I’ve been river rafting just one time in my life. We paid for a guided trip down Idaho’s famous “River of No Return — the Salmon,” and spent the day traveling stretches of rapids and stretches of calm. It was exhilarating enough for a newbie but not enough to ever feel like my life or livelihood was seriously at risk.
But I’ve also seen that same river at flood stage, and it is downright scary looking. There is simply too much water in the riverbanks going too fast, too many rocks underneath shaping the rapids, and too much uncertainty about which way your raft might go. Even an experienced guide who has shot Class VI rapids might not have the skill or strength to ensure the passengers of their raft would make it through at that stage.
In many ways, this is where doctors, other medical providers and, sometimes, even clinic administrators are at right now. The “rapid” pace of change in the health care industry is so volatile, so uncertain, so complex that it has created Class VI monsters ready to swallow doctors whole. In the past, this river used to have some dangerous places that could be anticipated and planned for, followed by smooth waters to recover in before the next rough patch. But no more — it’s just one giant raging tumbler after another.
Unfortunately, many physicians think of themselves as failures for being unable to paddle hard enough.
Thinking about the last 10 to 15 years of change in this industry, does anybody expect it to get slower, calmer or more predictable any time soon? Hardly. No wonder physicians are just flat out exhausted. If the river current is the pace of change in industry, then the banks are the medical culture this river runs between. This long-established culture can contribute just as much to the occupational hazards physicians face — for example:
- Pathological altruism (“patient needs always come first”) and its corollary, the lack of self-care as an occupational ethical baseline. We know the Coast Guard would never let anybody on an ocean-going rescue vessel without a life jacket.
- Shame and invulnerability. Never show your weakness — it can get you sued, fired or shipped off to an out of state evaluation facility.
- Evidenced-based everything. The scientific method simply cannot be applied to every situation, especially human interactions and emotional health. Overmeasurement and documentation is the bane of a physician’s existence right now.
Is there any hope of changing the stubborn banks of this river, removing some boulders or adjusting deadly vortexes?
I say: yes.
In fact, if there is any time in history to do this, it is precisely when there is a lot of water in the riverbed. Now is the time to identify the perennial eddies and the hazards that capsize or waylay physician careers and personalities; to put effort into the way medicine is taught, modeled and reinforced — to demand change from health care systems and employers and not settle just for safety-nets in front of the waterfalls.
Medical education is a great place to begin, and I’m intrigued by some of the ideas the Idaho College of Osteopathic Medicine is implementing as it starts its first class this fall. This summer, I took a tour of the shiny, new facility with Dean Robert Hasty, DO, who proudly showed off the student nursing mothers’ lactation rooms where they can still watch lectures and the unified faculty-student lounges to promote more interaction. They’re even planning to close the building before midnight in the hopes that students can learn to get more sleep. As Dr. Hasty has told me, “I can’t force them to sleep when they’re off campus, but I can keep them from staying on campus to study all night.”
I appreciate that sentiment from one of the “new river guides” in our medical community. We need enlightened leaders who are as much or more devoted to the peak performance of the individuals who make up the organization than the peak performance of the organization itself, believing they will accomplish the latter if they first focus on the former. And while ICOM’s ideas on this particular issue are a great start, it will only make a lasting difference if self-care and permission to be human is supported by the faculty, the mentors, the preceptors, the attending physicians they round with and, ultimately, the institutions they work for.
I challenge you to look at the current of change in this river as an opportunity to reshape the culture of medicine so that it isn’t so dangerous and deadly. We will always need to teach individual survival skills and institute safety-net programs like physician wellness and counseling programs. But while we can’t paddle back upstream to the old way of practicing medicine, we do need to do a much better job working to make this a safer river to be on in the first place. The old mantra of “well, that’s what I had to go through” and the new mantra of “we need to teach doctors the joy of working hard” rings hollow. This isn’t about getting soft on students, residents, or physicians – this is about making sure we have any doctors left when we all need geriatric care.
Steven Reames is executive director, Ada County Medical Society.
Image credit: Shutterstock.com