A few years back, I hurt my leg. Badly. So badly, I wasn’t walking well at all, was predicted to never run, ski, swim competitively or, do what had injured me – skate. The injury was dramatically sudden, painful and scary in ways I had never experienced. My first doctor was unsure exactly what I had done. The next ordered the right test but told me there was no repair. The next consultant agreed.
Then a friend stepped in to help. He lives in Switzerland but even from that distance, managed to turn the tide for me. How? By going online and searching for doctors and surgeries related to my injury and by finding a support group of people who also had my unusual injury. He emailed me the link to the support group and I responded:
Thanks but, I’m not that kind of patient.
Don’t be silly, he told me. So I clicked the link and found a world of education and support. In that moment of clicking, I became an “e-patient”
This new term, “e-patient”, is meant to describe a patient who is involved in their healthcare as an equal partner to their physicians. e-patients use electronic tools. They are empowered, educated and engaged. They see the importance in being equipped with the tools to help make decisions about their care. These tools can give e-patients access to medical records, education about their condition, or the support of groups of patients like them. e-patients are producing a culture shift in medicine.
This culture shift is especially visible in the area of breast cancer care. It is perhaps best illustrated with the story of one specific support group. Two friends who are breast cancer survivors teamed up with a breast surgeon from L.A. to start the support group #BCSM. It is held every Monday night as an hour-long “tweetchat” on Twitter. These three women explain:
While other physicians and academics debated how health care could even be discussed in social media and patients were warned to “be careful with research on the Internet”, two important facts didn’t budge. The Internet was not going anywhere. Neither was cancer. This year, some 290,000 women in the US alone will be told they have breast cancer. The need for #BCSM was clear. The project was on.
The mission of this impressive group is to support, educate and empower patients diagnosed with breast cancer. Patients meet and discuss their situation online to come out of the isolation that cancer diagnosis and treatment can create. Last Monday, 156 people actively participated and through their discussion, sent 2,724,048 impressions to their Twitter followers. Every week, expert physicians are invited to add “perspective and clarity” by discussing evidence-based recommendations and research with the group. The #BCSM support group’s mission has been accomplished through this inspiring model of weekly collaboration between physicians and patients. Both benefit.
This shifting paradigm is one we physicians may respond to with trepidation. We can feel irritated and challenged by patient involvement. And our patients do not respond well to our irritation. We are highly trained and this expertise gives us the ability to make informed decisions. However, our patients, especially those with chronic or unusual conditions, are also experts. They know about their own unique experience and through research can often know more about their specific diagnosis than their generalist physicians do. Patients can have an expertise to contribute to our decisions.
While I did not face the sort of life-threatening illness that catapults many into their role of e-patient, my experience taught me much. I see clearly that a well-educated patient has much to offer us. Seeking, supporting and trusting that input will serve us all well.
- In 1900 influenza was the leading cause of death.
- In 1918 Influenza killed between 50-100 million people worldwide.
- It is estimated by the WHO that in 2009 the H1N1 strain of influenza killed up to 575,400 people.
In the medical community, we’ll work to undo myths around vaccine safety for the rest of our lives.
Water!And, what do you drink?Juice! Apple and orange!
But, it is just so hard to say no
What does a working mother of three do when she finds herself home alone for three days? Well, true story, I can tell you the answer:
Bake, lots. Clean, prune and organize. And think. Lots.
Turns out though that I wasn’t completely alone. I had two rambunctious, trouble-generating puppies to keep me company.
I thought about the meaning of love – after all, it was Valentines Day this week. Turns out, when you look on-line for a definition of love you may find out that
Love is patient, love is kind. It does not envy, it does not boast, it is not proud. It does not dishonor others, it is not self-seeking, it is not easily angered, it keeps no record of wrongs. Love does not delight in evil but rejoices with the truth. It always protects, always trusts, always hopes, always perseveres.
The dogs certainly challenged this definition; I may not have been endlessly patient. I may have angered. I’m afraid I can list their wrongs (they got in the chicken coop – twice, vomited on the rug – once, peed on the rug – once, made a hole in the fence – once, escaped through their new hole in the fence – once, woke me at 530 – three times). And, I did boast a bit when a nice lady complimented my ability to walk two young labs at the same time (didn’t mention that I had run them in the fields for two hours before she saw us limping home.)
I watched TV and learned, from an episode of “How I Met Your Mother”, that
opening yourself up to another person means opening yourself up to going a little insane
Okay, that definition of love I’ve got covered.
