“The good life is ever-changing, challenging, devoid of regret, intense, creative, and risky.”
One year ago, bruised and battered like any physician practicing in this pandemic, I decided to double down on weariness and start writing a medical letter on Substack. I’ve been writing about once a week, with subjects ranging from the newest coronavirus variant of concern, to a reflection on the hidden strengths in frailty, to the pleasure and poison of drinking alcohol. My audience has been mostly my own patients, but with a growing number of other readers. Their appreciation and commentary back to me after each post have renewed my energy for practicing medicine more than I could have hoped. If you have ever enjoyed writing or found the process of putting thoughts into words therapeutic, then consider adding this to your arsenal against burnout.
The process of reflecting on and rediscovering the wonders and terrors of practicing medicine, through a journey of enlightening words and ideas you create, might just lead you up and away from the darkness.
I chose to write my letter through Substack. Some big-time writers like Kareem Abdul-Jabbar, Gary Shteyngart, Eric Topol, and Robert Reich are there. They build their audiences through a combination of free and paid subscriptions and are liberated from the pressures of always writing for traditional publishers. But most of us are small-time. As you slowly build an audience, you can also build a community dialogue with readers who respond and comment on your writing, unlike in the heyday of medical blogging.
I wrote in the introduction to my letter: “Most family docs went into this field hoping to truly know and serve our patients from a place of continuity, community, and humanism. Many of us are burning out or leaving the field entirely. There is so much change that is beyond our control, but the essential desire to help with sound science and compassion still compels us. Writing this letter has helped me broaden the conversation, enrich relationships while forging new ones, and stretch a capacity to reach beyond the narrow office visit.”
Expounding on that last sentence, writing has truly helped me broaden the conversation. During pressured office visits, getting through a list of chronic medical ailments, preventative care, and pandemic questions leaves little time for much else. Writing has allowed me to provide more thoughtful and thorough answers to common questions I receive in the office. I don’t try to be a comprehensive resource for all the new developments and clinical discoveries we read in journals, but I do try to highlight some of the more relevant ones. I try to write with a personal and sincere voice. Educating others helps us to master new concepts as well.
And writing a medical letter for people has absolutely enriched neglected relationships that are the lifeblood of being a doctor. With the game clock turned off, I can read comments, stories, and reactions from patients and readers that are posted on my connected website. I respond to each one happily. Here are a few examples:
“Thank you for your time and effort in making this stuff intelligible. These articles are so good.”
“Thank you so much for taking your precious free time to do this for all of us … and YES, a bitter metallic taste accompanied my Paxlovid. It helped if I thought of it as marmalade.”
“Thank you for this beautiful essay! Your insights are always thought-provoking. I feel privileged to have a doctor who has the mind of a scientist and the heart of a poet!”
How often do patients have time to say thank you during rushed office visits? How often do they actually feel gratitude as we struggle through their visits, exhausted, running 45 minutes late, suffocated by an EMR inbox of telephone calls and lab results and hospital discharge summaries? Writing for me has provided a parallel universe of sorts, one in which I have the luxury of time to focus on a medical topic, a reflection on my time doctoring, or a general note of sympathy for the suffering people for whom I did not allow myself the proper office time to convey: I hear you.
Although practicing medicine is a calling, most of us do not work for free. But when writing on Substack, I remind readers never to feel bad about just being free subscribers. But there is a paid option for those who want to support your project. Most writers turn on a paywall to allow participation in comments. I have found this filters out all trolls and spammers.
If you’re lucky, sometimes there might even be a moment of ego-affirming vanity, an otherwise rare occurrence for a primary care doc working in the obscure trenches. Because of my writing, I was interviewed on a podcast by a senior VP at Independence Blue Cross about the importance of primary care. I was also interviewed and quoted several times in an article about rapid antigen testing for COVID by the Philadelphia Inquirer. Supposedly it was picked up by other media outlets and reached 1.5 million readers. Countering all the misinformation out there is an exhausting task, but as health care workers, we can also rebuild trust with our candor and purposeful communication.
I acknowledge, however, a serious downside to writing. It takes time away from other pursuits: hobbies, zoning out while watching Netflix as your bowl of ice cream falls onto the couch after you pass out from your exhausting day job, or whatever self-care you can cobble together. It will not solve most of the structural, institutional, and mental challenges this field has painfully arrayed against its providers.
But composing these letters has also helped me shake off some mental rust. Writing engages so many neglected parts of the brain and synthesizes connections. I think I have redeployed my electronic-medical-record-
And so, if you find satisfaction in writing and can borrow a little time to do it, perhaps even just once a month, you might find some paradoxical solace in doubling down on your weariness, too.
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