It was two years ago. It was a rough morning and I felt defeated. I stood by the next patient’s doorway. I couldn’t see myself, but I knew my own appearance: head down, a look of resignation, shoulders slumped. I knocked on the patient’s door and entered. “Good morning!” I said to the patient. I felt my energy levels depleting in the effort to remain upbeat and enthused. The tank was close to empty. “How are you doing today?”
The patient looked at me with eyes of concern. She tilted her head. She gestured towards a chair by her bed. She patted its seat. “What’s wrong, doc?” I stared at her in silence. I was caught off guard. She pressed on in a stern but loving way, just like Mom would. “Come now, tell me. How are you doing? Really?”
A million thoughts raced through my mind. I need to be stoic. Gather yourself together. Show no signs of weakness. You’re a professional, damn it! Focus on the task of hand. Focus on her; she’s the patient! Don’t sit down. Maybe my pager will go off, that would be perfect Redirect the question. Don’t open up to her. Goodness, what are you doing? You have so many things to do! Focus!
I sat down beside her. “I’m really stressed out, to be honest.”
“Why’s that?” she asked with genuine concern. “I can listen.”
There is a paradox that modern health care providers face; it applies not only to doctors but anyone who interacts with patients in a health care setting: be human but be perfect. As a provider, the truth is that it’s hard to be perfect when you’re human. It’s hard to be human when you feel like the humanity is being suffocated of you.
Think about our workday. There’s the stress of achieving the medical objectives: diagnosis, treatments, and cures. There’s the stress of our work environment: high acuity, high turnover, abundant multi-tasking, frequent interruptions, and tremendous volumes. There’s the stress of money and litigation: what is a medical document now but a billing document and a potential piece of evidence in court? Then there’s the stress of managing our own daily spectrum of emotions — sadness, happiness, hope, frustration, anger, fear, and fatigue — perhaps in that order, but not necessarily so. Yet despite all of these stressors and all of these emotions, what are we expected to look like, act like when we walk through a patient’s door or even an administrator’s door? Unfazed. Unscathed. Perfect.
The modern health care provider becomes so task oriented, even revenue-oriented that humanity takes a backseat. We suppress our emotions constantly. Perhaps to remain professional? Or perhaps to detach from reality? Or not look weak in front of colleagues? Whatever the reason, we’re not allowed to show it. And if we did, to whom do we show it and when? There just isn’t any time. The never-ending to-do list rarely allows for decompression or a moment of reflection.
Each patient encounter — good, bad, or neutral — takes something out of me. This may sound familiar, but sometimes when I get home, the last thing I want to do is talk to a human being. I’ve done enough of that already. But therein lies the problem. The modern health care provider is too tired to talk, but has so much on his or her mind, so much to say.
How do we cope then? Sometimes in positive ways: exercise, running, cooking, eating, writing, music. Sometimes in negative ways: drinking, drug use, other vices. Burnout and suicide are real issues. What does that say about us, health care providers, in general? We’re humans too. We feel and think things too. Sometimes we feel like we’re alone, that it’s us against the world, with every action being scrutinized, questioned, penalized, reviewed, and sometimes denied.
I took the stethoscope from around my neck and set it down. For a moment, just a brief moment, I felt the burden being lifted. We sat eye to eye, and we spoke heart to heart. She asked questions. I answered them. She wanted to know what my day was like. I told her very honestly. We spoke for a good, long while. She offered a hug. I accepted it. I needed it. I let my guard down for once, and I felt vulnerable. It was refreshing. She thanked me for what I do. I shook my head. I thanked her profusely for checking in on me, showing concern about me. She never bothered me the rest of that day. But I checked back on her several times.
Patients need us to take care of them. That will never change. But we need someone to take care of us. That’s what needs to change.
Jeff Manaloto is an internal medicine physician.
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