Wednesday, June 01, 2011

psychology today

You may have already seen this, but I have a new writing gig on Psychology Today, and as my first post, I put up a piece that I've been noodling around for a while, about work-life balance during residency.  If you haven't seen it yet, take a look.

It doesn't totally surprise me, though I guess I'd be lying if I didn't admit that it surprised me just a little, the reactions I got to the piece after I posted it.  There are some measured responses, some balanced responses, but also some responses that make me realize: wow, some people really feel a lot of generalized antipathy towards doctors.  And that makes me kind of sad, I guess.  I don't deny that it's a privilege to go to medical school, or that it's a privilege to take care of patients, but I wish...I don't know what I wish.  Maybe I just wish that criticisms lobbed towards doctors didn't automatically lead with the assumption that we are all terrible people with icy, cold hearts made of cash registers and human tears.  Or that we all drive Lexuses.

(And, for the record, though I feel partially like I'm losing ground by even bringing this up--neither Joe or I drive a Lexus.  I myself drive a Toyota Camary that we got from a used car dealer, whose cosmetic imperfections compel perfect strangers to stop me on the road in order to harangue me about body work.)

I put the piece up to talk about the fact that a profession born out of humanism sometimes fails to use humanistic principles in dealing with its own trainees--trainees who are largely idealistic and hardworking and wanting more than anything else to do good.  And yet many of the comments I got sort of went in another direction, almost like an airing of grievances about the whole of medical profession itself.  So.  Three things.

One: I'm really glad I wrote the book I did.  If for no other reason to humanize the practice of medicine to the outside, and to let people see what it's like, really like, to be a young medical trainee who, like all young medical trainees, got into this profession not for fame or fortune or the promise of a champagne fountain in their two-story foyer, but simply in the interest of trying to do her very best, for her patients and for her family.  Many, many of the people who have read my book already are involved in medicine in some way, but now, more than ever, I'm determined to bring it more to a non-medical audience.

Two: I have no problem with getting comments opposite to my own viewpoint (so long as they are not gratuitously vitriolic), because that's the value of having a system which encourages open discussion.  So I really hope that, for this piece and future pieces, that I get even more discussion, on all sides, and that the culture of those discussions is as well-conducted as the ones we've been able to have on this page.  Do you have any thoughts about the piece?  Why not weigh in?

Three: I'm delighted to have started writing online for Psychology Today, because I'm excited to bring the topics that I care about to a wider audience.  The focus of my column on PT is the human side of the medical profession, and I can already see that we're going to have a lot to talk about.  So what should I talk about next?  I have some ideas, but you guys tell me: what do you want to read about?

36 comments:

  1. No topic suggestions, but I applaud you for being so patient (no pun intended) in dealing with all the comments. My BP increases just reading some of them! As a soon to be 1st year resident, I naturally agree with many of your viewpoints and wouldn't stay as measured as you are in dealing with opposition.

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  2. Outre9:03 PM

    I once thought all the stereotypical negative stuff about doctors until I started college in really got into my major, which is half healthfiedl and half something else.

    It wasn’t until I was exposed to healthcare from more of a provider (still not a provider -- I’m still in the consumer pool) standpoint I understood the bigger picture. The fact is, all of us, given a subject matter that we have a limited scope of understanding of have a very skewed views of it and often, those are negative. No one likes to talk about the positive stuff... it’s not fun. So I guess that’s part of the reason why some of the negative hateful attitude toward doctors exist.

    What I don’t understand though, is the god-like complex thing. Due to my many medical problems, I’ve seen many doctors, and often they are super-sub-specialists well known in the world types, and have always been treated well. It may be that because of my professional background, they seem me more of as their equal... but in all honesty? If I think someone is being a jerk I switch. I know that isn’t an option for some but for many of us with decent enough in-nework coverage, that is an option.

    Even the neurosurgeon who I thought was a huge jerk turned out to be having a bad day on my first visit, the following visits made me see the human side of him. (I always give any doctor two chances before I fire them)

    For those of you thinking doctors are rolling in gold at home, read up on reimbursement rates. Especially in primary care, it’s dismal. I will not blame my primary if he decides to close shop and only accept cash paying patients. Remember, your copay and insurance payment has to cover his salary as well as salary of all the staff plus overhead. Given that, reimbursement rate is over the top for certain stuff and I wish they were distributed more fairly.

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  3. Laura St9:09 PM

    Nearing the end of residency, I find my *patient* generalizations quite interesting. Patients never (ever) hear the risks, only the benefits. Patients always go home and do the exact opposite of what we tell them. The patients with the smallest problems are always the loudest complainers. And so on, and so forth.

