This post is for the physicians out there. We as physicians are concerned with the health and suffering of our patients. But are we concerned with our fellow physicians and should we? I ran into a plastic surgery colleague of mine today. He will retire soon, and was happy to discuss the stress on physicians, especially on surgeons. I have observed more interpretation errors in our radiology partners (or at least I think I have) over the past five years. One of my radiologists was telling me that the training radiologists now strongly stress that the learners review all films and question radiology reads.
My friend opined that volume expectations have become unsustainable. We order too many imaging studies. When you ask physicians to ramp up the volume, they make errors. As he described volume expectations and the impact on his field, I immediately categorized his laments as the same laments we hear in primary care, surgery and hospital medicine.
An underlying principle that insurers and policy experts do not understand frames the issue. You hurt patients when physicians cut corners. The predictable implication of excess volume is that physicians must cut corners and when they cut corners they make more mistakes.
Some patients require a 30-minute visit, yet administrators tell their physicians that they must average 15-minute visits. Radiology errors occur when the radiologist does not have the proper amount of time to spend carefully examining each film. The same concept occurs for virtually all subspecialties and especially when you consider that a fair amount of physicians, including we surgeons are employees of a hospital or health care facility.
Physicians generally have pure intentions. We want to help our patients. How can we help each patient properly if we do not provide the appropriate attention to his or her problems? We should spend enough time talking with the patients and examining them. We should spend enough time making certain that they understand their disease processes and prevention strategies. There are no shortcuts. We must spend time researching their problems when they are less usual. We should be able to communicate with patients while they are in the office, but also on the phone and through electronic means. These all take time and time with the patient and not just another technological test.
Our profession has great complexity, a complexity that payment formulas do not recognize. Each patient deserves our attention and enough time and unfortunately we don’t get paid for the extra time that we need for good patient care.
We need better trained physicians and enough physicians to care for a reasonable number of patients. This is a patient issue, but it is also a physician issue. We face a major burnout problem in medicine, which I have pointed out in prior posts. One reason for burnout is a personal sense that we are not devoting enough time to each patient. That dissonance between our personal expectations and outside pressures leads to great discomfort.
Patients are suffering while physicians are suffering. In what world does this make sense?
Its amazing that when you enter medical school, you have this very esteemed white coat ceremony. It’s a memorable occasion, where speakers tell newbie medical students and their families all that it means to wear such a coat: the responsibility, the ethical code, the professionalism, the compassion all intertwined to make up the very fabric of each emblemed white coat.
My coat was part of my dilemma. It wasn’t that I couldn’t be all the things that it represented; I just felt that it had its own large persona, and there wasn’t enough room for singing, laughing, dancing in me. You see, when I entered medical school Could a doctor have another passion? I didn’t think so at the time. Every time I put that crisp white coat on, I pretended to be someone very different. Less of me, I thought, more of who I thought a doctor should be based on my father’s behavior as a physician; and so I began to stifle myself, and I became very unhappy in the process.
It wasn’t until the third year of residency that I heard two amazing mentors tell me, “Be you as a doctor.” I know that sounds incredibly simple, but to me it was profound. Be me? I went home and contemplated this saying over and over. Be you as a doctor. I thought about how being me would including humming during procedures, singing for my patients, asking questions apart from the character, location, onset, duration, intensity of pain. I would improvise off the script and find joy in not just being me but searching deeper into who my patients are. From that day on, my world changed. I let myself be free to be me between the button and the buttonhole of my white coat. It was awesome. I felt I was running wild and discovered the secret of happiness: I got to be me!
It’s not just other talents and creativity such as music that the white coat tends to suppress. I know mothers and fathers that don’t speak about their children, world travelers that are restrained to tell their stories, photographers, painters, dancers, cooks: all doctors that seem uniform under one blank canvas cover. Maybe, the white isn’t for uniformity at all, but for us to bring our own personality and color into the mix. Maybe our profession would be that much more vibrant and enjoyable if doctors felt free to be who they are. Maybe we should all be you as a doctor. I hope those words change your life as they did mine.
There’s a lot of talk these days about patient satisfaction. Physicians are being measured in so many different ways. What concerns me is there’s not much talk as I have pointed out about physician happiness. With levels of physician burnout and discontent growing, why not pull back the curtain on how to improve physician happiness? Especially considering the increasing numbers of physician suicides.
Let’s think back to what life was like in grade school. For those of you who have children, what is the one question that strangers ask your child every week?
“What do you want to be when you grow up?”
We may not remember being asked that as a child. And if we do, we likely answered something adventurous like “trapeze artist” or “fireman,” not really knowing what the job description involved.
Did you ever look at how you wanted to feel in your chosen profession?
Yeah. Me neither.
Now that we’re in the trenches, what can we do to dial in some physician happiness?
Back in school as our studies continued, we narrowed down our job choices. The courses that we enjoyed or that came easily to us or that had the best teachers became our favorite subjects. Our high school guidance counselor talked to us about our strengths and weaknesses.
We continued our search as our college choices were made. We took one fork in the road. Then another. Then another.
And then we applied to med school. We were accepted. (Hurray!) We plowed through that next hurdle and completed med school. Then we went on to the next steps of internship, residency, maybe fellowship.
Finally, we landed our First Job, actually I turned down 2 jobs before I decided to start my own practice. We became Real Doctors and all that it encompassed.
And, if you’re at all like me, the idea of physician happiness never came up. We had a job to do!
In fact, that’s when most of us stopped moving forward in search of “what we wanted to do when we grew up.”
Our new goals were about taking care of patients, taking care of our practice, taking care of our families.
And we forgot to add “taking care of ourselves.”
We forgot to make sure we achieved a degree of physician happiness along with our medical degree.
We ended up, at the end of the day, with over 100 charts on our desk to complete. Patient calls to return. Insurance forms to sign. Pre-certification requests to finish for people who don’t know medicine like we do. In fact most don’t know medicine at all.
What can be done to improve our level of physician happiness?
I’d like to invite you to take a moment out of your day for the sake of physician happiness. And that’s going to involve gaining clarity.
It’s time we sat down with ourselves and got very clear on what our ideal day includes.
Do we enjoy patient interaction above all else? Do we love the sense of accomplishment we receive after a successful surgery? Do we relish the chase of finding the perfect treatment plan and the perfect regimen for the diabetic patients who can’t get regulated, despite their best efforts?
That’s the first step in finding clarity.
There’s one thing I’ve learned from becoming a certified life coach: It’s not enough to just think about getting clear.
One has to dream and scheme and really dig into what that life would look like.
Can you write down all the details of your ideal day? Start with when you first wake up. And end with when you go to sleep. Write down where you live, what you have for breakfast, who your friends are.
Think about what is in your closet. Are there piles of soft, well-worn scrubs for the surgeon in you? Is it an array of yoga pants for when you want to find time to lead your patients into alternative forms of well-being? Or are there fancy suits and shoes for the formal side of you, when you help guide your patients or your staff or your colleagues to the next level?
Whatever it may be, you and you alone know the answer.
Maybe thinking back to why you decided to become a doctor will help guide you.
Some will say you can’t find your way to physician happiness if you keep on doing the things you’ve always done that haven’t worked.
Dr. Rachel Naomi Remen says, “Finding greater meaning and satisfaction in your work is often not about doing things differently; it is about seeing familiar things in new ways.”
You and you alone can reach deep inside to see how you can make just one tiny change this week to move toward improved physician happiness.
Get really clear. And then take baby steps toward your goal.
The only one stopping you is you.
I will speak more about one of the other causes of physician unhappiness…physician abuse next week