My Kind of Medicine: Real Lives of Practicing Internists: Michael Mignoli, MD, FACP
Every year, Dr. Michael Mignoli visits a different baseball park. So far, he has been to 16, roughly half in the country. Baseball has long been an interest of Dr. Mignoli’s, something he says most of his patients know. And it was baseball that he and one of his patients, an elderly man with congestive heart failure, talked about one evening in the hospital, as the man neared the end of his life. Dr. Mignoli had been at the hospital for another patient, but decided to check on him to see how he was doing. Having been the patient’s internist for eight years, Dr. Mignoli had seen him through countless tests, procedures, office visits and hospital stays, but after it was all said and done, it was not any of those things that stuck with him. During a visit by the patient’s daughter shortly after the patient had passed away, she told Dr. Mignoli that of all the things he had done for her father, what he had remembered most was how much he enjoyed their conversation about baseball that evening.
Dr. Michael Mignoli at the Los Angeles Angels of Anaheim game
Dr. Mignoli says one thing he becomes more cognizant of as he treats more patients is how significant a part of his treatment is dependent on knowing his patients. "I can take care of my patients better than anyone because I know them," he says. "I know their history, I know how I’ve treated them, and I know how they’ve reacted to the treatment. That kind of knowledge is indispensable."
He says he enjoys all aspects of his job and knows he made the right decision for himself. "No day is the same. Each individual patient presents a new challenge, which I love," he says. "Plus, the more I’ve been in practice, the more I’ve come to understand how much medical knowledge changes. I love keeping up to date with the latest research and information. I also chose internal medicine because it presented so many opportunities. You have to love what you do," he continues. "If you don’t like what you do, no matter how much money you make, no matter what the perks or advantages are, if you don’t love what you do, you will never find enjoyment in your career. I love what I do." He says medical students who are unsure of which path to follow should tune in to what their gut is telling them. "Try on all of the hats you possibly can and see if there is something you like. Pay attention to how you feel when you’re doing it, which will tell you."
One of the biggest lessons he has learned as a practicing physician is learning what he is not comfortable doing. The proliferation of information that is constantly being channeled to patients everywhere via the internet and media creates a very serious challenge for physicians in their treatment decisions. "Patients will come to you and ask you about something they saw on Oprah or heard from a cousin or read on the Internet," he explains. "That’s where you have to really take a step back and consider everything at stake: your own sense of right and wrong, the patient’s desires and whether or not they parallel their needs, the payer’s authorization, and how much of a stand you’re going to take if you do in fact decide it’s a good decision for the patient and the payer doesn’t authorize. There are whole sets of competing principles."
The Oprah-watching, self-prescribing trend is a prime example of the downside of information overload, as he explains. "You may have a situation where another doctor prescribes something to a patient of yours without consulting the patient’s current medication list, which can lead to trouble. Without an internist, it’s like having fifteen chefs in the kitchen with no kitchen manager. It doesn’t work."
Dr. Mignoli is from Texas, but there is not a trace of an accent in his voice. He called it home for a long time too—all the way through medical school at the Baylor College of Medicine in Houston. He then decided to take his internship at the University of Colorado, and ever since he has called Colorado home. "I tell people I liked it so much that I decided to stay," says the 42-year-old, "which is great because I don’t need to leave. Being an internist, I can practice anywhere I want."
Colorado suits him—five years ago he learned how to snowboard and he is also a cyclist. He has a host of other hobbies and interests: photography, cycling, and traveling. He also invests his time in what he calls "pet projects," which to most sound like part-time jobs: he is a regular speaker on the subject of electronic medical records with local medical societies and has acted as the medical director for a local hospice for several years. He has integrated himself into his community, doing what he loves and is passionate about, which for him, is the only way to live.
Dr. Mignoli’s private practice that he shares with one partner in Highlands Ranch, Colorado, gives him many things: flexibility, satisfaction, and control. "It has allowed me to be the captain of my own ship," he says. "I can control my work and my productivity. I determine how much I work and how I actually do the work. I like being in charge of my own destiny."
But being the captain of his own ship requires more than calling the shots, as Dr. Mignoli is well aware. "A lot of times, my job is just about listening and offering human support. As an internist, you’re taking care of people, not conditions," he explains. "It’s rewarding to watch patients grow older, to see a patient survive cancer, or grow stronger and healthier after quitting drinking. You don’t get to see that in a lot of positions in the medical profession. I get to see the good stuff! There’s a lot of life between 18 and 80—I get to see my patients live it."
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