I recently asked 10 physician colleagues this question: What keeps you awake at night?
Some of the answers were predictable. Some were surprising. Some were downright inspirational. Here they are. See what you think.
A solo, rural physician in his 60’s recently retired due to “the hassle factor.” He still enjoyed patients and caring for them but had finally had enough of the interference by insurers, government and the demands of conversion to an electronic medical record (EMR). He was spending more time looking at the computer than the patient. “I finally felt I could not take care of my patients any longer.”
An academic department chair feels constrained by the inability to manage patients and coordinate care in a timely fashion. Despite the EMR’s initial hope and hoopla, the slowness of the functionality of his department’s system has made this worse. “It has become a major challenge. The shortage of various sub-specialties has made access to care very difficult, especially for marginalized and underserved populations.” He struggles to find high-quality rotations for the training of clinical year students and residents to help them develop their diagnostic acumen.
An early career academic physician loses sleep directly from staying up late finishing her clinic notes. She knows the screen time so close to bedtime is not good sleep hygiene. She views all the individual elements of her teaching and patient care as worthwhile but admits to anxiety over how to get it all done. Improving her time management is crucial to prioritizing tasks and knowing how much to take on and when to say NO. She wants to give quality time to her patients, keep up with research in her field and continually improve her teaching and presentations to students and residents. “I also want to give quality time to my family, my own personal growth and to public advocacy activities. Trying to figure out what is really the most important from day to day is often really difficult.”
A late career physician worries about getting in trouble with the medical licensing board over controlled substances. He joined a practice recently without knowing that one of the physician partners had questionable prescribing habits for controlled substances. He is being flooded with requests for controlled substances since his partner’s prescribing privileges have been restricted. “I worry I may have to leave this practice to avoid being caught in the middle between demanding, unhappy patients and the licensing board.”
A mid-career physician considers work-life balance to be her biggest challenge.
Her mentors have told her for years that her generation doesn’t want to work as much as they did. She simply feels an obligation to balance her family life and her work life in a way that is fulfilling. Some days she actually feels like she is doing it pretty well- but not consistently. “Some days I feel like I don’t make the grade. Most physicians don’t spend enough time on self care. Some days I need to self preserve- I feel washed out. We are all challenged to find love and peace in life.”
A late career academic physician struggles with “things I can’t control. I can’t control my patients’ lives. You can talk about lifestyle change all day long but they can’t make time for it. It takes a lot of practice to understand you’re just guiding patients, not controlling them.” She now recommends meditation to all new patients, referring them to HeadSpace.com and InsightTimer.com. “If you want to learn to meditate you have to practice a little every day. This also offers an opportunity for patients to see me as a provider in a new light.” She often combines the meditation recommendation with a little speech about exercise and diet.
A late career physician developed several personal health problems in recent years and gradually eliminated hospital, house calls and nursing home work. She recently retired completely due to the physical challenge of even seeing patients in the office. She worries, “Did I retire too young? Will my savings hold up? It’s so hard to keep up the house- will I be able to stay in it? How rapidly will my poor health get worse? I always put myself last and wish I’d taken better care of myself.”
An early career academic physician is frustrated by our health care system’s lack of focus on the health of the patient. “The focus is too heavily financial. It manifests in various ways but that is the biggest issue. The Physician Quality Reporting System PQRS is supposed to be about patients but seems to be more focused on revenues than the determinants of health. You see it in everything we do. I ask myself- Can I actually enjoy this anymore? Do I want to continue in medicine at all?”
A rural, mid-career academic physician says with regret, “We don’t really provide the care we set out to in medicine. We send them on their way and their life exists between these episodes of care. How do we cross the chasm from fee-for-service to comprehensive care of patients? If I see a patient 15 minutes for diabetes, obesity, mental health problems and social issues, we don’t have the ability to keep in contact with the patient and touch base on the mental health and social issues. Specifically, we don’t have a cohesive medical record to help us communicate with patients. We have a billion people on Facebook but hospitals that can’t communicate with our clinic.”
A late career, hospital-based physician and leader in organized medicine, worries about three big challenges. “The biggest challenge that troubles me is the lack of health care access for the entire American population. The second biggest challenge is the health consequences of climate change. I volunteer time working on both of these as personal and professional priorities. The third thing is the loss of global human productivity from a lack of education, often due to preventable illness and disease.”
The thing that strikes me most about these physician responses is the values they reflect. They are filled with concern for the common good, humane patient care and the Hippocratic ideals of professional excellence, putting patients first, compassion, causing no harm, service, generosity, trust, healing partnerships and medicine as a calling. The emphasis on the art of medicine comes shining through.
These values run deep in physicians. Reconnecting with them and honoring them may be an important part of serving our fellow physicians at risk of burnout and in despair over their current lives in medicine. No other profession attracts a higher caliber of human beings than those who enter medicine- committed to applying body, mind and heart in service to the relief of suffering.
Perhaps we can each draw on this sense of membership in our most honorable of professions as we assist a struggling colleague in despair- or while laying awake at night ourselves.
About the Author
Dr. Patterson Chairs the Lexington Medical Society’s Physician Wellness Commission, is past president of the Kentucky Academy of Family Physicians and is board certified in family medicine and integrative holistic medicine. He is on the family practice faculty UK College of Medicine and U of L School of Medicine and teaches nationally for Saybrook School of Integrative Medicine and Health Sciences (San Francisco) and the Center for Mind Body Medicine (Washington, DC). After 30 years in private family practice in Irvine KY, he now operates the Mind Body Studio in Lexington, where he offers integrative medicine consultations specializing in mindfulness-based approaches to stress-related chronic conditions and burnout prevention for helping professionals. He can be reached through his website at www.mindbodystudio.org