    I figure in this business, our clientele are sick, tired, frustrated, angry and nauseous. I can count on one hand how many patients I've had who have thanked me even when I have to make them uncomfortable. But I don't count that necessarily as a bad thing. It just means that everyone I treat is human. And if they take out their sick, tired, frustrated, angry and nauseous out on me, I figure it is part of the job. Just knowing that is sometimes enough.

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  4. Since it's for a Psychology site, do you plan on writing about psychiatric training med school? What it's like for medical students to see "the other side" of psychiatry? I think that could be really interesting, *especially* from the background of a non-psychiatrist.

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  5. Anonymous9:19 PM

    Hi Michelle, so glad you are writing a column for Psychology Today! I am the anonymous doc that wrote a comment about being a PCP and NOT rolling in dough and wondering about what happened to good manners in general. Thank you so much for shining a light on these issues!!! I hope your easygoing and conversational writing is able to change the opinions of those people that think doctors are evil money-grubbers.

    Some topics I would be interested in reading about: what happens to perfectly nice, sane people when they get sick; how to be a good patient (like, not asking for a rx for that "that cream that comes in a blue or white tube"); what doctors do that drive patients bananas (e.g., not making eye contact, spending five minutes or less with pt) ; doctors as patients (maybe you could write about your experiences as a woman in labor or the time you had the ruptured appy?); humor in medicine e.g., perhaps collecting anecdotes about embarassing or hilarious stories about medical training and beyond. Like the time that I was the standardized patient for an ENT session and after about 10 of my classmates and my clinical attending examined me, I went to the bathroom and discovered I had a huge booger hanging out of my nose. Or the presentation to the ER attending about a patient that came in to get tested for STDs because his ejaculate was brown after having sex with an air woman/alien. My face was red, attending's face was red...

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  6. I actually found you through the PT article, which a friend shared on Facebook. I'm a family doctor, one year out of residency. Your article really resonated with me as I'm currently on mat leave, (im)patiently waiting for baby #2 to arrive. #1 was born during residency, which in Canada means you can take a blissful year off and even get paid (a bit) to do it. Now I'm self-employed and mat leave isn't such a sweet financial prospect. Finances aside, though, what blew me away about mat leave this time around was the abuse that I got about it from patients. Many were pleased for me and wished me well, but a shocking number made nasty comments about "another pregnant doctor" and how it would be "nice if someone stuck around" instead of taking a whole year off over and over." (For the record, I am taking 16 weeks.) To be fair, I've spent the last 7 months covering a mat leave as a locum, so these patients have already "lost" their doctor once to mat leave, but for goodness sake, we ARE entitled to spend a little time recovering from birth and caring for our newborns.

    As for other topics...I wonder about something about the issue of clinical uncertainty and trying to become comfortable with that. I think a lot of people expect their doctors to know THE answer and don't realize that (very, very) often, there is not one right answer. I know that since starting practice, every patient I've lost sleep over is one for whom the "right" answer wasn't clear. I wonder if ordinary citizens understand how much uncertainty we face every day and how draining that can be.

    Doctor as patient is another fascinating one. I'm a terrible OB patient and I know it, although I try not to be. When I was in labour with my first, I kept saying, "I lie all the time and tell labouring patients that they're doing well when they're not and I KNOW YOU'RE LYING TO ME!!" (They weren't. Thank goodness my doc was both a friend and a colleague and has a sense of humour.) Also, I developed inflammatory arthritis during the MSK unit of med school and wouldn't go to a doctor because I was convinced it was just hypochondria from reading about RA and the like. I didn't want to look like an idiot. It went on like that until it got to the point that my boyfriend (now husband) was having to dress me and open doorknobs for me because my hands were so swollen and painful. Denial much?

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  7. Anonymous10:32 PM

    Totally agree with your overall work/life balance perspective. But I must (so sorry) point out a grammatical error that I found twice in your piece and might be worth correcting. I would suggest correcting it and then deleting my comment, but please do what you want. I am a big fan of your work; sorry to jump in as the grammar police.

    "Today's generation of physicians are (SHOULD BE IS -- the subject is generation, which is singular) choosing to limit their work-hours, altering the scope of their practice, and deciding to concentrate of medical specialties based on lifestyle choices as much as interest in the medicine itself. In essence, the current crop of young doctors are (SHOULD BE IS -- the subject is crop, which is singular) recalibrating. . ."

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  8. PS just ordered your book! Wee!

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  9. Anonymous11:32 PM

    Hi, just wanted to say I appreciate you starting the dialogue. I have to say, I agree with both sides - I have met doctors who are quite possibly some of the most arrogant people on earth, and others who are genuinely helpful and pleasant to talk to.

