(It dismays me to see that so often, when doctors start to speak about the often inhuman conditions they work in, the message they are sent is one of pure dollars and cents; their contribution is stripped of any humanizing qualities and distilled into the stark capitalistic purity of numbers on a page. I recently read a helpful book that suggests that part of the reason we are so demoralized in the West is that our lives and work have been stripped of every sense meaning and purpose but financial.)
And while, as an actor who was trained to acknowledge my emotions without being mastered by them and as someone who has practiced yoga for over five years, I agree that mindfulness is an important quality to cultivate for anyone performing a demanding and stressful job, it does not take away from the fact that working conditions for many physicians are intolerable. Mindfulness, meditation, and therapy may well help physicians deal with their workplace stressors, but does nothing to deal with the underlying problem; many of those stressors are avoidable. And this is where I think the Dr. Chen article missed the boat.
(Many would tell physicians to stop whining! After all, we're all making half a million dollars and all live in mansions and drive fancy cars. And we don't have it half as bad as lawyers and teachers, etc. To them I say, lawyers and teachers may well have shitty working conditions (my parents are both teachers, I KNOW they do), but I write about the doctors, because I will soon be one. This is the world I am coming to know. And frankly, the fact that some professions are willing to put up with shitty jobs and shitty working conditions for
Several weeks ago, I posted an interesting TED talk on what motivates us. And while Dan Pink isn't necessarily the most qualified of social scientists, and while his argument is somewhat jingoistic and simplistic, his description of intrinsic motivation is compelling:
Autonomy
Mastery
Purpose.
In our discussion of physicians and how they do their jobs, we often ignore these important aspects of what helps us get up in the morning to go to work. Sometimes, I think we assume that because we are in a "helping profession," we automatically have these intrinsic motivators covered. Perhaps, for that brief moment when we were writing our admissions essays, we did. But from the very first days of medical school, other motivators, mostly extrinsic, come into play: grades, social expectations, financial pressures. I wrote about this when I first started this blog; how easy it is to get sucked into the daily slog and stop seeing the big picture.
The irony of this is that I learned this lesson in my artistic life. No sooner had I stopped the pursuit of a career as a singer did I start to sing really, really well. As soon as I starting singing entirely for myself, I was able to discard the distractions of worrying what others thought and sing for the pure pleasure of it. This intrinsic motivation had an enormous positive impact on the quality of what I was doing as an artist.
I recently spent the weekend with a group of medical students in Ireland, who are participating in an almost entirely PBL* course. They spoke of their frustrations at "having to teach themselves to be doctors." I remember saying that had I been in their situation, I would have wanted to poke needles into my eyes. But for all the disadvantages I see in PBL, I can see that in the right hands, it could be a powerful tool for allowing students to nurture their own intrinsic motivation for learning. And frankly, isn't that what we ultimately all have to do, teach ourselves to be doctors? Learning comes from within, and while a negative external stressor can be helpful in the short term. Its that information that one learns for the sheer joy of it that often really sticks.
It's an interesting balance. We do what we do to help people, but ultimately, what we do has to be about us for it to really motivate and inspire us. I treat all my patients equally because I believe in the infinite worth of all, and because to not do so would run counter to the person I believe myself to be. And frankly, those physicians who treat patients because they want their patients to like them or even to get better aren't going to last terribly long. We have so little control over our patient's outcomes or what they think of us.
Autonomy, Mastery, and Purpose. I think that in many respects these motivations are often neglected and eroded in the modern practice of medicine.
There is so much ink spilled in discussing why new medical grads aren't going into primary care specialties, and financial incentives (or the lack thereof) are proposed as the most likely reason. I would like to suggest that while being able to pay off my massive student loans is important to me, a specialty where I am able to practice with as much professional autonomy as possible is even more important. I would suggest that part of this picture is that many, possibly even most, of the more highly sought-after specialties are ones that do carry with them more autonomy.
Mastery goes without saying, as physicians, we are all called to an high level of achievement; after all, people's lives and well-being are at stake. But this concept has twisted over the years among physicians. There is an extraordinary amount of hubris in the medical community, and the leaders of our profession seem to suggest that long-term, sustained, superhuman effort and achievement is not only the norm among physicians, but the measure by which all physicians must be measured. As a performer, I am very familiar with the phenomenon of post-performance letdown. We would sing a run of shows, and when it was over, we would crash for a couple of days, rebuilding reserves and recovering from the intense activity of the preceding nights. Airline pilots sleep after a flight. Sustained, high-level performance takes a toll; there is always a physical and emotional price to pay for excellence. As a community, our unwillingness to acknowledge that fact makes a lot of really smart people start to look really kind of dim. I find it simply arrogant to assume that just because I am going to be a doctor, that this makes me somehow a more capable, better person, and less subject to the demands of my body than the individual piloting my plane across the Atlantic. It doesn't work that way. We are all normal humans, physicians included, and while we are all capable of extraordinary things, we are none of us capable of extraordinary things all the time!
Why do you want to be a physician? The classic medical school interview question. And most of us try to come up with something that doesn't quite say, "I want to help people" but which means the same thing. We all generally have some sort of purpose in choosing medicine. But in many cases, that purpose gets lost in the struggle. I have come to the conclusion that in medicine, what we do for people and the help we offer them is often far less important than who we are to them. That saving my patients is often not possible, and that I can't do much for the vast majority of them. But I can walk alongside them for even a few minutes of their journey. I can acknowledge their humanity, and be with them in their pain. And if I use my knowledge and expertise to make their journey a little easier, then that's a bit of a bonus.
To change the way we do our jobs as physicians, to reclaim our professional (and personal) autonomy, to reconnect with a sane concept of mastery as normal human beings, and to find a renewed sense of purpose in our everyday lives; this is something worth striving for as a profession. To accomplish it will require that we change the way we see ourselves. Perhaps there is something to be said for mindfulness after all.
*Problem Based Learning - a way of teaching medicine that involves small group and self-directed learning for most of the curriculum.
2 comments:
Well said.
Agreed.
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