Danielle Ofri, MD, physician, writer and editor, often turns her pen along with her focus to the emotional complexities that accompany a career in medicine. Her book, What Doctors Feel: How Emotions Affect the Practice of Medicine, is an honest sharing of what many healthcare professionals are often processing behind a mask of false bravado and confidence. The book, a must read for every medical education program in the country, can prepare and provide a realistic perspective of the road medical students can travel, to know they are not alone when doubt or disillusionment creeps in. It also can serve as an instruction manual of sorts for patients to better understand the person who provides the care. In just the Introduction, she writes:
There has been a steady stream of research into how doctors think…In…How Doctors Think, Jerome Groopman explored various styles and strategies that doctors use to guide diagnosis and treatment, pointing out the flaws and strengths along the way. He studied cognitive processes that doctors use and observed that emotions can strongly influence these thought patterns, sometimes in ways that gravely damage our patients. “Most [medical] errors are mistakes in thinking,” Groopman writes. “And part of what causes these cognitive errors is our inner feelings, feelings we do not readily admit to and often don’t even recognize…
…The emotional layers in medicine…are far more nuanced and pervasive than we may like to believe…they can often be the dominant players in medical decision-making, handily overshadowing evidenced-based medicine, clinical algorithms, quality-control measures, even medical experience. And this can occur without anyone’s conscious awareness…
…This book is intended to shed light on the vast emotional vocabulary of medicine…how it affects the practice of medicine at all levels.
It was the recent reporting of two young physicians taking their own lives at a time they should be celebrating academic and professional milestones that prompted this post. While we are not privy to what contributed to these terrible losses, the frequency with which similar lives are lost among the healthcare ranks speaks to what can often be a Grand Canyon-sized gap in the expectations and the reality of a career in medicine–as well as what is often left untreated or acknowledged within the profession: mental health and wellness of the healthcare professional. As Ofri writes in a recent article for Slate Magazine, The Tyranny of Perfection:
…it is clear that a career in medicine also brings on tidal waves of pain, confusion, stress, self-doubt, and fear. The eddies nip at our ankles from our first step into anatomy lab, gathering in force and ferocity over the years of training and practice. During medical school, at least half of students experience burnout, and some 10 percent contemplate suicide.
So much of medicine is a tyranny of perfection. Medical students are asked to absorb an immense body of knowledge…Yet, we act as though this perfection of knowledge is a realistic possibility. No wonder nearly every student feels like an imposter during his or her training….We’ve been asked for a perfection that is unachievable, yet the system acts as though the expectation is eminently reasonable. It’s no surprise that disillusionment is a prominent feature in the medical landscape today. It’s also no surprise that such burnout is associated with unprofessional behavior and more frequent errors.
Each year (since 2010) we gather medical, nursing and health science students, and resident physicians together for the Telluride Patient Safety Summer Camps in Telluride, CO (now Napa, CA and the Washington DC area as well) for week-long educational sessions, discussing patient safety related topics such as the need for open, honest communication in medicine, the need to honor the patient’s voice, and in the past, the bullying that goes on in the healthcare culture. The hope is that we can empower young change agents that will put a more realistic, positive spin to a culture that seeks to heal versus harm one another, or patients, yet continues to fail on both accounts far too often. The students and residents that take time out of their ever-increasing busy schedules to spend a week of vacation focused on making care safer are some of the most interesting, well-intended and accomplished young people. They have big hearts and the energy to climb the healthcare administrative and cultural mountains required when choosing to open their eyes to the mess that is healthcare culture. What steps can be taken by those leading today, to clear a safer, more well-rounded path, for their training and well-being? The thought of any one of our Telluride alum experiencing what Ofri and others describe is untenable–as is the thought that there are people posing as healthcare leaders that would allow this to continue.
Today is the day to commit to do things differently. To act upon what your gut is telling you. Today is the day to protect those you lead as they learn!