Doctors need to find meaning in their work

“It is getting worse everyday.” “Medicare fix at the last moment.” “Too much paperwork not enough time with patients.” “ACO’s and bundling.” The headlines scream at us everyday.

If we have one word that underlies the medical community it is fear.

The looming uncertainties of reimbursement, insurance changes, electronic medical records and new regulations form the main topic of doctor worry talk. The country’s health system remains in perpetual flux and catching physicians in cyclone of more regulation, malpractice and decreasing reimbursements. Certainty of uncertainty is a cause of white coat hypertension in the medical community. We perhaps are the most unsatisfied professionals in the country.

Research supports that many physicians experience high levels of dissatisfaction with their profession, and that dissatisfaction may be on the rise. The ramifications of this are quite serious and pose threats to health care providers and patients alike. Physician career dissatisfaction has been found to be associated with physician stress, disruptive behavior, burnout and career exit, medical errors, reduced patient care quality, reduced patient compliance with medical instructions and higher health care costs.

Perhaps we need to find an anchor for ourselves and the communities we look after. As Atul Gawande puts it, “Meaning in life comes from each of us finding ways to help people and communities make the most of what is known and cope with what is not.” This anchor for most of us will be finding meaning in what we do.  Replacing that “fear factor” with service.

Meaning beyond the long arms of insurers or bureaucrats. Meaning in the sacred patient physician relationship that has been undermined by calling us providers.

Rachel Remen talks about a parable where three stonecutters doing the same work find different meaning in what they do, varying from “this is all I will do till I die”  to “have the privilege to participate in this great building.” Remen writes” Competence brings us satisfaction. Finding meaning in a familiar task often allows us to go beyond this and find in the most routine of tasks a deep sense of joy and gratitude.”

Meaning in smile, meaning in doing non-RVU (relative work units) things like talking to our patients about their family, cat or listening to Joe talk about problems with his boss at work. That is a meaning that is not outsourced to anybody, that does not depend upon either approval of or frowning on by our managers, payers or the bureaucrats and most important can not be taken away from us.

We share same instant gratification mentality, what do we have to show for our 15 minute visit? Never thinking that just listening (different from hearing), being present was as important as getting the glycated hemoglobin down. Reassuring a worried mom that her teenager son does not have a tumor that her grandfather had, all in the days work.

Finding a meaning in our work and in our life will provide the air bag effect in the event of life crashes that happen invariability. We should work tirelessly to avoid the crash, but also train well to adapt when somebody suddenly lurches into our lane and things do not go as planned. How do we teach resilience when we train ourselves to face everything, is it same as training to face anything? During those difficult times it is our meaning in what we do that will sustain us.

So when you go in the examination room next time pause outside the door, plant your feet firmly on the ground, take a deep breath and remember even if it is difficult, uncertain at times still we are blessed to have an opportunity to help a fellow being.

Sudeep S. Sodhi is a gastroenterologist. He can be reached @holisticgi on Twitter.

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  • http://twitter.com/NMJUNCTION NeuroMuscular Jct.

    I surprisingly enjoyed this article! It was actually quite refreshing to read from an MD doctor. I think in order to change how your system doesn’t work for you,  you need to change how you approach health & wellness. STOP just looking at treating the symptoms, but treat the WHOLE PERSON, start finding other whole person treatments that facilitate health instead of managing disease and symptoms. To break the 15 minute visit loop, you should one day decide that you are not going to over-book a bunch of patients in the same time frame and concentrate on quality care of a few patients. Medical doctors need to start realizing that pharmceutical drugs should be CONSERVATIVELY USED,  that diet and exercise and other NATURAL methods such as therapeutic massage, other forms of therapeutic bodywork & supplements can have a POSITIVE affect on many health conditions of patients.  start practicing more palpation of the body as doctors ages ago practiced. From my own experience as a manual therapist, you can find a lot of soft tissue anomalies just by spending time to provide caring TOUCH to the patient once again. There are other effective manual methods aside from the typical “Physical Therapy” to refer your patients to!

    There has been much research in recent times about the efficacy of these modalities of bodywork & massage for most pain & dysfunctional patterns, but from my perspective doctors are so busy reading the distorted “truth” about the pharmaceuticals that they have not had opportunity to see and read about scientific benefits in other modalities.

    To change habits, you must replace those habits or you will just return to the old habits. make small but significant changes in your current routine, and eventually you will find that quality of life in what you do as a physician.