I looked up the meaning of the word non sequitur.
I did some laundry (I may have been alone but, I do have three kids.) Pruned the roses. Organized the freezer (to fit in all the baked goods) and then felt compelled to eat all the odd bits of frozen things there for breakfast, lunch and dinner. Read the NY Times all the way through. Looked at Twitter despite planning to take a “holiday” from social media. And there I found this definition of love:
Love, I’ve recently recognized, is that moment when you desperately need forgiveness from the one who inspires your best self for having just been, in some small, petty way, your base self.
I walked the dogs again. Made the beds. Cleaned a closet. Sorted through the CDs; listened to lots of Alexi Murdoch, Macy Gray and The Cure. And, spent several nice hours on the phone talking with a handsome man from Switzerland who has always inspired my best self. My Swiss friend asked me – It is hard to live alone isn’t it?
Its going to rain Tuesday.
Some silliness unfolded this morning on Twitter. I think it began with this tweet (apparently sent by a tired pediatrician, early in the morning, after being called to a baby’s delivery):
Let’s play a game: what do babies and donuts have in common?
Let me explain a bit about Twitter. Somehow I, a fairly non-techy sort of gal have 3 Twitter feeds. Two for work: @KPHealthed and @KPBabydoctor. On these I try to be professionally focused. On my personal feed, @KateLandMD, I relax a bit more. My non-medical, non-tech savvy friends are completely mystified by Twitter let alone why a doctor would be using it. I explain that there can be power and value to the connection found in the space on Twitter. That it is important for doctors to be present for the discussion. That it is important to battle misinformation with truths; important to be accessible. I explain that we learn from each other; we stay current. I tried to explain that we make friends. Well, that last bit drew guffaws from one person recently. “Friends? Really?” she said with a sceptically arched brow.
Well yes, friends. Take this morning for example – we went on for quite some time making ourselves giggle by answering the question about babies and donuts. Here is a bit of the transcript:
You never want to squeeze too hard.
There is a powdered version of each.
Eventually, they both wind up stuck on your hips.
Oh good grief! You all crack me up!
#giggleswithmycoffee Now I want a donut.
Now I want a baby and a doughnut.
Coffee is a good accompaniment.” And necessary!I just have to pause and say, I am cracking up over these tweets!
A dozen is probably too many.
Have U noticed, while we are being silly some folks here are still thinking big thoughts
Silly is such an important part of life. I never want to forget how to have fun.
This fun question brought back two memories of babies and donuts that I couldn’t quite squeeze into 140 characters. First, from when I was pregnant with my middle child. I was a resident working way-to-many hours in the neonatal intensive care unit, not my favorite place to be even when not pregnant. The call nights were many and long; it was hard to talk myself through them at times. So, I developed a system: if I could make it through the night I earned a donut, an apple fritter to be specific. I had a lot of fritters. At birth she weighed in at 10 pounds – no surprise there.
The second memory, triggered by the Twitter silliness, was about this same donut-fed baby a bit older. In kindergarten she developed a problem with her blood cells. The diagnosis was at first unclear – she seemed quite ill; and the treatment was very high dose steroid pills. These made her a bit nutty and put her appetite off. In our state of worry we gave into the one food she would eat. Yes, donuts. Donuts for breakfast, lunch and dinner. Soon we got the news that her condition was benign and to be short-lived. So, we sat her down at dinner and explained that this was her last donut for a while. Later I found her talking in her sleep:
Pretty donut…pretty donut…
My time spent on Twitter can be hard to explain. Another pediatrician there, Bryan Vartabedian, often does a much better job in his infinitely readable blog 33 Charts. Recently when discussing physician’s roles in social media he said:
There are 50 ways to use something like Twitter to make your world, or the world of those around you, a better place. YouTube’s potential application in health care is limited only by the imagination. While no one has to use any of these tools, believing that Twitter is only a place to share what you’re eating for breakfast is to live with your head in the sand.
Ah yes but, while we explore Twitter’s more meaningful side, a bit of banter over breakfast with our friends is awfully good fun.
Using the concepts from the book Switch: How to Change Things When Change is Hard Chris Brogan came up with a refreshingly productive new approach to New Year’s Resolutions. In his blog post, My 3 Words for 2013, he walks us through identifying a goal, the barriers to obtaining it and then, identifying three trigger words to remind us how we need to change ourselves to reach the goal. He writes:
Switch, talked about needing three elements to bring about change: a rider (your plans and intents), the elephant (what your mood will do no matter what your plans say), and the path (the environment within which you intend to implement those changes). The concept of the three words is like the path.
