It comes as no surprise to anyone that health care is broken. Too many interest groups, too much regulation, too many poorly aligned incentives, too many unrealistic expectations, and too many myopic solutions. Worse, the physician voice has been weakened and handicapped by a combination of our patient-first mission and by the distraction inherent in a profoundly complicated professional discipline. Think of it this way: If your primary mission was profit and the financial engineering necessary to generate that profit, and if you could collectively bargain and lobby in defense of that profit mission with billions of dollars at your disposal, would it not be a strategic advantage? The special interests that physicians compete with are largely all advantaged in this way, and that makes us sitting ducks in the battle over limited health-care dollars.
In addition, we work under constant scrutiny from outsiders largely ignorant of or unrealistic about our competencies and the complexities of the discipline. Litigators, hospital administrators, state medical boards, governmental regulators, and even our own patients are constant reminders that we have lost control of our profession.
How can we possibly uncover the joy of practice within this mountain of misery? I have a plan, and I’m willing to share it with you. Making my plan a habit takes some practice, and it does not come easily to those who are quick to draw battle lines. Complainers and whiners will struggle too. (You know you’re out there.) Paranoid, judgmental, angry, and delusional? Sorry, that won’t work here. My point is that we all demonstrate these traits from time to time. But it is our ability to recognize and redirect these urges that will help us succeed. Putting my plan into action will open you up to discovery and opportunities that will change your life. Here is how it works:
As with all good journeys, start with a mission and vision. Here are mine:
- Mission: To provide genuine, nonjudgmental care to every patient asking me for help
- Vision: To celebrate the service opportunity within every encounter while tuning out internal and external negativity meant to distract me from my mission, so that I can better care for my patients, myself, and my family in a sustainable and joyful way
Next, apply your mission and vision to everything you do. Every patient presents to us in need. How they demonstrate that need is one of the wonders of human nature. When facing pain and illness, humans are not at their best. They may be afraid, feel vulnerable, or just feel uncomfortable. Layer on their overwhelming negative experiences within health care, and you have a pretty combustible and raw emotional context. Immature coping skills further complicate our patients’ ability to act in ways we might consider conducive to successful care outcomes. As providers, we see anger, hysteria, and unfocused and disruptive behaviors that distract from our ability to care. Pile on all the anxieties, fears, and burdens that we bring to the encounter, and it is not hard to imagine why physicians burn out at worrisome rates. Yet within every encounter lies a service opportunity, should we choose to find it.
At the core of our profession, and central to the oath we all took, is finding a way to provide care for the presenting need. Sometimes the clues are clinical, sometimes they are psychosocial, but often they are hidden. Investigating and discovering the cause of a problem are what we do best, and maintaining our focus on these tasks sometimes requires a level of poise and maturity beyond our training. But if you can apply this plan to your practice in a disciplined and accountable fashion, you will rediscover the joy of practice. Though many of the rewards are emotional, you will be surprised how your clinical acumen improves. Together, these victories will reinvigorate the rationale for sacrifice and help sustain a joyful life and career.
Lee A. Resnick, MD, FAAFP
Editor-in-Chief, JUCM, The Journal of Urgent Care Medicine