“Doctor, why don’t you remember when I was last hospitalized? I told you about that two months ago. You obviously don’t care if you can’t remember. Is all of psychiatry like this? Maybe I need to see someone else. Why won’t you prescribe Ambien for my insomnia during pregnancy along with all the other medications I am on? My last doctor had no problem giving me Ambien during pregnancy.”
This was the third time I was seeing this patient and was thrown off by her announcing she was pregnant with her sixth child. I was more focused on what to do with her multiple medications to control her bipolar disorder, given she was now pregnant, which apparently affected my ability to pass her “memory test”!
Never mind the fact that I see 15 to 20 patients a day and don’t have the memory that I used to have. In her world, I was not willing to give her what she wanted, so I must not care about her.
The current paradigm of medicine is based on patient satisfaction scores and TV ads for drugs, as well as internet blogs that point out to patients that there is a medication for every ailment. However, despite all the information available to patients, it does not create more engaged patients or consumers ready to partner in their care. It creates patients who want the latest pill or test as the solution to their problem, which they have self-diagnosed on the internet.
The current paradigm of medicine also does not see physicians as human anymore — or maybe it never did!
Maybe, we don’t see ourselves as human and hold ourselves to a higher standard. The expectations of patients and the level of entitlement displayed by them seem to be at an all-time high since COVID.
It is curious to me if this is because patients have experienced increased social isolation in the past two years, causing them to lose some ability to relate well to others on a brain level. Or if the general political chaos of the past five years has created people that function purely from their amygdalas with no ability to access their prefrontal cortex!
As physicians, we are trained to be disembodied, to ignore when our bodies are signaling the need for rest or a break.
Disembodiment can be useful when surgically cutting on or sewing up a patient. But it is not helpful to our overall mental and physical health over the long term. We have learned to sacrifice sleep, exercise, and time with family, all under the guise of duty, obligation, and loyalty.
We got positive reinforcement for making those sacrifices, which makes it harder to choose to do anything different than what the culture of medicine supports.
We have learned to become “doing machines” both within the world of medicine and the greater culture of American society. We do not balance “being” versus “doing” well. At a minimum, it is a challenge! There is no support for just “being” unless on a vacation or retreat. We have become human “doings” rather than human “beings.”
My challenge to “why don’t you care?” is that we need to care more about taking care of ourselves. Otherwise, we are useless to everyone around us, including our patients and our families. It is no different than what is recommended when the oxygen masks are talked about when released on the plane.
“Put your own mask on first, then help someone else.”
Providing ourselves with effective strategies to maintain health in the face of high demand and irrational patient behavior is about being fully embodied — to read the signals of what the body, mind, and heart are craving.
We have to take our own needs seriously and make ourselves part of the equation of daily life to take action.
Personally, it has taken me a long time to put my own needs ahead of everything else in an attempt to manage burnout and improve my own personal resiliency.
It all started with listening to my own body’s needs and loving myself enough to identify and take my wants, needs, and desires seriously.
Quality sleep, exercise, better nutrition, and stress management flowed from a commitment to put on my oxygen mask and listen to what creates the most effective strategies for living my life in a more fulfilling way.
It is a daily challenge to focus on what I need to function optimally in a high-stress medical environment. But that daily challenge got more manageable when I found a coach to help walk with me as a guide. Working with a coach empowered me to set the boundaries and make the changes needed for my personal and professional life to run more smoothly. It helped me be accountable to myself and my vision of an optimal life, rather than be solely accountable to everyone else’s expectations of me.
When do we get to step off the treadmill of the public’s expectations as health care providers? Well, probably never! But at least when we are addressing our own needs, we get to be part of a more balanced equation, and it is easier to care for ourselves and others — even if patients don’t recognize that caring.
Anne M. Miller is a psychiatrist.
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