I am resolution averse. However, I have had a measure of success lately with resolutions: in 2010 by not answering kids when they yell at me from some other room, in 2011 by starting this blog and in 2012 by baking cookies. This year my goal feels fuzzier: I want to write more or better or be read more widely. Hard to pin down; hard to define and therefore hard to accomplish. But, let’s see what I can do with Brogan’s technique.
So, I’d like to write. The elephants are crowding the room. I am too busy. I shoot down my efforts. I lack skills in grammar, style and writing technique. I get distracted. What is my path?
Stretch means to make myself a bit uncomfortable. I am short on time. I hate getting out of bed in the dark but, perhaps finding time to write means doing so. Writing regularly means writing less than perfect pieces at times. Or, asking for feedback. Or, writing about difficult topics. Stretching means risking.
Focus means remembering my goals. It is so easy to be swept away by the small pleasures and simple tasks of the day. Day after day until I realize a year is gone again. Focus means giving myself permission to put writing before laundry or phone calls or pleasant visits from neighbors
Learn is easy to define. I went to a liberal arts college which at the time had no general education requirements. I took political science, philosophy and science… no English. Therefore I have a load to learn. Starting with grammar; for example, how to use a semicolon.
At work I have two exam rooms. This card hangs in the one reserved for teen patients so that I can see it daily. Hopefully some of them read it and I’ll bet many of those that do wonder why on earth number 6 is on the list but, I know.
Thanks go to Bryan Vartabedian whose blog post at 33 Charts got me started with my 3.
Yesterday I called a friend near the time his clock would tick over to 2013 to wish him Happy New Year’s. I was informed in so many words that, while happy to hear from me, he doesn’t buy into the whole New Year’s thing. This set me thinking.
Today resolutions abound. We all know that tomorrow most will be broken. In fact, one study from 2009 showed that a full 88% of resolution-makers fail. So, why keep trying? Why make such a big deal of New Year’s Eve and Day?
I too think they are overblown; you certainly won’t find me celebrating on Time’s Square. But, I do enjoy the chance to reflect backwards and to look forward. As I wrote, in my very first blog post on January 1st 2011, it seems better to assess our life’s path as we walk it rather than on one night a year. However, there is a nice symbolism to the passing of one year into the next that provides many of us the focus required to pause and reflect.
I have often resisted making a resolution. Last year I made one and succeeded gloriously! My resolution, broadcast far and wide, was to move through my cookbooks, recipe by recipe, to find, make and perfect my favorite cookie recipes. It took a lot of diligence; it was hard but now, my work has paid off: I have my perfect versions of chocolate chip, oatmeal, ginger, black and white, almond and snicker-doodle cookies. My kids loved it – they were thrilled by watching their possibly insane, semi-perfectionistic mother make batch after batch until she was happy. They, in turn, kept telling me more work needed to be done, that whatever one I had just produced wasn’t quite right, that I needed to try…just one more revision.
Was this resolution silly? Perhaps. It was a fun-loving way to make myself take more time to do something I love with and for those I care most about. Less work, more time with the kids. Who cares about the extra cookie weight? If I were a person who went in for making much of New Year’s Resolutions, that might be the one for 2013.
And, now if I am ever asked if I ever made a NY’s resolution I kept, I can say “Yes!”
My favorite day of the year is December 26th. All work done, house a mess but, who cares – the kids are happy. No dinner to make. There’s enough left-over turkey for the apocalypse. I was sitting by the fire, new book in one hand, glass of Prosecco in the other. I never sit and haven’t read much this year so you’ll forgive me that I did not at first jump at the voice from upstairs.
I am reading a good book, The Memoir Project. It is perhaps worth a blog post soon. I was sucked in by the promise of relaxation (fire, Prosecco) and uninterrupted creative thought (book). But then, there was something in the tone of voice that made me ask
Do you need me?
Is someone …hurt ?
This last bit uttered as I ran, up the stairs, because by then I already knew.
The big brother sat wide-eyed by the crying, stiff little brother. They had been wrestling as bear-cub brothers will and, it had ended with the little guy crying out. Later, I asked his brother what made him stop the grip he had on his brother’s neck and he said simply that he said “ow.” Must have been a loud “Ow.”