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  10. I wish my heart was made of cash registers...it would really help knock off some of those student loans =/

    I hate generalized antipathy the most. It comes across as a purely petty grudge that probably stemmed from a bad experience years ago that they were too cowardly to address. Those kinds of people are always passing judgement and trying to make examples of an individual who only expressed a harmless wish or sentiment. It's irrational, unnecessary and utterly counterproductive. The rant on bullying was totally unwarranted, unrelated to the topic and utterly misguided. While bullying can and does occur in hospitals, there's plenty of bullying going around in all professions as well. Bullying isn't one-sided either. As one commenter pointed out: there are plenty of cases where RNs bully doctors, or younger RNs, or med students.

    I wish people were more rational and less hateful.

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  11. Anonymous12:40 AM

    I agree with the potential topics raised so far: many angles you can take with doctor as patient, nurses bullying young doctor trainees, patients able to trash you anonymously on the internet, why some specialties are just mean, health care system: the unsustainability of the canadian vs. the many short comings of the american.

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  12. Anonymous12:49 AM

    I finished reading your book last month, and am sure it's not going to be the last time I'll read it. It'll be a book I'll prob read at every new stage of my medical training. Btw, have you ever thought about going on the Today show or something similar to promote your book and maybe talk about this topic about work-life balance? (There are other good morning shows too, but I just happen to be a big fan of the Today show)

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  13. Anonymous1:51 AM

    This is totally unprofessional but if I ever meet any of those meanies on the PT comments section the shoes and earrings and stethoscope are coming off!!!

    Agree with prev Anonymous: Hoda and Kathie Lee and drinks at 10 am. Wheee!

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  14. jane doe3:43 AM

    Your "It Gets Better" blog entry spoke volumes to me. Depression and burn out amongst trainee doctors is an issue that goes unacknowledged all too often - I'd love to see you get it out into the public arena a bit more.

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  15. Miss-G-3:55 AM

    I'm an intern whose home off sick today because I injured myself sprinting up the stairs at work and woke up the next day unable to move. The It Gets Better post has held me through many nights and I've just bought your book. Here I am in this profession that apparently is a privilege to work in and there's this expectation that I should do NOTHING for myself because everything I live and breathe should be for my patients.

    Doesn't *anyone* understand that if *I'm* good, then patients will be a million times better because they'll get far better care from a happy doctor than someone who is burned out and overworked and just barely keeping it together?

    I'm so sick of being told about this 'privilege'. It feels like it's just a lie perpetuated to squeeze every last piece of labour out of me.

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  16. Bullying. Not pimping med students, but the kind of bullying that goes down the food chain and has a detrimental effect, not only on the medical and nursing staff, but also on the patient. In fact, bullying patients is also a good topic. Not seen so much in gas passers, I admit.

    The Us vs Them mentality - how we get it, what we do with it, how it affects us as persons and the care we give our patients.

    And given that it is PT, how about a piece on our own inner processes when confronted with cultural issues that have a negative impact on care.

    Oh, I could go on and on...

    (Read your book in two evenings, and enjoyed it. I'm trying to get a decent picture of it in front of an arrow slit in the ancient wall surrounding Old Jerusalem, but I'm having trouble with the angle and lighting.)

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  17. Anonymous8:41 AM

    Hi Michelle I am reading your book, did you have to make up time for Cal's maternity leave?

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  18. @Anonymous above: Yup, paid back my maternity leave with vacation time. I think that's pretty standard.

    Great topics all, and thanks to everyone for emailing and Twittering and sharing the link to the Psychology Today piece on Facebook, etc. Excited to write my second post!

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  19. Anonymous6:21 PM

    I know my patients get crappy care when I'm exhausted, starving, and haven't had time to use the bathroom for the past 8 hours. It's really hard to focus on taking care of other peoples' medical problems when your own basic needs are not met. I'm still in residency, but I see how hard the attendings still work. I know things have improved somewhat in terms of work hours and expectations surrounding work hours, but medicine still seems like a losing game most days.

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  20. Anonymous8:56 PM

    My husband just finished residency and I'm interested in hearing more about how to keep romantic relationships going if one or both of you are doctors. We have such a hard time since he is always so tired (even as an attending) and it seems hard for him to be emotionally available...

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  21. i, too, was surprised at the reception of your article. i did not realize there was so much negative feelings towards physicians, that, unfortunately, are driven by misconceptions and generalizations.

    if you find the time and inclination, a post on gender differences in the medical profession is something i would like to read. why are women doctors still underpaid compared to their male counterparts? and considering that we are the more emotional beings, why is the suicide rate higher among us? why can't there be paid maternity leave? :)

    i am a mom and a doctor ... there are so many of us trying to balance these two equally challenging and wonderful roles. thank you for being our voice.

