Human first, doctor second
Belachew Tessema MD, FACS, ProHealth Physicians
ProHealth Physicians, part of Optum, is a community-based medical group with 85 locations statewide. ProHealth’s primary care doctors and specialists care for more than 360,000 people in Connecticut at all stages of life.
You’d be hard pressed to find professionals who derive more meaning from their work than doctors. Physicians devote over a decade to school and training, often under circumstances of high stress and low sleep.
We choose medicine, a path that demands excellence and endurance, for the privilege of a life of meaningful work.
Crisis of meaning
The reality of practice can shatter our expectations. We are squeezed and cramped by technology and administrative tasks, so that the requirements of the job compete with perhaps the most meaningful and desirable aspect of practicing medicine—indeed, the very thing we came to medicine for—our relationships with our patients.
We can easily become overwhelmed by these seemingly endless and competing demands, and the ensuing feelings of being stuck and of failure, create crisis. Suffering is often solitary, and the opportunity to seek comfort in our colleagues all too rare.
Where is the joy of our meaningful life in practice?
Expanding a life
I believe that the best way to deal with such a crisis of meaning is to expand our lives. The approach I recommend might, to the doctor leaving the clinic late every day, staying up nights to finish charting, fearful of missing yet another child’s triumph for work, sound absurd.
How could spending more time outside of the clinic make work more manageable?
But I am certain that developing your humanity in the outside world will increase your happiness and will both facilitate and bring perspective to work.
Being a whole person is the full expression of yourself as a being on this planet. It encompasses your role with friends, family, and community; your ability to express yourself creatively in a way that brings you (and hopefully others) joy; and the quest to always be a novice at something, and, in things mastered, a teacher. These are all components of living a satisfying life.
Within this life, your identity as “doctor” may always be present, but not diminished by leaving the white coat at the clinic.
As humans first and doctors second, we bring energy and experiences, a more fertile soil, in which to grow our practice. Being a whole person makes you a better doctor.
Rules to live by
First, one key to satisfaction with clinical work is the awareness of your capacity to influence outcomes, and the courage to acknowledge it. Medicine is, as is so often said, a team sport.
In the workplace, lowering the hard boundaries we put around ourselves as doctor, nurse, MA, patient, receptionist—rather than the egoic ordering of roles—viewing each person as doing respectable, essential work contributing to the same goal.
Second, carry the knowledge that you, as a physician, are not "in charge" of sickness and health. View illness as more than the binary of success (cure) and failure (no cure). Metaphors like “battle”, “win” and “lose” are not always helpful.
The patient’s perception is key to choosing metaphors. We have a chance to help the sick, and this is where our responsibility and meaning come from. This is our contribution to helping a patient.
Life’s rich experiences will tell you that this “helping” will look very different from person to person.
Third, practice relationship-informed care: Acknowledge the wisdom of your patients, trusting and valuing their individual experiences.
Pathophysiology provides a method to learn about and treat illness in the body, but a broader understanding of the whole patient, the context in which their illness arose, and their human experience, is vital to the best possible care.
Respect and treat patients as people, and, indeed, as family. The value of listening. Honesty in giving bad news and good. This honesty is the foundation of shared decision making, a crucial way to afford autonomy to patients.
At my practice, my colleague often jokes that patients make appointments just to come in for a chat. I’ll admit it does look that way! And while I’m always happy to catch up with a familiar patient, and see how they’re doing, our chats are anything but idle.
Recently, a patient 6 years post diagnosis, came to see me. I was surprised to see her name on the schedule as she had been cancer free for quite a while and was not due for follow-up.
She sat with me, sharing that she had come in fearing a recurrence at the site of the tumor I had removed surgically many years ago. She massaged the back of her neck with her hand, saying “It’s just this pain here, it’s new; I’m so worried.”
After examining her, I reassured her that she showed no physical signs of cancer. She remained upset. I asked, “Is something going on that makes you worry more now?”
She was, in fact, under great stress: Her marriage was struggling. Her partner had raised the specter of her cancer during an argument and had expressed resentment over the burden of caregiving.
Our relationship, built over the arc of her diagnosis, treatment and survivorship of cancer, informed my understanding of this patient’s state of physical and mental pain.
Given this long-standing relationship, she trusted my assessment that there were no concerning signs of cancer recurrence and that her life and the stress within her marriage were a likelier source of the pain. Her faith in my understanding relieved her of the cancer worry.
These are the “check-ins” I’m happy to have with so many patients.
Humble in my humanity, and with mutual respect, I believe that my patients know themselves, and know when there is something wrong.
It is my work to untangle root systems of fear, learned or associated pathologies, TV and internet-based diagnostics, to find a meaningful explanation and, hopefully, give relief.