And that is where the point of this story begins. They say that doctors should never practice on their families. There are good reasons and, dire examples. But how, I ask you, is a mother (doctor) supposed to not treat her kids? I don’t do their well checks. I don’t treat their colds. But I am present for their emergencies. At those , there is always a juncture when I have to wrench my mind out of motherhood and disassociate to be … a doctor. Sometimes it works.
This time it worked fine. I was able to calm the little guy, assess his sore neck (muscle spasm) and hug his sorry brother. Whew. But, don’t think that visions of quadriplegics weren’t dancing through my mind as I acted.
Other times it has been harder. I was an exhausted intern, coming home off a 36 hour stretch when I saw the rash. My firstborn (a.k.a. the big brother) was at a friend’s house when I picked him up. She calmly said that he had the strangest rash. I looked. He did. His rash was that I saw in the hospital on kids who died. My mind churned; it twisted – I had to be the doctor again?
Another day, one when I was supposed to be home recuperating from a big leg surgery I again, had to make that shift. The kids had gone kayak camping with their dad. They had paddled into a remote lake and broken camp, gone to bed and the next morning the sister felt ill. All their dad can tell me now a few years later, is that he just “knew”. So, he and her brothers packed it all up, boated everything out and then carried her out. She came home to me and they asked
is she okay?
Well, I will say I tried. I tried to make my mind turn from mommy to doctor. I tried to think clearly but.. it did not happen. Thankfully, her dad was wise and took his little girl with the near-ruptured appendix to the hospital.
I’ve also missed a few broken bones. Correctly pegged headaches as nothing to worry about. Ignored appropriately, several random stomach aches and, imagined cancer at least a half-dozen times.
The New England Journal of Medicine reports the dangers of treating our families. The American Medical Association advises against it. Many hospitals forbid it. I am a fine doctor. I am the best mother my kids have. I should not though, have to play both roles. But, I do at times and during those moments I hold my breath and try to avoid the worst while I summons a brain-shift from mommy to doctor.
I am fortunate to have a wonderful group of women as friends. They form several overlapping and intermingling groups. My “birthday group” – six women who meet for dinner on the six birthdays. (Well really five, one gets slighted every year since her birthday is on 12/29; somehow we are all so relieved to have survived the holiday season and all of its joyful work, that we can never quite coordinate to meet on her day. She’s awfully sweet about it and teams up with our January birthday.) My book group, together since early 2000 with many additions and departures but with a core that has stayed from the beginning. I have a group from when our kids were all at the same parent-cooperative preschool. Our families meet for dinners, holidays, camping and gather to each others arms in times (too many lately) of loss. My bunko group. Bunko? Really? Well, we haven’t actually played for years. We evolved instead, to host nice dinners monthly for each other. Then when that began to seem like an unnecessary amount of work added to our already too-busy lives, we started “Bunko-lite” meant to be just drinks and dessert. Last night, we had even better – just went out to a local pub! Perfect.
So, I do have two or three dear, close male friends. One recently asked me what all these women talk about when we get together. Men? Kids? Jobs? Sex (he said hopefully)? Hmmm… what do we talk about?
So, last night…. We did talk about men some. Sex was mentioned. Our kids too of course. And our parents, jobs, puppies and in-laws. But what captivated our attention? Ironing.
One wonderful woman, a skilled R.N. by training and super-mom by love, was telling us about how she had been inspired by my recent blog post How the Grinch Got it Right to let some things go. Like ironing the sheets. Ironing the sheets?! We giggled over that and decided that must be a nurse-thing since my mother does the same at times (and they both miter their corners nicely also). Then we all joined in the laughter as another friend told us about her son showing her an iron he had found in the closet once and asking what it was. A few of us remembered a comment one friend’s grandmother made: “I’d rather whore than iron” – a comment that has stuck firmly in my mind; it has such earthy wisdom about it. One gal then volunteered with a twinkle in her eye, that sometimes as she flat irons her hair, she touches up her shirt as well! We all liked that time-saving, practical, modern-mom tip. Another remembered that her family had an ironing lady when she was a child. When I asked the friend next to me if she was an ironer she responded simply “no”. Ah, why would she… her husband irons. And cleans. (now that is a man to talk about).
I have ironed. I was able to say proudly, that in fact I ironed last month. And, almost exactly four years before that. I ironed while watching Obama’s inauguration and this year, while watching the election returns. Generally though, I subscribe to Erma Bombeck’s theory:
My second favorite household chore is ironing. My first being hitting my head on the top bunk bed until I faint.
