When I was growing up, I thought that doctors had it made. About three months into med school I realized how wrong I was.
Question: “Hi professor, what part of the chapter do I focus on?”
My text books would be out of date by the time I finished them. Just as I learned where they kept supplies in the hospital it would be time to switch rotations to a different floor. Never really knowing where to be and what parts of the exam to focus on was disorienting. This disorientation was new to most students who spent most of their lives at the top of the class. This was a wake-up call.
And just as I got comfortable, it was time to advance to residency. Then fellowship. Then creating a new clinic. Then new insurance rules to code differently. Did I document treatment failure on a cheap drug before I prescribed the expensive one? My patient and I worked diligently on a treatment plan. Was it approved by insurance?
The situation today
So how do I manage this stress? Do I slow down, ask for directions, or simply get used to being disoriented. Certainly, there were times where I didn’t have the answer. I’d tell my patient that, and we’d work together to figure things out. I was lucky. I’ve always had a strong network of colleagues to ask questions and receive support. Over time, I used their tips and tricks to get through it successfully. Over time, I’ve become privileged to be someone other doctors ask for career and happiness advice. But what if you don’t have that access?
The isolation that can come with stress has made being a doctor one the most depressing profession in the US. Possibly, due to the desire to never show vulnerability or weakness, the profession carries one of the highest risk of suicide.
Approximately 400 physicians commit suicide every year in this country. A study showed the incidence of depression increases from 3.9 percent to 27.1 percent in the first 3 months of their intern year. There are so many articles describing the misery of bad days and double booked schedules, but let’s leave that aside for this article. Just, simply, what needs to be done?
How docs can fight back
For me there were two main causes of stress:
- Not having enough time with patients.
- Outside powers interfering with the decisions patients and doctors make.
These two issues can force doctors to change from a relationship based practice to a transactional one. Transactions are an exchange of goods. You get healthy, doctor gets money.
That’s lame. Because in a transaction based system if the money breaks down then the transaction feels unfair. Also, if the patient doesn’t get better, they’ll feel it’s unfair too (not to mention that they are still sick).
I don’t think many people become doctors to graduate medical school to manage transactions. Instead, I think most (I hope) people go into medicine for the relationships. That we can control.
Yes, in the perfect world patients and doctors spend all the time they need to craft a treatment. Until then, what can be done? I can think of a few things:
Take time to appreciate what you are doing. I would focus on being mindful during the patient visit. I’d experience how the room feels differently when my patient was there. I’d notice posture, cadence, expression (yes, we are trained to notice these things). I’d actively put aside my worries of paperwork or schedule when my patient was there.
You have my full attention. Not just for your sake, but for mine. I really want you to get better. I really want your suffering to disappear as fast as I can. This is the most important thing.
Surround yourself with community. I think isolation is a place where helplessness grows. In training, it was really important for me to have friends who were nurses and residents. These are people you spend the most of your day with. It’s also important to have access to more experienced doctors you can call for help. It’s obviously useful during training, but I didn’t realize how important it is once you are practicing.
Because the following can happen to you:
- Your employer wants you to do something unethical.
- The insurance company says no.
- You aren’t sure what to do with a medical condition.
- You suspect fraud somewhere.
- Someone is trying to take advantage of your patient.
You can either clear your schedule and reinvent the wheel to fix the problem. Or you can call someone who’s been there. Your choice.
Once I was finished with training, I joined my local medical association. It was another chance after medical school to interact with people with more experience and from different specialties. For me it was a special place to get advice and work on big picture things. And yes, a strong local network is your friend if you want to find another job. Just join one. Now. Community is important for everyone, but since you have special stressors that are unique, some part of your support network needs to live this stress also. No matter where you find it, a community that empathizes with your doctor stress is key. If you want to practice medicine for a long time, you’ll need community to help you. It is almost unsustainable otherwise.
May and June is the time of year when 1st-year students become 2nd-year students, when people graduate, and start practice. Manage your stress during the transition. Talk to each other.
Nitun Verma is a physician and co-founder, PeerWell.
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