• Rosalind Kaplan, M.D.

Physician: Love Thyself

I am writing a Valentine's Day post. It's not about my husband, who I love dearly. Sorry, Larry. It's about me- and self-love.

It's been nearly 8 months since I left my academic medicine position, and primary care medicine, the job in which I finally crashed and burned after practicing medicine for decades. And I am happy to report that I feel I am finally 'recovered'. I was considering whether I could say that, since I don't like the whole 'burnout' concept in medicine, and I can't say that I'm a 'recovered physician', as one person I know, who left medicine entirely a while ago, likes to call himself. I am still definitely a physician. But I think that I have recovered from the exhaustion, sadness, humiliation, and self-doubt that plagued me when I left my position last June.

The exhaustion. I was constantly tired- no matter how much sleep I got, all I wanted to do when I finished a day of work, or even on a day off- was go to bed. Sounds like depression, maybe? But it felt like exhaustion. I didn't have the energy to exercise most days, even though I knew it would help. And the quality of my sleep was definitely poor when I did sleep. Now? I haven't napped during the day in a long time. I'm exercising, vigorously, most days, and while my muscles are fatigued, I am not. I can work a 12-hour shift at urgent care without flagging. Looking back, so much of that exhaustion was mental and emotional. I couldn't get away from work, even when I was not at work. My inbox and the phone calls and on-call and texts and constant emails from work reminding me of the unending 'tasks' of my job (most of which had nothing to do with teaching or patient care) followed me wherever I was.

It's not that I have less to do now. I have a 20-hour-a-week job with urgent care- one 12 hour shift weekly and 8 hours of administrative and teaching work. In that 8 hours, I review the charts of Physician Assistants, give feedback to them, and create and deliver education for the urgent care providers and staff. I also work freelance on clinical overviews for doctors for a medical publishing company- generally I create one or two clinical overviews a month on topics ranging from smoking cessation to fungal disease to malignancies. And I'm a 'full-time' Master's student, which means about twenty hours of writing and reading work weekly.

The difference is that I run my own life, instead of my job(s) running my life. I get work emails and attend meetings for work, I have deadlines for my MFA, and I communicate with other writers and editors at the publishing company. But I am treated like an adult in all of these endeavors. Consequently, I decide what to do when, and I also take the time I need for self-care. I eat, sleep and exercise regularly, and FINALLY, have gotten better treatment for my migraines, so I have less headaches. When I do get a headache, I take the time to deal with it, instead of pushing through, which decreases both the intensity and the duration of the pain.

At my clinical job, I am responsible for myself and I am not constantly harassed about when I'm going to close my charts (they know I'll close them as soon as possible) or metrics (someone else deals with these). I don't get report cards. It's assumed that we are all doing our best making clinical decisions and that we are treating the patients kindly. The Chief Medical Officer will respectfully tell me- in the form of educating, face-to-face, not berating- if there is something I need to change clinically or in terms of teaching. During meetings, if I raise a question or make a suggestion, I am listened to respectfully, and we discuss options. Our meetings are a combination of medical education and discussion of procedures and protocols. No, nothing's perfect. We are all people, and occasionally someone says or does something I don't like, but the general tone is one of respect and working together.

Even as a student, I am treated more like an adult than I was in my last job, where administrators were constantly telling me what I could and couldn't do, and when and how I had to do it, and non-medical managers told me what to do. I know my deadlines, I meet them, and my professors and colleagues respectfully give feedback and accept the feedback I give. Amazing.

Obviously, I have plenty of work to do. Yet I feel so much less stressed, because I have control over how and when I do my work. Data on physician wellness says that physicians, even those doing primarily clinical work, have much better mental health when they are in control of their own schedules- how many hours they work, how many patients they see and at what intervals, and how they manage their administrative tasks. Doctors will say that they will accept the financial consequences of such decisions. Yet most health systems will not allow doctors a say. Having control has made my life not just manageable, but pleasurable. I like doing my work. I don't even mind the charting I do the morning after a busy 12-hour shift. I sit down at my desk with a cup of coffee, and plow through my charts. It's not bad, because I only chart what is relevant and important to the visit.

Feeling respected in my endeavors is also so important. When I talk to an urgent care colleague or staff member, or an editor, or a professor now, I feel like there is an earnest attempt to understand what I have to say, and I make that same earnest attempt. I have not experience defensiveness, and I haven't felt defensive. I even feel like people like me, and enjoy talking to me! I'd forgotten that was possible when my previous office devolved into accusations and denials (kind of like the government!), rather than respectful dialogue. This has all allowed me to love myself, my work and my life again.

Along with an increase in my energy and self-esteem, I am feeling more productive and more engaged, not just in my work, but also in life in general. I am reading broadly, and writing essays about things beyond the medical world. I am spending better time with family and friends. I have the energy to go to movies, plays, and concerts. I even knit a sweater, something I haven't done in 25 years. I think this is called balance!

I talk to a lot of physicians, both people I know well, and people I don't, who contact me because of this blog or my writing they have seen in MedPage or KevinMD. What I'm hearing is that doctors usually want to be doing medicine, and care deeply about their patients and about the state of the medical community. But they are thinking of leaving, or looking for ways to change their lives, because they are being ruled, 24/7, by their inboxes, hospital administrators, and the bureaucracy of insurance companies and related entities.

I feel so lucky now that I have found a way to balance. But what I have done is not right for everyone. Some people want only one job, or they need more income than I'm making in my patchwork career, or they are clear they want to stay in their chosen specialty. And I'll admit, over and over, that leaving my longterm patient relationships was very hard and was a sacrifice. I miss them!

But that doesn't mean that balance can't be achieved. Our institutions need to find a way to relieve the stress. Different coverage arrangements, to give doctors time away from their inboxes, and to allow doctors not to work while sick, more support for administrative tasks (especially metrics and insurance prior authorizations!), and giving control back to physicians to manage their schedules are ways that can begin. I will also venture that restoring respect to physicians can occur partly at an institutional level. Physicians, staff and administrators all need to band together to fight insurance bureaucracy so that doctors can prescribe tests and medications without all the hassles, too.

That being said, if you are a physician in despair, if you feel you can no longer stand it, there are options out there! Before you crash and burn, take stock. Your mental and physical health is all you really have. And if you can't love yourself, you can't love anyone else very well, either.

#physicianwellness #physiciansatisfaction #physiciandepression #physicianburnout #health #patientcare #medicalpracticemodels #selfcare #medicaladministration #primarycare #writing #doctor #urgentcare #patientsafety

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