“It is getting worse everyday.” “Medicare fix at the last moment.” “Too much paperwork not enough time with patients.” “ACO’s and bundling.” The headlines scream at us everyday.
If we have one word that underlies the medical community it is fear.
The looming uncertainties of reimbursement, insurance changes, electronic medical records and new regulations form the main topic of doctor worry talk. The country’s health system remains in perpetual flux and catching physicians in cyclone of more regulation, malpractice and decreasing reimbursements. Certainty of uncertainty is a cause of white coat hypertension in the medical community. We perhaps are the most unsatisfied professionals in the country.
Research supports that many physicians experience high levels of dissatisfaction with their profession, and that dissatisfaction may be on the rise. The ramifications of this are quite serious and pose threats to health care providers and patients alike. Physician career dissatisfaction has been found to be associated with physician stress, disruptive behavior, burnout and career exit, medical errors, reduced patient care quality, reduced patient compliance with medical instructions and higher health care costs.
Perhaps we need to find an anchor for ourselves and the communities we look after. As Atul Gawande puts it, “Meaning in life comes from each of us finding ways to help people and communities make the most of what is known and cope with what is not.” This anchor for most of us will be finding meaning in what we do. Replacing that “fear factor” with service.
Meaning beyond the long arms of insurers or bureaucrats. Meaning in the sacred patient physician relationship that has been undermined by calling us providers.
Rachel Remen talks about a parable where three stonecutters doing the same work find different meaning in what they do, varying from “this is all I will do till I die” to “have the privilege to participate in this great building.” Remen writes” Competence brings us satisfaction. Finding meaning in a familiar task often allows us to go beyond this and find in the most routine of tasks a deep sense of joy and gratitude.”
Meaning in smile, meaning in doing non-RVU (relative work units) things like talking to our patients about their family, cat or listening to Joe talk about problems with his boss at work. That is a meaning that is not outsourced to anybody, that does not depend upon either approval of or frowning on by our managers, payers or the bureaucrats and most important can not be taken away from us.
We share same instant gratification mentality, what do we have to show for our 15 minute visit? Never thinking that just listening (different from hearing), being present was as important as getting the glycated hemoglobin down. Reassuring a worried mom that her teenager son does not have a tumor that her grandfather had, all in the days work.
Finding a meaning in our work and in our life will provide the air bag effect in the event of life crashes that happen invariability. We should work tirelessly to avoid the crash, but also train well to adapt when somebody suddenly lurches into our lane and things do not go as planned. How do we teach resilience when we train ourselves to face everything, is it same as training to face anything? During those difficult times it is our meaning in what we do that will sustain us.
So when you go in the examination room next time pause outside the door, plant your feet firmly on the ground, take a deep breath and remember even if it is difficult, uncertain at times still we are blessed to have an opportunity to help a fellow being.
Sudeep S. Sodhi is a gastroenterologist. He can be reached @holisticgi on Twitter.
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