Dr. Tovia Martirosian Smith '98

A young doctor shares four lessons she has learned

featured in the Richmond Times-Dispatch, Jun. 18, 2017

It’s not often that you can say your first “real job” was in the place you were born. It took me a while to return – college, medical school, residency and fellowship training – but in 2014, I started working at the same medical practice where my mother brought me into the world in 1980.

At Virginia Women’s Center, I’m a urogynecologist – that means I help women who have disorders of the pelvic floor or urinary tract and may need surgery. Over the past three years, working with many great patients has taught me many valuable lessons. The first one starts with something as simple sounding as taking a patient history. This used to be a time-consuming process, but in the data-driven world that doctors work in today, I have to remind myself to slow down and listen – really listen – to my patients.
When you see your doctor, you often begin by providing a medical history, in which you’re asked to describe your health and why you’re seeking care. As a doctor, I could be tempted to lead the conversation with “yes/no” questions to get as much data as soon as possible. But this would be shortchanging my patients. t takes discipline to stop posing questions and instead make eye contact – and to let my patient do the talking. These moments help develop trust, which is one of the most powerful elements of the patient-doctor relationship. If the patient trusts me and gives me the chance, most often she’ll tell me exactly what I need know to understand how to help her. 

I once had a patient who suffered from an overactive bladder. After we met and talked for a while, it became clear to me that something else was bothering her. It turned out that her mother had a history of bladder cancer that caused immense suffering. “Could I have bladder cancer, too?” my patient asked. I reviewed her lab results, which didn’t point toward cancer. I explained that screening for bladder cancer wasn’t indicated, and that such screening actually carried its own risks. After we talked some more, my patient and her husband agreed that while we definitely would treat her overactive bladder, there was no reason to overreact with unnecessary testing. Much of medicine falls into such gray zones. I thought the best thing to do was to discuss the situation with my patient, let her see all sides of the argument and bring in her husband so everyone was on the same page. I think she appreciated my honesty, as well as my concern for her emotional and physical well-being.
But could I be sure that I did the right thing? I think about my father, a practicing cardiologist with an unparalleled work ethic. He always taught me that showing up, putting one foot in front of the other and remaining level-headed can get you through tough times, and that doing so takes courage.  So that’s my second lesson. No matter what job you hold, having mentors to guide you and give you courage is imperative. In addition to my father, I was blessed to learn from female surgeons who offered fantastic care to patients and maintained some work-life balance. It was one of my mentors at the University of Virginia who persuaded me to pursue an OB/GYN residency and seek a postgraduate fellowship in urogynecology. She and others helped nurture my own commitment to patient care.

Looking back, medical school instilled in me not only knowledge and work ethic but a commitment to lifelong learning, which is a third lesson. Doctors must feel responsible for expanding their knowledge, and my real continuing education is my patients – they walk through my door every day, ready to challenge me to be the best for them.

That leads to a final lesson, one that might sound simple but really isn’t: keeping the focus on the patient. Doctors today are constantly rushed and face many expectations that have little to do with our actual time with patients. In this era of corporate medicine, we deal with technology, facilities, medical records and compliance with state and national accreditation guidelines. So on any given day, I not only see my patients, but I must document extensively, participate in billing and manage staffing. Despite these responsibilities, I will never go wrong in putting the needs of my patient first.

So how will I know if I did the right thing? Maybe I won’t always know. But by leaning on my mentors and embracing new lessons – and really listening to my patients and placing their needs first – I have a fighting chance in the challenging but exceedingly rewarding profession of medicine.


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