Erma Bombeck was also wise about the value of friendships. As she suggested, I have friends who would tell me to eat dessert, never defend a husband who gets me an electric skillet for my birthday and who will definitely tell me that
they saw my old boyfriend and he is a priest.
I have friends who have brought me countless dinners when needed, cared for my children and held me while I cried. But, darn them, I just can’t get them to come over and iron!
And the Grinch, with his Grinch-feet ice cold in the snow, stood puzzling and puzzling, how could it be so? It came without ribbons. It came without tags. It came without packages, boxes or bags. And he puzzled and puzzled ’till his puzzler was sore. Then the Grinch thought of something he hadn’t before. What if Christmas, he thought, doesn’t come from a store. What if Christmas, perhaps, means a little bit more.”
There is a rock in Switzerland that is making me think.
Once I heard the author Anne Lamott speak in part, about her writing process. One tip that has stuck with me for many years is her recommendation to keep a notebook for ideas and impressions that make one think. (As an aside, another tidbit from this author comes from her book Operating Instructions in which she discusses new motherhood and describes the way her postpartum belly lays next to her like an obedient puppy). Last week, a cool rock made me think and therefore, entered my notebook.
It lays on a hillside somewhere outside Zurich and is huge, really more of a boulder. It has been finished with a fabulous iridescent blue/green/purple varnish and is presented as art. As such it might bring me back to my ongoing discussion of what exactly, counts as art. But, not now.
The rock is named “Findling”. I asked my friend, my perpetual translator of all things foreign there, what this word means. He did not pause in the answer that it means “a rock left behind after the movement of a glacier”. Not that I question my fine Swiss-German translator but once back in America, I looked up the meaning of “Findling” and found a few options:
- an infant that has been abandoned by its parents and is discovered and cared for by others.
- a white German wine grape variety
- and to be fair: an erratic boulder
Putting aside the slow nature of a glacier’s movement, I have always imagined them as being quite destructive to anything underneath. Having lived for a bit on a glacier in Antarctica, I can tell you that glaciers look huge and mean. Any rock left behind has seen a bit of tumbling. This particular Swiss rock? It came out polished and pretty and can serve as a metaphor for us all.
After the slow but painful tumbling that life can present, the strong ones amongst us come out intact. And, in some cases, even better off. And sometimes even iridescent.
I spoke with a patient’s mother this week. She said that she was sure doctors hear this all the time but… “thank you.” She explained that it seemed what we do must become commonplace in our minds. That we could not really grasp the meaning to her as a parent, of the work we do. She thought I could not understand how much it means that her child is alive and I found it hard to answer her. “You are so very welcome” of course came to mind. Beyond that I felt a bit tongue-tied.
A friend of mine lost a beloved family member recently. The tragedy is overwhelming. So overwhelming that when I was talking earlier to a mutual friend he commented that it was bringing up his own past struggles. He said he felt as if he was “wearing her coat” of pain along with her. Yes. Exactly.
I have at times shouldered that same coat. In random dark moments my mind slips into thinking about my children’s mortality. Just last night as my eldest drove off in the minivan (a hot date car for certain), I called out to him to “please drive safely!” As if that call out could prevent anything. But still, as my mind wandered towards the worst, I tried. Last year a child I knew (out side of work) died in a heart breaking way. It took me months to stop waking up on the occasional dark, early morning in a cold, silent panic imagining the pain that her family must feel. I imagined the tragedy, the event. I dipped my toe into their shoes. I wore their coat for a bit.
How could simple words tell my patient’s mother how well I understood her thanks? While I have not walked in her shoes, I have tried her coat on at times. Doing so gives me the strength to reach out and help her more fully. And to answer her that “No, what we do is not commonplace at all. I too feel the wonder of a life helped.”
Earlier this evening while having a beer with a friend at an outside cafe table, I watched a pink haired, belly ring-showing girl walk down the sidewalk. She was giggling and talking with animation into her cell phone. While I kind of admired her style, she made me long for an earlier time. A simpler time.
I grew up in part, in a very small, rural town in Virginia. There were three hundred citizens there. Three hundred and, one little girl who spent every vacation possible with her grandparents in the woods and on the water. It was peaceful and simple. We talked to each other directly. The electronic communication then consisted of listening in on the party line while waiting for our turn to make a phone call (seriously).
