The winter holidays always seem like a good time to reflect on those things which are important to us, whether it's looking backwards in gratitude, being present and in the moment with those we hold dearest, or making plans for the future. Ironically, it is the hustle and bustle of those holidays that often competes for our attention and our intention to reflect can get easily left behind.
Sounds a lot like the practice of medicine these days, eh?
In the spirit of gratitude, joy, and hope, I want to stop for just a moment to reflect what I observe from my vantage point.
Gratitude – In every job I've had, there is always a choice to make: how close will I get to the people I work with and work for? In other words, what "professional boundaries" are appropriate and healthy to keep and what needs to be loosened a little to get past the sterility of "professional correctness?"
The human need to connect with each other beyond phatic communications is part of our nature and our nurturing. I am very grateful for the physicians who I have become friends with, those I feel comfortable calling by first name, even those I can be playful with about their quirks. This year, I have felt especially honored by those who were vulnerable with me about the level of pain they experience because of their profession.
Joy – I know there are probably some physicians who enjoy staying alone behind a microscope or screen, and I do not begrudge them. However, the ones I talk with most still find the relationships they build with patients and colleagues to be the most meaningful part of their work. Walking with people through the most painful and uncertain times in their life can be a deep, rich, and – dare I say – even joyful part of their vocation. How can this be true? Once again, I think it is because of powerful human interactions that somehow satisfy a part of our souls, whether in triumph or in loss.
Hope – I suppose there are some physicians who work only for their own hope of a more secure financial future. I really haven't met many. The ones I know work their tails off because they want to offer hope to their patients and communities that there is a way to live more wholly and robustly. They work to improve systems which function more efficiently and effectively and persist despite overwhelming bureaucracies to battle with. They push forward with an eye to their own health and security while keeping their overall pledge to put the patient first.
Sadly, there are also some physicians I have met who have lost all gratitude, joy, and hope in their work. It is for these that I am most concerned and I know that I interact with only a fraction of them. These are your colleagues who walk around with glassy eyed stares, present in body but not in spirit, wondering if they can keep going on.
Ultimately the greatest good I can do in my role is to encourage you all to amp up your engagement with those around you. Together, you can fight against everything that robs your work of meaningful interactions. As each of you does your part, transformation of the medical culture is possible.
Thank you all for making this work a joy for me to participate in and Happy New Year.
As we move into December, I am reflecting how much has changed for me since I started here three years ago. At a board retreat in March 2015, ACMS picked up the banner of "Physician Vitality" and began to make a charge on the enemy (i.e. burnout) that has resulted from the burden of EHRs, pre-authorization, meaningful-use, MACRA, hospital employment, independent practice and numerous other pressures on physicians that have bled their joy away. When I started, promoting physician wellness wasn't even part of the conversation; now I spend between 30-40% of my time on it.
For years, efforts at developing physician wellness may have felt like getting stuck on a sandy beach in your front wheel drive mini-van. (I learned a thing or two about that this summer!) But numerous physicians have told they have hope things are starting to change. "I've been working on this for five or six years and I feel like we're finally gaining some traction," says one former chief-of-staff who is active on these issues. Much of this work goes on behind the scenes in wellness committee meetings, one-on-ones, pushing books into the hands of administrators, and even now beginning to lobby the Board of Medicine and health systems.
I wanted to pull the curtain back for you and let you know what all has been happening this year.
Physician Vitality Program
Although ACMS has historically left advocacy up to the Idaho Medical Association, typically because it was a regulatory issue, we now have entered the arena to address the current angst of physicians at local and state levels.
It has been a bellwether year for physician vitality in our Valley with these and other gains. Sadly, we have also endured the loss of doctors who have chosen to leave medicine early or life altogether because of their occupational distress.
Is the membership of Ada County Medical Society resilient enough to continue weathering the changes in the medical industry? I believe so and that the foundation of it is based on our inordinate degree of collegiality and relationships across specialties, employment statuses, and hospital affiliations. Your involvement and voice matters and there are multiple ways of becoming more engaged in this and other topics.
Take a look on-line for committees and work groups you can get involved in or use our physician angst form to help us understand ways we can help pull you out of the quicksand you may have found yourself stuck in.
On October 14th, major revisions to The Declaration of Geneva, a modern successor to the Hippocratic Oath for physicians around the world, were approved by the World Medical Association. It is the first major change to the Declaration, now to be called a pledge, since its inception in 1948, which has become a core document of medical ethics and a modern version of the 2,500-year old Hippocratic Oath.
It's about time!
Significantly, the oath has added is a requirement for physicians to attend to their own health, well-being and abilities in order to provide care of the highest standard. This reflects a huge sea-change to inform the responsibility physicians have to fill their own cup up before they pour their lives out in service to others.
For too long, physicians have been trained and expected to put patients' health and life above all other things. In the pledge, it still remains the physician's first consideration, but the additional self-care clause indicates that there can be others as well. It echoes something I wrote to one of our health-care leaders just yesterday: "The prevailing operational ethos of putting the Triple Aim first at all costs cannot be sustained."
The massive changes in healthcare have been so rapid, so sustained, and so intrusive to regular medical practice, that the real cost is not just in terms of actual dollars, but in physician lives as well. The incredible decrease in work satisfaction fuels the epidemic increase in work-related burnout which in turn drives earlier retirement by physicians. For those physicians who feel like they are caught in the surf with wave after wave pounding them into the sand, some refuse to stand up anymore and succumb to it altogether.
Now the real work is for institutions to stand up and say, "Yes, we support that medical ethic and this is how we're going to align ourselves with it." Consider:
The Physician’s Pledge
AS A MEMBER OF THE MEDICAL PROFESSION:
I SOLEMNLY PLEDGE to dedicate my life to the service of humanity;
THE HEALTH AND WELL-BEING OF MY PATIENT will be my first consideration;
I WILL RESPECT the autonomy and dignity of my patient;
I WILL MAINTAIN the utmost respect for human life;
I WILL NOT PERMIT considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient;
I WILL RESPECT the secrets that are confided in me, even after the patient has died;
I WILL PRACTICE my profession with conscience and dignity and in accordance with good medical practice;
I WILL FOSTER the honor and noble traditions of the medical profession;
I WILL GIVE to my teachers, colleagues, and students the respect and gratitude that is their due;
I WILL SHARE my medical knowledge for the benefit of the patient and the advancement of healthcare;
I WILL ATTEND TO my own health, well-being, and abilities in order to provide care of the highest standard;
I WILL NOT USE my medical knowledge to violate human rights and civil liberties, even under threat;
I MAKE THESE PROMISES solemnly, freely and upon my honor.
*Hat tip to Dike Drummond, TheHappyMD, for his blog post on the subject.