By Kevin Walsh, MD
In my years as a physician, I’ve learned a lot – both personally and professionally. One of the biggest lessons came early in my career: the medical field wasn’t exactly what I expected. I had to adapt quickly.
When I began training in the 1980s, there was a sense of freedom in medicine. You could help people, feel financially secure, and be your best self. But by the 1990s, things had shifted. Economic forces, health care reforms and increased patient volume changed how we practice. I wish someone had told me back then how important it is to keep your priorities straight and stay true to what matters most to you, especially when the field around you is constantly evolving.
I started as a primary care doctor, but after a few years, I felt stuck. It became routine. The patients would come and go, but it often felt like I was addressing only the superficial aspects of their health. Deep down I knew that it wasn’t just their bodies that were hurting – it was also their psyche and their social world. It made me realize I wanted something more. I wanted to get deeper into my patients’ lives, not just treat their symptoms. Then came more health care changes, like managed care and new policies that reduced patient time and increased volume. It felt like we were being pulled in all directions.
That’s when I paused and reconsidered what I was doing. I needed to adapt, but in a way that allowed me to thrive, not just survive. That’s when addiction medicine found me. It was a career change that perfectly aligned with my interest in treating the whole person – body, mind, and spirit. I found a way to practice that fit my personality and allowed me to focus on what matters most: communication, listening, and understanding the person behind the symptoms.
The lesson? Stay true to yourself. Match your practice to your personality. When your personal and professional identities align, you’ll find happiness and fulfillment in all areas of life.
Another thing I wish I knew is how critical relationships with colleagues are in medicine. We aren’t really taught how to manage relationships – whether with patients or colleagues, or even ourselves. It took me years to figure out that having positive and supportive relationships with colleagues — and with non-physician coworkers — are essential to being happy. My quality of life improved dramatically when I started having lunch with the medical assistants and nurses and making an effort to build more friendships. Unfortunately, forming connections with colleagues can be just plain tough. Everyone’s so busy. Taking time to be curious about others and share a conversation can make a world of difference.
One final thing I wish I ‘d had a clearer understanding of early on is how evidence-based medicine would evolve — and how it would be used. I was there when it first gained traction. As a medical student, I held the first book on evidence-based medicine, written by experts in Canada, and I remember being excited. It was revolutionary. We could move beyond just intuition or what our professors taught us in medical school years earlier. By applying a scientific method and critically analyzing data, we could figure out the best course of action for our patients. No responsible doctor would argue against the value of this approach.
Dr. David Sackett is regarded as the father of evidence-based medicine. His book was revolutionary for Dr. Walsh.
But over time, it became apparent that not all studies are created equal. Some have significant biases, whether it’s because they didn’t include diverse populations such as women or people of color or because the quality of the evidence itself wasn’t strong. There’s also a lot of variance across patient populations, which makes it difficult to apply findings universally.
The problem isn’t with evidence-based medicine itself; it’s with how we interpret and use it. Guidelines based on studies can be a great tool, but they shouldn’t be followed blindly. Every patient is unique, and sometimes, the guideline just doesn’t apply to the individual in front of you. COVID-19 taught us this lesson in a dramatic way. We saw how social, psychological, and even political forces can influence how data is interpreted. Instead of using evidence to guide thoughtful decision-making, there’s a tendency to treat guidelines and algorithms as rigid rules.
That’s not what evidence-based medicine was meant to be. It should serve as a framework, not a final answer. I remember someone saying early in my career, “The mark of a good surgeon is knowing when not to operate.” I think the same logic applies here. The mark of a good physician is knowing when not to follow the guidelines, when to step back and think critically about whether it truly fits your patient’s situation.
As artificial intelligence becomes more prevalent in medicine, this will only become more important. AI will help us analyze vast amounts of data, but it won’t replace the human element; we need to understand each patient as a whole person and to apply our knowledge in a way that fits their individual needs.
In the end, my advice is simple: adapt to the changes around you but stay true to yourself. Invest time and attention in the people around you because you can’t thrive without them. And don’t be afraid to question guidelines if they don’t fit the situation — trust the instincts that got you into medicine in the first place.