Today we are all glued to our phones. Many days in the office I have to ask a parent or two to please turn their phone off so we can talk about their child’s health without distraction. Even I feel a constant compulsion to check email, text, tweets….It is not a simple world. On a radio ad the other day I heard that one car insurance company now considers those that purchase from them – “members”. When I shop for groceries I am a “member” of the big box store nearby. My own company is now recruiting “pre-members”. Pre-members? What kind of marketing nonsense is that phrase?!
This made me look up the definition of the word “member”.
mem·ber [mem-ber] noun
1. a person, animal, plant, group, etc., that is part of a society, party, community, taxon, or other body.
2. Government .
a. a member of Congress, especially of the House of Representatives.
b. a member of the British Parliament, especially of the House of Commons.
c. any member of a legislative body.
3. a part or organ of an animal body; a limb, as a leg, arm, or wing.
4. Botany .
a structural entity of a plant body.
5. the penis.
Focus on item #1 above (and for now, ignore #5 ) for a moment. In the past we were members of our communities and families. Now our devices allow us to be connected with everyone, everywhere if we choose to be. This may be making us in turn, less in tune with the people who most matter. And this is an important point to discuss with our teens.
The American Academy of Pediatrics published a report last year entitled The Impact of Social Media on Children, Adolescents, and Families. It looked at the benefits of allowing kids to be online and ran through many of the risks. The report seemed though to miss a subtlety. Many of the risks of social media may stem from a preoccupation with the online world that precludes being truly present in the physical world. If we are constantly driven to check our devices do we fully experience the moments occurring in front of us? We risk being made less members of our towns and homes and more members of marketers toolboxes.
Ask your kids if they agree. Do they feel this disconnect at times?
When asked last week to write an article about physician burnout I had to laugh. Really, laughter was the only choice. After all, laughter is indeed good medicine. You see, lately I have been feeling an increased affinity for the 38% percent of practicing physicians reported to be burnt out, according to the most recent issue of the Archives of Internal Medicine.
A sad number isn’t it? Burnout is a syndrome described by a triad of emotional exhaustion, detachment or cynicism, and a low sense of accomplishment. The authors, Shanafelt, et al. used the gold standard Maslach Burnout Inventory to assess burnout in over 7000 American doctors. Try these numbers on for size:
- 46% of all physicians reported at least 1 symptom of burnout
- 37% felt their work schedule did not leave enough time for personal or family life
- 38% of US physicians had high emotional exhaustion, 30% had high depersonalization, and 12% had a low sense of personal accomplishment.
All of this brings me back to a conversation I had a few years back. I was out of residency and had been working for Kaiser for some time. Long enough for the penny to seem a bit less shiny. I was enjoying a glass of wine with friends around my old backyard table. One of them, a pilot and I started talking about work. Our careers, which we had long dreamed of having, and for which we had worked incredibly hard, were in ways somehow lacking. As cool as being a doctor or a pilot sounds when one dreams it up, in the end what you have is a job that has long hours, enormous stress and may not fully pay your bills. Too cynical? Maybe.
As I read about physician burnout for this article, it occurred to me that perhaps we were making too much of ourselves. The Pub Med search entry “physician burnout” yields no less than 1,233 articles. Are we really that much worse off than the rest of the population? Well, yes we are. The Shanafelt study compares our rate of burnout to that of population-matched controls and suggests that
the experience of burnout among physicians
does not simply mirror larger societal trends.
And, burnout in physicians has disturbing consequences. This study also measured the rates of depression and suicidal ideation amongst doctors, both found at alarming levels. Emotionally detached doctors are less likely to be empathetic and more likely to make errors. They are more likely to leave the profession altogether.
I met with my financial planner yesterday for a regular review. We talked about this issue of burnout for a while. I learned that he has been concerned by the increasing numbers of physicians sitting before him to ask how they can afford to get out of the field. Pauline Chen in this week’s NY Times writes that this trend
has serious repercussions in a system already facing a severe doctor shortage as it attempts to expand coverage to 30 million or more currently uninsured Americans.
So what do we do about this? I read a good dozen articles on burnout. Each offered a similar list of platitudinous suggestions for the suffering colleague. Exercise more. Spend more time with loved ones. Consider a change. Set limits at work. Only this recent article by Shanafelt et al. delves into a discussion about the need for evidenced based recommendations and system-wide change.
