Who will care for us?

Physicians are sensitive, intelligent, dedicated servants of humanity who bear witness to immense human suffering and do their best to mitigate this suffering. They sacrifice a decade of their lives to study the skill and science that allows them to serve, often incurring student debt larger than the mortgage for a family home.  They are tough, resilient, and value driven, with a strong work ethic and self-reliance.  Also, they are humans: children, and grandchildren, siblings, parents, spouses. They get sick.  They make mistakes and grow weary.  Sometimes, their frustrations and the stresses of their work get the better of them. Occasionally, these tough, caring, intelligent people stick up for others in a way that puts them at risk as well.

When a physician’s performance suffers, the first skill set to deteriorate is often interpersonal communication.  Patient or staff complaints about communication can lead to destructive labels for the physician. Difficult. Not a team player. Not a good “culture fit’. Sometimes, physicians are asked to leave their jobs, their hospitals, and communities when their performance in communication suffers, without anyone ever asking, “Why?” or “What can we do to help?”  Physicians can make good decisions about diagnosis and treatment, and have great compassion for their patients, all while undergoing extreme mental or physical pain themselves. Sometimes the nuances of communication suffer, like a terse reply to your friend’s inquiry when you have a bad headache.  Other times, the strain of witnessing avoidable suffering repeatedly can lead to the physician judging the patient as a way of distancing themselves.  The cognitive dissonance of sacrificing your sleep, your family time, and the ability to have a full stomach and empty bladder to serve people that you are judging is destructive to both happiness and skillful practice.

Instead of prescribing simplified formulas for communication to physicians struggling with communication tasks, a deeper inspection into the situation is warranted.  A friend, a peer, or a manager (I’m looking at you, good medical directors!) can be a critical life line to a physician who is struggling.  Ask.  Listen to what is going on from the physician’s perspective. The physician may be dealing with a personal or professional struggle that puts their behavior in context.  Try to buy some time, so that the physician has a chance to address the concerns while also looking after themselves.  Observe what is happening.  Is the physician being interpreted properly?  Are they being difficult by advocating for needed change?  Are they consistently challenged by a specific type of patient? Do they need to work on a specific communication skill?  Finally, coach. Talk it through.  Offer help and know the help that’s to be had.  Be a friend.

Physicians are sensitive, which can make them uniquely vulnerable to witnessing repeated suffering. They are intelligent, which allows them to function under great strain, often not showing any decline in performance except in extremis. Physicians are self-reliant, which can make them unwilling to seek help. Not all physicians are angels, but many of the ones I’ve worked with over the years as a peer coach count among the best people I know.  When a capable person is working hard to do a difficult thing under duress, in a challenging setting, and struggles, they deserve protection and assistance. We all deserve the chance to be our best selves.  We owe it to our patients.  We owe it to each other.  We owe it to ourselves.

Watch the full FIX18 talk below!