    As a manual therapist, I start out  most clients in 2 hour sessions. This allows me to understand them better as a person. I fit many “diagnostic” elements into my sessions, and much of it deals with not just medical history but their lifestyle practices and the small little things come out seem to give me the best clue at how to help my clients find the answer to their problem. That’s another thing, as you said in your article, LISTEN to the patient, even if it is not medically related, and allow the patient to find the answer to their own problem as well as realize what other ways they can deal with their condition besides drugs and surgery. This can offer them some control over their own health and wellness.

    In every instance in the media, people are told to “TALK to their doctor” but the doctor doesn’t seem to have time to “TALK” with them!

    As a manual therapist, that spends more time with my clients, I become a sounding board for their concerns and troubles and even things they enjoy doing that all give clues to how I can help them, even the most what seem to be insignifcant banter and talk about “nothing”.

    I am passionate about what I do because I get to enjoy what I do, why? because I take more time instead of rushing through the process.

    • http://twitter.com/theYogadr Kathleen Summers

      But how do you get paid for two hours of quality time? Are patients paying out of pocket to see you, or are you on the insurance merry-go-round nightmare? 

      Many of us would love to spend so much time with every one of our patients and really talk to them, to “treat the whole person” as you say. But our hands are tied (or at least we perceive that they are) by the system and reimbursement issues.

  • Anonymous

    A GI doc wrote this, eh?  Making about $500,000 per year?  Done by 3 or 4 in the afternoon?
    Just saying…….

  • http://www.facebook.com/people/Chagai-Dubrawsky/604353306 Chagai Dubrawsky

    The current article published,like many other articles,published in the professional literature,is testimony to the big confusion, that medicine is now in.”Where is the beef?”,everybody asks now.Unfortunately,nobody knows.Medicine today is in crisis:Financial and ethical.In order to get out of the crisis,a change in direction of Medicine is suggested.By changing direction to more:Preventive Medicine,a saving of 1.1 Trillion dollars as expressed in prevention of forty million sick days per year,in the U.S.A.,will be achieved,starting the year 2023.Reference:”A crisis is looming over medicine”, MD&DI  from the editorial.Nov.15,2007.Also: Devicelink online.This is the publication of the American Society of Producers of Medical devices and Instruments.
    To do the change, it is essential for Medicine to discover Innate Immunity,H.D.L. and Niacin(Reference:
    C.A. Janeway: Future directions of research in immunobiology. Immunobiology 5,textbook,Pp.608,
    Garland Publication 2001 Ed.)
    According to Janeway,it will take society a year,decade or centuries,to discovered Innate immunity.
    I say:I discovered it now!.Everbody says:This is weird(Toll in German.). This reminds me of Dr. Neusheim
    Tubingen  Germany,that,while working on the Drosophila receptors,she obsereved very odd looking receptors.She proceeded to exclaim(in German):”Das es ja Toll”.translation:This is weired-crazy.
    So was born the concept:Toll Like Receptors(T.L.R.)

  • dlschermd

    I totally agree. This will be a big difference between this and future generation physicians.

  • http://www.facebook.com/Physio.Ergo.Therapy Michael Willems

    NICE, Well said,  the love of the profession is perfectly articulated in the last paragraph.

    As a patient (left forearm re-plantation) and a fan of the digital world, may I humbly suggest you take a look
    at iPad based EHR/CHR professional software, like DrChrono, that offer very efficient streamlining of medical professionals activities, patient record keeping/sharing, facilitating efficient multi-disciplinary co-operation with speedy and accurate accessibility to patient record, and easily customizable to specific needs of each specialty. I believe such easy to use tools are going to make medical professionals more efficient and happier.

    Surely more education on nutrition and physical exercise can contribute largely to reducing the ”demand”
    and slow the surge of spiralling health costs.

    While we are at it, you may find additional large scale savings in Tutor rehabilitation systems which include
    tele-rehabilitation software thus largely reducing the need for travel for out-patient traffic and allowing physicians easy cost-effective follow-up.

    Thank you for the great work you all do !!!

    Michel ”Mike ” Willems
    Patient and Representative of Tutor Biofeedback Rehabilitation Systems
    MediTouch (Canada)
    http://www.meditouch.co.il

  • Bradley Evans

    Some things get better. You couldn’t take a doctor from 1980 and have him or her practice today, without extensive training. Surgeries are better, medicines are better, testing is better.

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