Most of the available literature focuses on
individual interventions centered on stress reduction
training rather than organizational interventions designed to address the system factors that result in high burnout rates…Given the evidence that burnout
may adversely affect quality of care and negatively affect physician health, additional research is needed to identify personal, organizational, and societal interventions to address this problem.
As to my own fight against the burnout triad (loss of enthusiasm for work, cynicism and a low sense of personal accomplishment), I am on most days winning. I do find that the best approach is humor. My patients make me smile. I find enjoying the bond with my patients and their families can get me through even the hardest days. I do not tend to be cynical by nature so when this mood hits me it can truly seem comical – as if I am doing a bad imitation of a cranky doctor. To maintain a sense of pride in my work I try to continue to challenge myself by aggressively reading about any new patient diagnosis or diagnostic dilemma. Outside work, by taking on jobs that challenge me in new ways like writing, bike repair and learning German. I do this to avoid the apparent alternative to burnout presented first by President Millard Fillmore and later, Neil Young: rust.
And, when I have a vacation I work hard to follow the Dalai Lama’s teaching:
In dealing with those who are undergoing great suffering, if you feel “burnout” setting in, if you feel demoralized and exhausted, it is best, for the sake of everyone, to withdraw and restore yourself. The point is to have a long-term perspective.
Vacations do not involve using the electronic medical record, email, Twitter or my cell phone. But these steps are only stop-gap measures while I and nearly half of the physicians in this country await more research and, perhaps more importantly, system-wide changes.
Sometimes I find my self paralyzed here before the keyboard. I am paused by concern that my thoughts are mundane or trite; that anything I say will have been said before. And better. Ah well, sometimes that which has been said before is worth saying again. And perhaps, again.
I went to my 30th high school reunion recently. I was ambivalent about attending; my life now seems so remote from those days of the past. I am here, they are there. I am not who I thought I would be. I have family, friends, career…an identity that seems to have little to do with then. There were though, reasons to go, places to revisit, people to embrace, relationships to nurture. So off I went.
I was moved and surprised. Sure, it was fun. Unexpectedly, stay up-til-3AM-two-nights-in-a-row kind of fun. Sure, there were people who I was surprised by. I found more people than not unchanged; we slipped back into easy conversation. It was as much fun to watch who looked the same as they always had as it was to see who had satisfyingly evolved (not sure where I fell exactly). Sure, it was interesting to see what had come of old flames.
The real magic though was not so simple to explain. I have since, been coming here to this keyboard to write, only to pull away, in a struggle to explain something different. I found my voice through remembering the words of Elizabeth Barret Browning quoted by a classmate as she warmly led us in a remembrance for the too many that we have lost:
What I do and what I dream include thee, as the wine
Must taste of its own grapes.
The people we knew in our youth, the people of our growing years shaped us. They have defined us in ways hard to account for. I was embraced by a warm air of recognition, understanding and support by those many faces from the past. We all move forward into our lives and, the people we become? They are in large part shaped by our relationships of the past. I found this especially poignant and reassuring. I have next to no family of my own left; I have lost many. Yet I know well that they are with me, they are in me. Even so, I was surprised to see how strongly even small acquaintances of the past were a part of who I am today.
As we re-encountered each other we asked and, answered over again, the same set of questions. Where do you live? What do you do? Married? Divorced? So sorry. Children? These were our descriptors used to define us. But just as easily, the questions to define us upon meeting could be: Where were you from? Who was your first kiss? Who taught you art? What were the trees like there in the summer? Which friends motivated you? Who do you love still? What did your high school look like? Who still intimidates you? Who do you miss?
What I do and what I dream include thee, as the wine
Must taste of its own grapes.
Indeed. I am shaped by my past. I taste it.
A friend of mine sent me this yesterday. He had read a print version of my post Art for the 99% and immediately knew what I was saying had been said by others before me. And well. And in the year 1984!
Manifestos written to present the intersection of art and politics are not new; the list of them is long. I especially enjoy Claus Oldenberg’s
“I am for an art that is political-erotical-mystical, that does something other than sit on its ass in a museum.
I am for an art that grows up not knowing it is art at all, an art given the chance of having a staring point of zero… “
Then there is the Stuckist Manifesto which ends, confusingly in this way:
Stuckism embraces all that it denounces. We only denounce that which stops at the starting point — Stuckism starts at the stopping point!
The Stuckists define themselves as being anti-anti-art or against anti-art and for art. Huh? Simpler to understand is what my friend sent me. Enjoy!