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Anthony Bourdain: From ‘Kitchen Confidential’ to Hospital Hallways

Good Advice from Anthony Bourdain

grapefruits-stockMy wife and I are big fans of chef Anthony Bourdain. In his bestselling book, Kitchen Confidential,1 Bourdain lists some sage advice for anyone considering a career as a chef. On reading this list, I realized that many of his bon mots apply equally well to a life lived in medicine. Below are listed, with short commentary, 10 recommendations that resonated with me.

  1. “Be committed.” – There is no doubt that medicine is a very demanding career choice. Without a strong personal commitment to the profession, one cannot hope to be an accomplished physician. Bourdain suggests that working as a chef is like being in the military: “Be ready to lead, follow, or get out of the way.” This comment often applies to our profession as well.
  2. “Learn Spanish.” – In every hospital where I have worked, there were many patients whose primary language was Spanish and who were greatly reassured when I was able to speak to them using my elementary Spanish skills.
  3. “Always be on time.” – Colleagues and patients dislike being kept waiting. I must admit that I am not perfect in this category, but I do try to be on time despite multiple demands on my time.
  4. “Never make excuses or blame others.” – This is certainly relevant in the potentially libelous environment in which we work. The best advice that I received as a medical student concerning bad clinical outcomes was to be honest and candid with the patient when apologizing for and explaining the event. Take responsibility when making a mistake. My experience and that of many of my colleagues is that you learn best from your mistakes, not from your successes. I still remember mistakes that I made as an intern, ones that I will never make again because I remember the consequences of those errors.
  5. “Never call in sick except in cases of dismemberment, arterial bleeding, sucking chest wounds, or death of an immediate family member.” Bourdain is, of course, exaggerating here, but the point is well made. Patients, staff, and colleagues depend on us showing up. Anything short of a serious illness should not deter us from getting to work. A good example of this is one that I remember from my time as an assistant professor at the Peter Bent Brigham Hospital (now Brigham and Women’s Hospital). One of our best cardiology trainees and I were seeing patients in clinic. I could see that the trainee was pale and sweating while we discussed the patients. I asked, “Are you OK?” He told me he was a little “under the weather,” but that he would finish clinic before going home. That night we admitted him with Gram-negative bacterial sepsis!! I call that real professional devotion.
  6. “Lazy, sloppy, and slow are bad.” – No need to say anything more about this adage.
  7. “Be prepared to witness every variety of human folly and injustice without it screwing up your head or poisoning your attitude.” I have to remind myself about this one when repeatedly re-admitting specific patients whose failure to adhere to an evidence-based therapeutic program or abuse of various substances results in disastrous medical problems, for example, recurrent infectious endocarditis.
  8. “Try not to lie.” In daily clinical medicine, this means not writing a historical or physical finding that you did not personally observe. For example, many times in a patient’s chart I have seen it reported that the patient had normal ocular muscle function. I am sure that very few of these examinations actually involved testing ocular muscle movement, despite the written report stating that normal ocular muscle function was observed.
  9. “Read.” As medical students and trainees, we hear this adage repeated again and again. I agree completely with this piece of advice. A doctor who fails to keep up with current scientific advances and guidelines quickly becomes a danger to his/her patients.
  10. “Have a sense of humor about things, you’ll need it.” As physicians, we witness a great deal of pain, suffering, depression, disability, and death. Physician “black humor” in these settings is often misunderstood by our lay friends and colleagues. I see these examples of “black humor” as a means of maintaining our equilibrium under difficult circumstances.

As always, I welcome reader responses to my editorials on our blog at http://amjmed.org.

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– Joseph S. Alpert, MD

This article originally appeared in the November 2015 issue of The American Journal of Medicine.

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