, which will mean that someone else will need to step up into this capacity. This may lead to growth for one and inevitable loss for another. All points of view are worthy of empathy.

In this country, transition for the patient and their family may also be marked by major economic change. It may mean the loss of the major household income and with it the loss of home and/or lifestyle. It may mean moving from independence and a sense of hope for the future, to loss of home and all prospects for upward mobility. It may mean children who were expecting to be able to pursue an advanced education, may now have to work to help support the family. In one case in which I was involved, a young man who was the sole English speaker in his immigrant family had a stroke plunging his entire family from a functional state in which his parents and sibs were working while learning English with his help, into a state of near complete linguistic isolation overnight.

I have had the privilege and responsibility of witnessing and helping when I could, both individuals and families face their own transitions. I have seen those who accept change with grace, resilience and strength even under the worst conceivable circumstances. And I have seen others who lash out with anger or who are swamped with self-pity and inertia when faced with what I perceive as relatively minor changes. What this has taught me is a respect for each individual pathway through the process of acceptance of change. The problem and the path to resolution is that of the patient and family. It is mine job to observe, attempt to understand and to alleviate pain and suffering when I can, and to accept when I have no ability to help further. It is never my right to judge the reaction of another. To do so is to limit my capacity as a healer. Every time I minimize a complaint, symptom or concern, I limit my own ability to serve as an advocate for my patient in terms of helping them to achieve the best possible outcome. Every time I become angry, or frustrated, or impatient, I become a less effective health care provider.

In medicine, transition is not limited to patients and their families. For health care providers, transitioning is a constant in our world. The rate of accumulation of knowledge, use of different drugs, different surgeries and different treatment modalities is accelerating far faster than it was even at the beginning of my career. This requires providers to be learning on a near daily basis.

The pressure to master any given field of care is bringing many to much a sharper realization of their limitations and with it the need to either self limit the scope of their practice or face the reality that sooner or later they will be forced to do so as they prove unable to transition ( acquire updated skills in all knowledge areas) quickly enough to be considered competent to practice. In addition to this need for constant updating of learning, medicine has an especially formulaic process of transitioning.

Medical school and residency are characterized by a yearly transition in lock step. Every July, ready or not, the trainee is expected to make the transition from a lower, less independent level of care to a higher position with much more responsibility. The stakes are extremely high. Some programs will allow for additional and more intensive training if the individual has not quite mastered all of the expected skills. Some will not and failure to advance may be the end of a career. This is of course necessary in extreme cases for patient safety. But failure to make this arbitrary cut off and transition to full responsibility for the new set of expectations can prove devastating.  The ultimate transitional step in this process, becoming an attending or independent physician can be a very smooth and natural process. Or it can be a terrifying realization that the buck does indeed stop with you even in life and death situations. Some will adapt to this position very gracefully and seemingly almost effortlessly. Some are nearly paralyzed with fear. Most of us are somewhere in between and almost every one makes the transition with adequate and appropriate support. This requires a degree of empathy from all those who have already successfully made this transition. What is helpful is differential support of our juniors including the assurance that those of us supervising will not allow our students to hurt the patient. What is singularly unhelpful is to criticize, belittle their concerns or lack of confidence , or deliberately shame or blame them publically. A timely word of encouragement can make or break someone’s sense of worth when something has gone wrong and there has been a bad outcome regardless of whether or not they were to blame.

In medicine, we are at our best when we recognize that best outcomes for our patients are achieved when we are all working as a team, acknowledging, respecting and honoring each member’s contribution as opposed to belittling someone who has not yet transitioned to the top position of independent attending physician.

Our outcomes in medicine are demonstrably better when we work in an integrated manner with other members of our health care team. It is only though this integrated approach that we can fully recognize the patient’s condition, their style of problem solving, their personal priorities as they transition through various stages of health and wellness. This willingness to set our own egos and preferences aside and to fully appreciate the patient’s possibilities for making the optimal transition for them and their families so as to provide the best possible advice and guidance.

If you ever find that you or a loved one have a serious illness and are struggling with a major health transition, I sincerely hope you will find a physician who is respectful of all of your concerns, who places your well being, as defined by you, as their first priority, and who recognizes that in medicine the patient’s perspective is far more important than the prejudice of the physician no matter how knowledgeable. Even the world’s most skilled physician will not have good outcomes if she insists that she knows best and disregards the difficulties faced by this particular patient during their, not her, transition.

So to move full circle, I have a few thoughts about my own transition from practicing physician to retired physician. My hope for myself is that I will make this particular transition with grace while focusing on making a meaningful contribution to our society in my new, evolving situation. I am still considering my options: teaching at the new medical school in Elk Grove, continuing to participate in public health on the county level, volunteering in community clinics in my area of expertise, attempting to form a new collaborative center with others interested in sharing their time and expertise for time, not money. There is much that I could do. The most difficult part of the transition now is choosing which will be the best fit

I would be very interested in hearing your thoughts about my experiences and about your experiences with transitions in your own lives and professions. I would see this as a very interesting topic for sharing and am thankful to hpierce for the suggestion.

