Blogging 101, Assignment #9: Write a post that builds on one of the comments you left yesterday.

It’s from today, but I think it still counts.

If you have not already visited Catching My Drift by Pam Kirst, I highly recommend it. This morning, when I should have been preparing more diligently for my noontime presentation, I found myself drawn into and reflecting on her story, “A Wheel That Never Squeaks.” A college administrator puts together a series of student panels to help faculty address the unique needs of certain groups, such as single moms and students with autism. An advisor asks her to arrange a session for returning veterans, and the story unfolds as she learns from three veteran students about how their military experiences influence their campus lives. One cannot stand the disrespect that a professor tolerates from a fellow student. Another feels a sense of urgency to earn his degree so he may once again serve as breadwinner for his family. The third looks more like a hippie than a soldier, with a long ponytail and body piercings.

Some lines that grabbed me:

“The message was always the same: We want to help our students succeed.  We are not going to dumb it down for anyone, but we do want to work with unique situations.”

“Lesson number one, she thought to herself.  Lose the stereotype of what I think a returning veteran looks like.”

“Did you notice they all sat facing the door?  Returning veterans find it very hard to sit with their backs to a door–it goes against all their training.”

I encourage you to read the whole story, if you haven’t already. For me, it brought multiple aspects of physicians’ work into specific relief.

My comment:  “I’m getting ready to present today on physician burnout and resilience. Continuing education at this hospital occurs every Monday around lunch. Wouldn’t it be great if every month or so, one of those sessions were devoted to some humanist aspect of practice? Who are our patients? What are they dealing with outside of their medical problems? How can we best serve them? And holy cow, what would a panel of patients say to an audience of doctors??”

I have given versions of my burnout/resilience talk three times before today, each time to a different audience. Today was in a community hospital, to about 20 or so primary care physicians and some subspecialists. It was their weekly noon conference, with hot food provided. As the doctors trickled into the basement conference room, we spoke casually about burnout—so much regulation, administrative red tape, stress. Suicide came up–one doctor mentioned that he himself knew three doctors who all took their own lives. When I asked the Continuing Medical Education coordinator how often they have a presentation on non-clinical topics, she said maybe once or twice a year. Does this surprise you?

The breadth and depth of medical knowledge grows exponentially these days. Even in subspecialties, physicians must work harder to keep up with updated guidelines, new technologies, and patient expectations. So it makes sense that ‘continuing education’ would center around the ‘hard’ stuff—clinical knowledge and practice.

But what about the ‘soft’ stuff? Do we assume that all physicians just know how to manage their relationships with patients, staff, and colleagues? With themselves? That they practice optimal strategies for maintaining their own well-being, in this complex and demanding healthcare environment?

At first I thought of practicing physicians as the faculty in the college story, in need of learning how better to connect with their diverse patients. I want to go to grand rounds and hear from a panel of patients with autism about their experience in our healthcare system. I want a case manager to show me the resources available for my patients whose insurance does not cover mental health services. I want to connect with my colleagues in other specialties, learn how I can best prepare my patients to see them in consultation, and know the rationale behind their decisions. I see my own presentation as an attempt to fill this gap, inviting my colleagues to consider ways they can take charge of their own happiness at work.

On further reflection, I see my colleagues also as the returning veteran students. In the story, they are the ‘wheels that never squeak.’ Their training and mindset preclude them from complaining, even while they feel severe discomfort in their classroom surroundings. Similarly, many physicians experience great distress at work but don’t let on. For most of us, effective self-care is never role modeled in our training, let alone explicitly taught. If we express fatigue, sadness, or feeling overwhelmed, we are often shamed as being weak, rather than encouraged and shown how to overcome these challenges. Some of us become the ‘non-squeaking wheel,’ with deadly consequences. The suicide rate for physicians is estimated to be 1.4 to 4 times greater than the general population.

“The message was always the same: We want to help our students succeed.  We are not going to dumb it down for anyone, but we do want to work with unique situations.”  When we sanction conversations and conferences around the soft stuff, we validate its importance. We want our patients to succeed by helping them understand their illnesses and treatments. We want our physicians to succeed by giving them the tools to communicate and connect effectively with patients. This serves everybody; it’s a win-win.

“Lesson number one, she thought to herself.  Lose the stereotype of what I think a returning veteran looks like.”  Let’s lose the stereotype of the bullet-proof physician, the one who helps all others and never needs help herself. Let’s lose the stereotype of the lazy patient, who cares less about his health than his doctor does. Let’s find ways to know each other’s challenges, and see one another as individuals who deserve our full attention and honest caring.

“Did you notice they all sat facing the door?  Returning veterans find it very hard to sit with their backs to a door–it goes against all their training.” What do we need to notice about one another? What details do we miss in our daily routines that, if we knew, could help us connect and heal one another?

Thank you, Pam, for giving me more to ponder. I hope I can contribute to these conversations and make our system function better for both patients and doctors.