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  22. I just stumbled on your blog for the first time today. Somehow I thought I was the only woman who's a mom and a doctor (ok, soon to be doctor). The one trend I've noticed amongst many moms, as well as my family and friends, is that for some reason people just don't trust their doctor. They always think that the doctor is wrong about things, particularly when their doctor tells them they or their children are ok and don't need all these tests or medications.
    I'm all for being an educated, "empowered" patient, but when you're trusting Webmd over your own phsycian, there's a problem. It's almost as if people are looking for the worst and never satisfied when we say "You're OK!". Just my two cents...

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  23. Anonymous9:03 AM

    what's the matter with people who drive a lexus? are you not supposed to, even if you can afford it? does it imply you don't care about people? are people who drive corolla's inherently better than lexus drivers?

    i can see the disconnect if you are complaining about your income and driving a luxury car, but complaining about someone else's income and commenting about the cars they drive is a neverending exercise in frustration and poor manners.

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  24. Anonymous1:53 PM

    In your book, you wrote how your mom only had 3 weeks of leave and you had 6 weeks with Cal. Perhaps, something about the changes in maternity leave policies.

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  25. I'm not sure about the 'work-life balance applicable to all other professionals' everyone seems to be having a hard time with this. I just get bitter at my doctors because I know they are making much more than I am but seem not too far off from the work-life balance I have

    also the idea that "We want our doctors to be perfect. We want them to know all the answers, to never say the wrong thing, and above all, to always, always, be there for us. We want our doctors to be superhuman. " is something I see doctors getting upset about a lot. It seems more about your own perceptions than ours. I don't expect anyone to be perfect.

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  26. Ooh, I love Psychology Today! I recently started getting the back issues from the library and have been reading them nonstop.

    OK, now that I have shared that, I will go read your column.

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  27. To Moplans: You might not but other people do. I remember how surprised I was one day when I looked up a dose on a medication I was prescribing to someone because it's not one I prescribe often. The person muttered something about "you'd think you'd just know it by now" and seemed a little upset they were seeing a doc who couldn't remember. Yes, I remember the dosages of probably the top 200 drugs I prescribe. But is it not enough that I know what ails you and the appropriate therapy? Especially given that dosing can be different in different scenarios?

    Some people really do think that doctor's should know everything about everything, but the most important trait for a doc to have is actually to know what you need to look up!

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  28. Anonymous12:11 AM

    I'm the "A Canadian Family Doc" commenter on the Psychology Today article. If you're still looking for topic suggestions, I'd suggest more pieces to educate the non-medical readers about our stressors, and at the same time to educate the medical readers about how to cope with the stressors.

    I don't blame people who are bitter about doctors with their 6-figure incomes, if they perceive that doctors work the same hours that they do. My own colleagues who are in specialty residencies wonder what I do with all my free time now... and are surprised to learn that after my clinical hours, I spend hours every night doing paperwork. Hopefully with more information, people's perceptions will change and there will be less resentment.

    - Another (Canadian) Michelle

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  29. What about a "Day in the Life" piece? Obviously you'd have to change patient characteristics, but it could make for an interesting and fun read, especially for those who have little background in anesthesiology and/or the doctoring lifestyle.

    Plus, focusing on aspects like finding time for your family, navigating difficult personalities, bureaucracy, etc. would resonate with anyone who has ever held a job, medical or not.

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  30. doctor mom10:32 AM

    Hi Michelle, perhaps you can talk about being on the other side of the interaction...a doctor being hospitalized for illness. Your insight and feeling as a patient, judging the medical establishment from the other side.

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  31. BossMD11:24 PM

    Dr. Au - I love your blog and I love this piece. Wonderfully balanced.

    I think the way Drs are portrayed in the media is a total caricature. Its as unrelated to my experience as Gray's anatomy and Scrubs. I don't understand where Nurse Brown from the NYTimes works. Her tales from the ward seem to me to represent nursing/medical team work from the days of the 100 hour work week (by which I mean its from an era known as Ancient History where cell phones and computers didn't exist).

    ONCE in a great while I have a patient who is a pain in the ass and has the "I hate doctors and don't trust you by definition" attitude. But this is rare. And I'm a resident in San Francisco! My experience (both as a resident and in the land of alternative medicine) should represent a gross OVERSTATEMENT of doctor/patient clash.

    Anyhow, its nice to hear a voice of reason. Thank you.

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  32. Anonymous8:35 PM

    http://www.montrealgazette.com/news/Arbitrator+quashes+medical+residents+hour+shifts/4909714/story.html

    Heard about this on CBC and immediately thought of you.

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