About The Author

Tia is a graduate of UCDMC and long time resident of Davis who raised her two now adult children here. She is a local obstetrician gynecologist with special interests in preventive medicine and public health and safety. All articles and posts written by Tia are reflective only of her own opinions and are in no way a reflection of the opinions of her partners or her employer.

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  1. hpierce

    Was thinking about “transition” in the OB_GYN sense, that Don and I recall as front-seat spectators, but Tia’s could well be an interesting tack as well…

    As I understood it (second-hand), “transition”, as part of the birth process, includes (no matter how much you learned what to expect) feelings that “things have gone horribly wrong!”; “can we have a ‘re-do’?”; “who’s REALLY responsible for the situation I’m in?”; “don’t you dare tell me that it will be ‘over in a little while’, and I’ll be fine when it’s done!”; what one person perceives as a short period of time, another perceives as “an eternity”… then, the ‘bag of waters’ breaks, there’s a lot of “pushing”, and a new reality enters the world, which will require a lot of care and nurturing, with no guarantee how things will turn out… could be very good, could be very ‘bad’, but most likely somewhere in between… often joy, often powerful frustrations, some happening almost simultaneously…

    Or, another medical analogy might be a doctor’s possible ‘slant’… “this, like a kidney stone, will pass…”

  2. Tia Will


    Was thinking about “transition” in the OB_GYN sense”

    I suspected that your question was much more targeted, but felt that to deal with only the aspect of birth or rebirth would be to ignore the possibilities to explore how I perceive transitions in the field as a whole. Once again, thanks for the idea.

    I liked the kidney stone analogy. To build on that I think it is important to point out that usually a kidney stone will only cause severe pain. However, on occasion if not managed, promptly,  broken up or removed, it can cause the permanent loss of a kidney or in those with only one functional kidney, the need for dialysis, transplant and even death.

    1. hpierce

      You took your own tack on the ‘invitation’ to talk about “transition”… perfectly correct in doing so… no harm, no foul…

      Thank you for your honest perspective… like you, will take some time to cogitate before (or if)  I comment further…

      But again, thank you… sincerely…

  3. quielo

    Hi Tia,


    I have made numerous transitions both vertical and lateral. One of the most disappointing was into management. I was the top salesperson for a company and they promoted to head of sales. At that time we had a salesforce and a combined order entry and customer service group. Our client base was clinical labs. I was flattered with the promotion and the new title. The transition from a outward facing role to an inward facing role was unpleasant.

    “Quielo, can you talk to Larry? He smells bad and I don’t want to work next to him anymore”

    “Quielo you are now representing your department at 27 different standing committees, each of which meets weekly”.

    “Quielo, the CEO wants to know why things on the bottom of your priority list never get done, why don’t you do everything on the list at the same time?”

    It was horrible and somewhat traumatizing. Going from a position where I had almost complete freedom and a simple goal to one where my day was calendered months in advance and I was never sure whether I was doing a good job caused me to resign and seek out an individual contributor role where I have stayed ever since.


  4. Tia Will

    Hi quielo,

    I can totally relate to your experience. The coaching, counseling and ultimately progressive disciplinary action regarding individuals who had previously been my peers was an extremely difficult transition for me, and ultimately I never really mastered that portion of my career. Truly appreciating where one’s own strengths and weaknesses lie and letting your own superiors know that you are not sell suited to a certain position is key. I never just came out and told my personal friend and superior that this was the wrong position for me, and she did not realize since there were other aspects of the job at which I excelled and those were what she saw. Ultimately I let her know, we changed my position back to one of clinical and running projects and all was once again well in my world. One of the concerns that I have about our current national transition is that our current president elect does not seem to be able to conceive that he is not the best informed on every subject and that perhaps there is some truth in being “stronger together”.


  5. quielo

    Hi Tia,

    “Truly appreciating where one’s own strengths and weaknesses lie and letting your own superiors know that you are not sell suited to a certain position is key. ” This is part but also where I find satisfaction. I generally like most of my clients while long committee meetings are unendurable for me.

  6. Marina Kalugin

    I see what I post disappears nearly as fast as I can type…oh well…not important, because there was nothing to learn from it if one is an AMA kissup….

    And, I felt that this title was going to be about some real significant transitions …meaningful changes in the medical field… otherwise I wouldn’t have even clicked on it…

  7. Tia Will


    because there was nothing to learn from it if one is an AMA kiss up”

    Spoken in line with a common thread of misunderstanding of the positions of others.

    I have never been a member of the AMA. Their positions have never been representative of mine.

    While these transitions may not have been meaningful to you, I can guarantee you that they are significant to the patients , students, residents and colleagues who are faced with them. And please, feel free to ignore anything I write so that you will not be disappointed nor waste your time.

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