During my first year of practice, I was told over and over again that I should "just get over it”, that things get better in 5 years, that what I was experiencing was normal.
When I noticed that I was diagnosising at least 5 cases of cancer per week, I confessed to a friend that I was concerned and a bit freaked out. She told me to get over it. That's what family doctors see and do all day. (It's not, especially not in a small rural practice, but I guess surgical residency makes you cynical). I was also told by a colleague that I should expect lots of cancer in my first few years because I will be seeing people who haven't been reviewed in years. But then he walked away.
I missed a few cancers because I was so far behind on my paper work. They came to light and the patients will survive despite me. This concerned the hell out of me. I asked for extra staff to help me stay on top. I was told to make my staff I already have work faster. My staff that is already overworked with the difficult set of patients we have. There are parables about beating overworked animals, I definitely wasn't going to add to my staff's excess burden.
When I received my second death threat in 8 months, I told my colleagues. They laughed and told me that I was a real doctor now. (Apparently two of them had received one threat in the past 15 or so years. The rest had received nothing.)
There was a tragic, horrible, incident on my watch. Then, my colleagues surrounded me and offered help. Looking back, I do wonder how much was because they were worried I'd get the yips and need to stop working the ER. They did do a good job though.
Seeing patients with more mental health concerns than years in their lives, listening to stories of horrific childhood trauma, being manipulated by personality disorders and drug users was exhausting. When I brought it up I was told to fire these patients, to not ask them questions (I didn't, they offered me their horrific stories on their own), to not let them speak. This advice suggests that I completely ignore my values and put my license in jeopardy.
I burned out very early in my first year of practice. Looking back, reflecting on the times I asked for help and the lack of actual help I received, it's fairly obvious to me why. I expected my fellow family physicians to care about people enough to care about me. Now I see that I was making a mistake.
Everyone has been working for themselves and doing what they can to keep their heads above water, even my good friend. No one is able to help someone else when they aren't able to handle themselves. This is why I now have a therapist. It's also why every new doc needs a dedicated mentor. Someone who has time carved into their schedule just to help the new doc and answer all their questions, let them know what is reasonable and what is not. Knowing at least one person will listen and not tell you to just learn to deal with it is vital to keeping your new docs in practice.
Sunday, September 27, 2015
Wednesday, September 16, 2015
Screw it
I’m just so tired of having to be persistently pleasant while at work, in the grocery store, on email. If I’m not, I’m seen as a bitch. Other (read male) physicians are allowed to be as moody, rude, blunt, cruel as they want to be. If I’m not smiling constantly and holding peoples’ hands I’m the bitchy doctor.
Screw this. Screw gossipy nurses who still treat me like I’m not a physician. Screw the backwoods attitude that men are held to a lower standard and that women are supposed to be soft, pink, and fluffy 24/7. Screw “business feminists” who write crappy leadership literature that perpetuates these ideals. Screw jackass patients that don’t like hearing the truth. Screw the parts of my professional life that are unprofessional and make me lose my temper.
Saturday, September 12, 2015
Fluids are Magical
Everybody feels better after fluids. When I'm working ER I call them my fairy dust. Everyone who looks bad gets 'em.
Kid who is pale and crying and sleepy? Enough Advil that she can latch and get all the breast milk needed to get her up and dancing.
Lightheaded and falling down? Litre of saline and his blood pressure is stabilized and he's ready to go home.
Head splitting in half, vomiting, pneumonia, and fever of almost 40'? 2 litres, some metoclopramide and she's ready to go home with antibiotics.
And yet, I'm just starting to drink something myself 13 hours into my shift.
Kid who is pale and crying and sleepy? Enough Advil that she can latch and get all the breast milk needed to get her up and dancing.
Lightheaded and falling down? Litre of saline and his blood pressure is stabilized and he's ready to go home.
Head splitting in half, vomiting, pneumonia, and fever of almost 40'? 2 litres, some metoclopramide and she's ready to go home with antibiotics.
And yet, I'm just starting to drink something myself 13 hours into my shift.
Friday, September 4, 2015
Soft skills
I’ve become part of the medical culture that minimizes the “soft skills”. Before the brainwashing cult of medical school, I almost worshipped those soft skills. The culture I’m embedded in has made me loathe much of what makes me a good doctor. In general, the men I’ve been working with have little respect for the areas I excel in - palliative, psychiatry, geriatrics, and pain management. They think that patient centred methods are not something any physician should aspire to.
This has rubbed off on me. Now I think that the areas that I am strong in are not worthy of being considered real medicine. It’s something I’ve been struggling with since clerkship. On all my evaluations, I was lauded for excellent communication and advocacy skills. I never took these seriously because the hidden curriculum taught me that my soft skills aren’t real medicine. I wished that someone would say that my cardiology skills were amazing, or that my physical exam skills are exemplary.
If these skills are so soft then why do so many physicians have a hard time with them? Maybe there needs to be another name for them. Making a list of possible alternatives, I think about collaboration, organizational, conversational skills, but I imagine these as also being diminished as being too “pink” to be considered real medicine. Could try something like supratentorial skills but given how frequently we use that as code for somatization, that also wouldn’t be treated seriously. Even people skills are “pink” - something we expect those who work in retail to have to learn by watching videos in a break room.
