Family Medicine Vital Signs

By: Erika Sullivan, MD

When I was a third-year medical student, I had a rotation on the far north side of Chicago, in Evanston, at a local community hospital delivering babies on the OB Ward. Because the arrangement with this hospital was a new one, and because the hours on the OB deck were quite long, my University arranged for the medical students to stay in a hotel room not far from the hospital during their eight week OB rotation. There was a movie theater and strip mall full of restaurants across the street from the hotel, some of which stayed open pretty late – late enough for me to be able to grab a bite to eat after work, before heading back to my room.

One evening, after a long OB shift, I arrived at the restaurant still in my scrubs and told the maître D’ that I’d like a table for one. He sat me in a quiet, dimly lit part of the restaurant, either in an effort to afford me some privacy or because he wanted to hide my casual dress from the other diners. My memory has faded, so I cannot recall whether I arrived first or second, but soon after sitting down, an older, white-haired gentleman several tables away approached me and asked if I would have dinner with him. At first, I declined, lacking the talent, as they say, of conversing easily with strangers¹, but he pressed me, and finally resorted to telling me that he too, was a medical doctor and that he was dining alone in a strange city and he would be ever so grateful if I would join him.

I don’t remember what we ate, nor do I particularly remember the substance of our conversation, other than to say that he was a recently retired OB and was visiting his ailing sister who was dying of cancer. I do, however, remember one thing that he told me. He asked if I knew what an “RD” was, and I replied, “a registered dietician?” “No,” he said, “it’s a ‘Real Doctor.’” I must’ve looked puzzled because he went on to explain that upon graduating medical school, you are awarded your “MD” but that it is not for some time after that you earn your RD.

As I said, the details of our meal have fallen through the cracks of time, but this notion has stuck with me. I am now nearly four years out of residency and I am certain that I am an MD, I have the badge that tells me so², but I am not so sure about the RD; I think, perhaps, that I am closer than I once was, but I am not quite there yet. And this got me thinking, how do you earn your RD? What are the steps that you take to obtain this venerable distinction?

Unlike other degrees, which have clearly delineated steps and sequences that are required for their attainment, the RD has no set curriculum, and is, by its very nature, a different road for everyone. For me, the road to the RD has been marked by my own failures – personal, professional, and medical. But looking back on my short career, these “failures” as I call them, are not low points, but rather inflections. They have universally presented me with opportunities to grow, to improve, to do better… next time. And if I am aware of them when they happen (which if I’m being honest, is not always the case), they are also opportunities for those around me to learn from my failure.

Failure in medicine is a tricky thing, because when we mess up, or we fail, there can be real consequences. But there is also benefit to failure. It makes us stronger and smarter and kinder and more humble, and humility in medicine is an underappreciated asset. In my life, I have “failed” at many things, but the ultimate failure is not being able to learn from your mistakes and to continually improve.

As Yoda recently said, “the greatest teacher, Failure is.” Or to quote from another of my favorite movies, “The Core,” “It’s just you’re used to winning…. And you’re not really a leader until you’ve lost.”

1. A personality trait that I gladly share with a certain fictional Fitzwilliam Darcy.
2. And the medical school debt as well

Erika Sullivan, MD, is an Assistant Professor (Clinical) in the Division of Family Medicine in the Department of Family and Preventive Medicine at the University of Utah.