1. Our health care system is broken, and there isn’t going to be an easy way out. Costs are too high and our outcomes too poor. There’s a lot of finger-pointing in how we got to this point, but one thing is for certain — physicians must lead the way to a better system. The heart of health care is still the doctor-patient relationship and that needs to be protected at all costs. Historically speaking, physicians have tended to shy away from the business side of medicine in lieu of caring for patients, but that’s no longer a realistic option. Physician leadership is a must.

2. Nurses are underpaid and underappreciated. Physicians diagnose and develop treatment plans, but the nurses are the ones who carry things out. They’re present for the good, the bad, the embarrassing and whatever else becomes necessary. They spend substantially more time with patients and families than the physician. A competent, compassionate nurse is an invaluable benefit for a physician and shouldn’t be taken for granted. I feel this more strongly with each passing year I work alongside them.

3. There’s still nothing better than connecting with another human being and alleviating their suffering or supporting them in the face of death. Despite all the problems in health care, these moments have an amazing ability to strip away all of the “noise” and remind me why I decided to be a doctor in the first place. To see a patient present with an illness and be able to cure it is one of the coolest things ever. Similarly, helping a patient face death with dignity and alleviating suffering at the end of life is humanity at its best.

4. The bad patient outcomes never leave you. Even if everything is done perfectly, sometimes things go wrong. I know this with my mind but it still always leads to second-guessing, no matter what. Physicians often carry many of these memories with them for years afterward. Unfortunately, the culture of medicine doesn’t often encourage talking about them with others.

5. Patients are now much more likely to suggest their own treatment plan. With the endless supply of online medical information and medical apps, many patients read extensively and come armed with well-researched ideas and suggestions. This can be a very good thing, but can also create challenges when the online source isn’t trustworthy or doesn’t take into account the intricacies of the individual patient.

6. The epidemic of physician burnout has exploded since I finished medical training ten years ago. Many of my colleagues are considering leaving medicine or transitioning to a non-clinical job. Physicians don’t seem to be respected much nowadays, and many are tired of unrealistic productivity demands, lack of work-life balance and excessive administrative burden. The system has pushed physicians so hard that many have decided to tap out. This saddens me, and I worry the problem will only worsen over the next ten years.

7. Too many doctors don’t take the time to explain things to patients in plain language. It’s amazing to me how little patients truly understand about their own medical problems and it’s typically no fault of their own. Rushed doctors and fragmented medical care contribute to such a problem. I’m not perfect, but one thing I pride myself on is explaining complex medical issues in patient-friendly language and allowing patients opportunities to ask questions. In fact, that’s one of the reasons I started this blog.

8. I’ve grown mostly accustomed to being cursed at, threatened and belittled by angry patients. Typically, this just requires listening and deflecting and trying to understand where their vitriol is originating. Often, it’s because they’re in pain or scared. However, over the past few years, there have been many articles in the news about physicians being murdered or assaulted by angry patients. On a couple of occasions, I’ve seen nurses slapped by patients. This isn’t something I fixate on, but I’d be lying if I said I don’t occasionally glance over my shoulder after such encounters or when walking across the parking garage after work. You just never know.

9. Keeping up with the latest medical information and emerging studies is nearly a full-time job. The standard of medical care can rapidly change, and physicians must commit to lifelong learning. Working at an academic institution and teaching makes this much easier, but it is still time-consuming. It can be both fun and challenging.

10. It’s virtually impossible to “turn off” being a doctor. From the perpetually busy work schedule to friends and family members asking medical questions, to being at home but still worrying about patients, being a physician becomes part of your identity. I’m not asking for sympathy as I knew what medicine would entail when I applied to medical school. However, when the job of physician is done well, I think it’s nearly impossible not to leave small pieces of yourself behind along the way.

Bonus lesson. Cherish each day you have and tell those you love how you feel. None of us are promised anything, and your health can change in an instant. I’ve seen far too many young and “healthy” people die unexpectedly or be diagnosed with a life-changing illness.

Kevin Tolliver is an internal medicine physician who blogs at My Medical Musings.

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