These “soft skills” are not gained that easily though. Yes, we can learn them through videos and work, but the best of them are learned by experience. By watching what our mentors do well and emulate the people skills they display. We learn them through collaborating with our allied providers and seeing how they advocate for patients. There are no textbooks to show us how to be the best at advocating, listening, collaborating, communicating, organizing, and generally being patient centred. We need to shed tears, sweat, blood, to get to that point.
These skills are not obvious and difficult to describe, maybe the opposite of concrete skills? Abstract skills? That might work.
But then again, what is so wrong with calling them soft skills? As long as we start to acknowledge the efforts made to learn them. There shouldn’t be anything wrong with the pink skills that are associated within the soft skills. All physicians should strive to be the best doctors they can. That means practicing their concrete skills, (clinical skills, rote learning, anatomy) as well as their abstract or soft skills. To be a fantastic doctor, one shouldn’t have to hire another MD to provide bedside manner. We should expect it of each other to want to be a complete physician who is able to provide all a patient needs from their specialist or primary care provider.
If female providers are better at the abstract skills, we should be congratulating them rather than acting like they have done something wrong. I’ve been told several times that I care too much, that I am too passionate. This is ridiculous.
I want a doctor who is passionate about their job. I want a doctor who cares. No, I don’t want my doc taking their work home with them, spending their night going through all the coulda’ woulda’ shoulda’s. They shouldn’t cross boundaries to make my experience better. But, that doesn’t mean that they shouldn’t cry when they feel like, argue with specialists who refuse to take my care, give 100% during office hours.
If you think my passion and caring is the problem, I think it’s safe to say that you are the problem. The concrete thinking physicians with a limited view of medicine should really just get the hell out of the way of the physicians who flex both soft and hard skills and are kicking ass. Those are the physicians who are asking the questions in research, are pushing the boundaries of what we are able to do to make our patients’ lives better. We need to repair our culture to catch up with what patients expect from their physicians, and what we expect from our colleagues. The concrete thinking docs need to be called out for being the dinosaurs that they are.
This has rubbed off on me. Now I think that the areas that I am strong in are not worthy of being considered real medicine. It’s something I’ve been struggling with since clerkship. On all my evaluations, I was lauded for excellent communication and advocacy skills. I never took these seriously because the hidden curriculum taught me that my soft skills aren’t real medicine. I wished that someone would say that my cardiology skills were amazing, or that my physical exam skills are exemplary.
If these skills are so soft then why do so many physicians have a hard time with them? Maybe there needs to be another name for them. Making a list of possible alternatives, I think about collaboration, organizational, conversational skills, but I imagine these as also being diminished as being too “pink” to be considered real medicine. Could try something like supratentorial skills but given how frequently we use that as code for somatization, that also wouldn’t be treated seriously. Even people skills are “pink” - something we expect those who work in retail to have to learn by watching videos in a break room.
These “soft skills” are not gained that easily though. Yes, we can learn them through videos and work, but the best of them are learned by experience. By watching what our mentors do well and emulate the people skills they display. We learn them through collaborating with our allied providers and seeing how they advocate for patients. There are no textbooks to show us how to be the best at advocating, listening, collaborating, communicating, organizing, and generally being patient centred. We need to shed tears, sweat, blood, to get to that point.
These skills are not obvious and difficult to describe, maybe the opposite of concrete skills? Abstract skills? That might work.
But then again, what is so wrong with calling them soft skills? As long as we start to acknowledge the efforts made to learn them. There shouldn’t be anything wrong with the pink skills that are associated within the soft skills. All physicians should strive to be the best doctors they can. That means practicing their concrete skills, (clinical skills, rote learning, anatomy) as well as their abstract or soft skills. To be a fantastic doctor, one shouldn’t have to hire another MD to provide bedside manner. We should expect it of each other to want to be a complete physician who is able to provide all a patient needs from their specialist or primary care provider.
If female providers are better at the abstract skills, we should be congratulating them rather than acting like they have done something wrong. I’ve been told several times that I care too much, that I am too passionate. This is ridiculous.
I want a doctor who is passionate about their job. I want a doctor who cares. No, I don’t want my doc taking their work home with them, spending their night going through all the coulda’ woulda’ shoulda’s. They shouldn’t cross boundaries to make my experience better. But, that doesn’t mean that they shouldn’t cry when they feel like, argue with specialists who refuse to take my care, give 100% during office hours.
If you think my passion and caring is the problem, I think it’s safe to say that you are the problem. The concrete thinking physicians with a limited view of medicine should really just get the hell out of the way of the physicians who flex both soft and hard skills and are kicking ass. Those are the physicians who are asking the questions in research, are pushing the boundaries of what we are able to do to make our patients’ lives better. We need to repair our culture to catch up with what patients expect from their physicians, and what we expect from our colleagues. The concrete thinking docs need to be called out for being the dinosaurs that they are.
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