Food for Doctor Soul

2023 February 4

When pay raises, “self-care,” and coaching leave us unfulfilled.

Don't get me wrong, these can be remarkably helpful. A pay raise signals that we're valued and increases security. Yoga and mindfulness practices provide relief and improve our emotional regulation, and vacations and time off help us decompress and rediscover parts of ourselves that don't get an airing in our work. In coaching, a smart person accompanies us and provides perspective when a reassessment is in order. The problems show up when we hear ourselves saying things like, "No amount of money is worth this," or "We can't meditate our way out of the EMR" and hearing bitterness about so-called physician wellness measures. Perhaps we run up against their limitations when we realize that a coach might be eager to help us find a better work/life balance and better fit, so we adapt more comfortably to what is. The problem is that we know something is wrong outside of us in the objective world. It's not just an attitude problem, and it's not just our institution, town, state, or specialty. We're left with an irritating itch that just hasn't been scratched and told, “The only thing you can change is yourself." Is that even true?

 Unwilling to settle for the idea that there is nothing fuller, richer, or truer and nourishing than this, I started chasing down this and other difficult questions. After completing 700 hours of yoga teacher training and Urban Zen Integrative Therapy training under the guidance of skillful yoga leaders and even opening a wellness center myself, I had more substantive thoughts about wellness practices. It seemed to me that one reason these things fall short in medicine is because of how we use them.  They are often deployed as palliative measures or as bandages when what's really required is to go deeper. As awful as it feels at the outset, these are signs (in my surgeon's mind) that we need to see what's under the scab; we need to probe the wound to find what's festering and why to get true relief.

At this point, the eyes of the exhausted doctor roll back into his or her head. He says, exasperated, "All I do is think about medicine. How is more going to help?" She says, like the acerbic voice of reason, "I don't have time for this. Nothing's going to change anyway. The system is broken, and we just have to walk the line until we can afford to retire. If you'll excuse me, I have a patient to see." Although it's probably not what he consciously meant, the first doctor's prophesy is correct: more of the same won't help. More of the same kindof thinking will lead to more of the same result.  The second doctor's right, too, that nothing will change if we think our only option is to persevere in a broken system, just staying afloat until we cross the finish line. In that scenario, we find ourselves in the extremely uncomfortable position of both being part of what's broken and perpetuating it. The healthcare system may be the lock, but we're the key that makes it work.

 It's my observation that we doctors have a hazy idea that behind the intellectual, technical, and emotional activities of practice, there's an operating system that got installed in us somewhere along the line that makes the doctor channel run. Our faith in the fidelity of this OS is so strong that when we blow a fuse or run out of energy or get an error message, we see it as our failure, never questioning whether or how the OS works because the OS is invisible and perfect. It continuously self-improves, and it is maintenance-free. It never occurs to us that we might need to fiddle with it or insert some unique code to get everything to hum. We don't know how to take the cover off, nor could we pinpoint when or describe how the OS was installed; we just assumed it happened and that it helps us. It's more mysterious than how that quarter appears under our pillow in exchange for the lost tooth.

 There's an architecture to the practice of medicine, and it's worth knowing something about it. It can be a bit tricky to sort out because some of that architecture is internal and some is external, but that interior bit is partly designed and influenced by the outside bit. In an open system, the opposite would also be true. And being complex beings in a complex world, there's another tangle: our private signature, like our genetic code, interacts in all this as well. There are also some wonky archaic parts or what might be space junk that we don't quite know how to account for—are they trouble or help? They're a bit elusive and yet they crop up at interesting times and make demands on us, particularly in the form of moral requirements or kind of irrational desires. All contribute to the OS.

 Maybe it helps to think of bees making a honeycomb. How can we engage this mental picture in ways that are meaningful, ways that help us feel better and be the doctor we imagined we would be? Not only is there no handbook, but there is also no standardized formula. Each doctor, it turns out, must discover and refine her or his own. This bit of aggravating yet somehow essential chaos is what set me on the path to sorting things out and decoding things like the doctor channel and our mysterious doctor OS. More than once, this has felt every bit as challenging as driving a dog sled through a blizzard in subzero temperatures yelling, "Mush, you huskies" to my mental capacities. If we could be more familiar with this architecture (a matrix?), perhaps each of us could then begin to fiddle with the OS, tweak the dials, and conduct some personal experiments to see what helps, both generally and specifically. We could, for example, practice meditation as a generally fortifying tonic, but we could also be more precise. We could explore different types of meditation practices as different kinds of medicines. We could be our own first and most important patients and assess the efficacy of our own therapies to improve our personal and specific concerns.

 In the 18 months or so since my last email to you on the theme of help for doctors, I've continued my work on The Missing Curriculum, FIRST AID, and some other tools and ideas, dissecting and synthesizing, reading, talking, and exploring. If you're curious about this and want to know more or to engage in this dialogue, it's possible to watch videos here, sign up to receive the email newsletters here, or join the Metamorphosis Medicine free online community here. This community is for doctors who are intent on finding deeper satisfaction in doctoring and closing the gap between what we dreamt this work would be and what we find in day-to-day practice. There's more information about all this and other projects on the Metamorphosis Medicine website here. In 2021 I manually entered almost 4,000 physician or program director email addresses to every doctor I could reach, realizing that many would not identify themselves as wanting or needing this connection but perhaps might know other doctors who are searching for more connection and meaning and even peace on this difficult path. If it occurs to you that a colleague or student or physician at a transition point might like to drink from this watering hole. pass this along. We truly, profoundly need each other.ething more. Or maybe you have a creative project to share with the world. Whatever it is, the way you tell your story online can make all the difference.