What an epic last full week of 2018! -Christmas -Blog anniversary: 12/26/18 -My birthday! Due to my scripting (I'm supposed to blame my parents like a good millennial, right?), I'm kind of a grinch about Christmas and since celebrating the 4th anniversary of my 29th birthday is a little cliché, I'll just round out the end of the year with my reflections on a year of Reflections.
I haven't really talked much about my toxic work environment as a cause of my burnout, not because it didn't exist at my clinic but because this seems to be universal in all of healthcare at all levels. What else could I possibly add to this discussion? This is the reality of the world we work in. Fear based leadership. Seeing people as cogs in a machine, to be spent in any way deemed useful to the organization with no concern for the actual person. There will always be another you - don't forget, you are easily replaceable.
"So when should we see each other again?"
She's young and healthy, M. No reason to have her come back sooner than her yearly physical. Are you OK with her just getting a letter in the mail notifying her that you're gone?
The thought of her discovering I was leaving via an impersonal letter on clinic letterhead filled me with dread. She deserved better than that. To hell with my promise of keeping my mouth shut.
"You know, you're being that annoying prodigal daughter you used to complain about in residency. The one who wouldn't let her estranged parent go until you came in as the hospice queen and convinced her to pull the plug.
Your current job is already dead, you’re just keeping it alive for some reason."
No preamble. Just straight to the quick.
"M... what's stopping you from signing your new contract?"
These last 11 months, I’ve been telling my story of burnout, but I suppose I should rename it Death of a Primary Care Physician's Career.
I’m letting go of the person, the doctor, I wanted to be.
Ironically, she is the person who dug this 6 foot hole for me, and now I’m laying her in it after 3 long years.
As a millennial physician, I grew up in the world of team-based care, evidenced based medicine, and "To Err is Human." I graduated a rigorous, work-hour rule bending residency program that still managed to provide a supportive environment filled with camaraderie.
We celebrated success and newfound skills together. We also suffered, grieved loss and failures - together. The togetherness gave it meaning.
I was eager to join the community of practicing physicians. On the other side of board certification, I found no such community. Rather, I found merely a group physicians in close proximity doing similar tasks, but in pursuit of individual and often disparate goals.
In my search for community, I found myself alone.
"You know your job is killing you, right?"
Startled, P's back stiffened, gaining him another 2 inches of height as he sat up straighter on the exam room table.
Gah!! What is WRONG with you!? You don't have time for this pandora's box today. You're not Dr. Now from TLC's My 600 lbs life! Ugh.. fine. You're in too deep now.
"How do you keep doing this every day, patient after patient and still keep saying the right thing?"
A thousand thoughts raced through my mind.
Do I demure and say what I'm supposed to say?
"Oh, this is all just part of being a doctor! It's such a privilege to be allowed to enter into someone's fears and emotions. Everything is awesome. Just living the dream."
Or do I say,
"I'm fine. You're fine. We're all fine. Please stop asking questions for which you're not prepared to hear the answer to."
Or perhaps the truth,
"I'm actually not fine. Thanks for asking. The only thing that's allowing me to make it through the day is that I've formulated an exit strategy, because I can't take this anymore."
Mom nodded, eyes glazed over from the bombshell I just threw her way.
Taking and squeezing her clammy hand in mine, her attention returned back to the room from reeling into the land of "What if's?".
"Mom... it's going to be ok. O's going to be ok. I just need you to get him to the hospital. Can you do that, or do you want me to call 911?"
"No... I can do it. It's only 5 minutes away. It'll be faster if I take him now," the determination grew in her voice.
"I love my doctor! She's the best."
"Aww.. thank you! You're going to set some unrealistic expectations for him from the get-go... see you next time!"
Turning to A, my new scribe, I pondered out loud after exiting the room,
"I don't know what it is about having you here, but all of a sudden people are coming out of the woodwork saying nice things. It's to fill the awkward silence of having someone new in the room, I think.
This is not typical. AT ALL.
You can't ever let this stuff get to your head, because it just makes the bad days worse."
Watching A nod his head, probably in an effort to patronize me, I couldn't silence the inner monologue.
You're just teaching him foreboding joy*, M. Don't pass on your maladaptive coping skills way before his time.