How Substack Makes Me A Better Doctor.
And, how it compares to my day-job.
Background
Before starting this online publication, I led the life of an academic doctor. Between hospital shifts, I’d spend countless hours conducting research to be published through the typical channels of academia. Conference proceedings, textbooks, and peer-reviewed journals.
The reason I did this (or, so I told myself) was to become successful enough in my chosen field such that I could conduct any research that piqued my curiosity. Honestly, I didn’t have a very long career in academia. But, in the short time I had a degree of success which was satisfactory to me.
For example, this is the ranking of one of the last articles I published in a peer-reviewed medical journal.
I say one of the last because this research was completed in 2020. When lots of things changed. There was a crystal clear trajectory for my career - I had just been accepted into one of the most highly sought after fellowships of my chosen specialty (at the time). But, then the covid fiasco happened.
I couldn’t ignore the warning signs any longer.
The Fear of All Doctors
When I finally broke free from the mainstream pharma-centric medical industry, I began writing online. Including here, on Substack.
That’s when other doctors with similar concerns began reaching out to me. Many brilliant young doctors out there who have found themselves in similar positions.
Everything they thought they knew had been flipped on its head.
Which sounds wonderful for those of you who have been waiting for doctors to come to terms with the shortcomings of their industry, and go back to what works.
But, there is no “go back.”
My generation of doctors were never exposed to the lost arts of medicine. Not only is our education woefully incomplete…but, the environment in which we are taught and trained is flooded with industry influence.
To many of the young doctors I know…there is nothing to fall back on.
Once they see the flaws of the practice they were brought up in, they find themselves lost. Out in the water, with no boat. Barely a floatie.
I hope you can now appreciate why so many continue to keep their head buried in the sand. It is not only a cognitively challenging task, but it is also financially and socially strenuous.
The ideas out there in the real world are so radically different. By real world I mean:
The world as experienced by the people, or patients. This world doesn’t care about the bullshit of our industry. It just is.
The medical arts that have withstood the test of time for thousands of years, across cultures from around the globe.
Many critics of doctors may say something like “They should just do more reading.”
Oh, really? Where?
The Cycle
Doctors are educated in institutions heavily funded by either the government or industry partners. Usually, both.
So, their curriculum is heavily influenced by these actors.
Then, doctors are trained and work in hospitals almost entirely funded by insurance companies, pharma and biotech, and government.
When doctors need to accrue continuing medical education (CME) credits to maintain their certification, they can do so with various activities (conferences, journals, online educational platforms) that are almost entirely funded by the same institutions.
The industry actors have the doctors by the balls.
There are a good number of bright people in medicine. But, in many cases, their attention is focused on shadows on the wall.
In practical terms, what this means is that doctors aren’t typically presented with the opportunity to learn something truly new. It is always some rearranged or blended version of the same ideas that are allowed into the ether of the medical industry. So, even when you have time to discuss something with your colleagues, you are already looking at a problem from a very narrow scope.
On the off chance novel ideas poke their nose through, the doctors are armed with the casual “pseudoscience” or “quackery.” It’s just so vastly different from what they “know,” it’s that much easier to dismiss.
What’s the consequence?
Doctors don’t really get “better” by testing out new ideas. Instead, they get better by repetition. No matter how faulty the practice.
Contrast with Substack
Before I get to the data, I need to humble myself.
When I wrote “…makes me a better doctor…” I was not claiming to be a good doctor by some objective measure. I am not even sure if it’s up to me to decide. Maybe it shouldn’t even matter.
I’m trying to improve. That is all. My belief is that all doctors should try to improve, for their entire career. The question is, how best to do this?
Should you publish in journals that nobody reads? Behind absurdly expensive paywalls? Even when the people you would expect to read your articles (i.e. the people citing your research) probably don’t read them?
If nobody is reading them, nobody can provide constructive feedback.
Then, how can the writer or reader appreciate an educational benefit from this publication?
Compare this with online writing.
It’s not just to get thoughts out of my head and unto paper, as was the initial motivation. It grew into something very different.
First, the people who could benefit can actually read your findings. That’s good for them.
Second, these people can implement your findings, and then give you feedback. That’s good for you.
Then, there are people who may disagree with your work and provide either criticism or an alternative perspective on the same problem.
There are also those who now engage with your work regularly, and can provide you with recommendations to explore something entirely new.
This feedback is coming from people around the globe. Not just my niche or microcosm.
I’m just scratching the surface here. I could not be more grateful for the community that we have built up on Substack (and Twitter). You’ve all taught me much in a short period of time.
If I stayed on my prior path, there are things I’d never have learned. Most likely.
Yes, the first couple months were quiet. But, after three years of publishing online, we get turnouts like this:
The numbers you see up there are decent, if these are the metrics you are after.
But the most useful for me is the comments. Currently at 136, this is more feedback than I have ever received from any mainstream academic channel.
That’s where the real growth lies. Not in the new subscribers, or MRR. But, in the comments. The emails. The stories people share in private messages.
Can’t say this enough.
Thank you.
Keep writing friend for your work has opened many eyes and continues to do so. Though I am not a physician my background is in Pharmacology and Biochemistry. You have and continue to validate much for me and others.
I am very conflicted. Years ago we made some very decisive moves to safeguard our family and took a big hit from the world “as it is”; we made a lot less money, we shopped at thrift stores, we didn’t eat out, we didn’t take vacations, we stayed in our “starter home” and put up with crowded, but cozy, spaces. We kept dad at home, as he was in the corporate world and that required a lot of travel and requirements (coercion) to choose the career over family. We were blessed beyond measure as we watched God direct our lives as we lived in faith.
Now, the kids are grown and having to make these hard choices, and as hard as it was for us, I think it is harder, perhaps, now. Yet, I personally have met young(ish) doctors who admit they became a doctor for the money and prestige. I have been insulted in nearly every way possible for over 30 years by the arrogance when I chose the better things that are now becoming more widely known. And the scandal of the last five years is the icing on the cake. How do I trust these individuals who have sold out? What keeps them from making some hard decisions akin to our choices? Is it still money and prestige?
I would challenge any of them with a pang of conscience to make the leap of faith to do the good thing, the brave thing, the countercultural thing. How I wish we could have adequate, affordable, effective and humane health care. It can be such a noble profession.