THE SYSTEM VS. DOCs: DOES THIS PERSPECTIVE SERVE US?
When I listen to colleagues talking about the challenges we have to face as physicians, more often than not, the crux of the conversation turns into a litany of complaints about “The System”. They refer to “The System” as if it were a monster with its own consciousness, or a machine programmed by aliens running our world. In other words, they completely separate themselves from this entity called “The System”. Yet, what is “The System” but a group of people, an organization, that we are intricately connected to?
When we talk about “The System” we need to remember that we are, in part, referring to ourselves. We cannot continue to see ourselves as juxtaposed to “The System”. This does not serve us. In fact, it only hurts us. In doing this we proclaim that the power for change is outside of us. We alienate ourselves from the possibility of being the force for transformation. We relinquish our power to the nebulous “them,” expecting that they understand the intricacies of our daily challenges and our needs, waiting for them to take action.
I, by no means, disagree that the medical system is in crisis and that it is of the utmost importance for many changes to be implemented in order to improve the efficiency, equity, development, and delivery of healthcare. Not to mention, the quality of the patient AND physician experience. We must focus on improving the day-to-day sense of wellbeing by the healthcare providers, for they are the purveyors of the service of healthcare. If they are not well, it will be impossible for our healthcare system to be well.
It is incumbent on US to bring about these changes. And, in order to do so we need to have: 1. Clarity about our deepest values and purpose, 2. The ability to communicate effectively, and, 3. The courage to take action on our own behalf. None of this can occur without us first looking within.
A well known author and psychologist was recently quoted saying, “If the problem is the workplace, you can’t say, ‘let’s teach physicians mindfulness’ and expect it to fix the problem. I think mindfulness is a great skill to have, but it implies that you are the problem and you have to change.”
I absolutely disagree with this statement, and this is why:
1. Teaching mindfulness in and of itself isn’t going to change the work place, but which physician has a greater possibility of creating change? The one who is engaging with “the powers that be”, other colleagues, and patients in anger and frustration, or one who has deep understanding of what she needs to make her daily practice of medicine more rewarding and joyful, and can bring creativity and curiosity into making that happen?
2. Mindfulness absolutely DOES NOT imply that anyone has a problem. This attitude is one of the reasons why it has been so challenging to transform the culture of medicine. The practice of mindfulness is also NOT ATALL about fixing anyone. It is about sharpening our skills in the process of disengaging from fear-based reactions by learning to pause to allow space and time for measured responses-responses that represent the best of us, that uphold our deepest values, that respect who we are, and that open up opportunities for growth.
3. This is not an either, or situation. This is a YES, AND opportunity. Mindfulness is not exclusive of bringing change to “the system”. It does not in any way diminish this endeavor. On the contrary, it empowers this effort by giving us greater clarity of what is truly needed to create the change.
We cannot ever expect to change the world around us, unless we are willing to examine the world within us. In this world of immediate gratification, we are seeking the “magic pill”. Similarly to how our patients frequently desire a pill that will immediately relieve whatever ailment they have, and are often resistant to look at themselves for things that they can do better such as, improving their diet, exercising more, or managing stress; we want “the system” to offer up the solution, to provide “the cure”. We resist recognizing that how we are and how we engage plays into the inefficiencies of “the system”. We reject the process of looking into ourselves and considering how we can become more self-actualized in order to engage with the world in a more effective way.
I know that so many physicians are hurting deeply. I know that they are exhausted and overwhelmed. And, I understand that the idea that they need to do more is simply unbearable. But that is just it. Mental fitness and positive intelligence, mindfulness, are not about doing. They are about BEING.
To conclude, I want to make it clear that I am not saying that providing physicians with the opportunities and the tools to promote their being is the only thing that we need to do to achieve change in the medical system. What I am saying, however, is that “the system” is simply a group of people, and that the best way to create change within a group of people is by building connection and trust between all the members of the group. This can only be done through authentic, clear, and focused communication. And, the type of being we have to be in order to do this is supported and developed through the mindfulness achieved by the practice of mental fitness.
THAT was the equation. EXISTENCE!… SURVIVAL… must cancel out… programming!
……Ruk
The only person whom you can depend on to look out for your best interest is yourself. You are an adult and you are competent. Do not be a martyr nor a slave. If you cannot find some kind of fulfillment after working so hard for your degree/education, you may need some kind of professional counseling. Allowing yourself to be conscripted should not provide any happiness for you. By the way, I have seen some job openings for ship’s Phyicians on the major cruise lines.
Mmmmmmmm… Mindfulness…
Sounds sweet, light, cleansing.
But I’ll say to you what I said to Jim Jones that muggy day in Guyana: “Y’know, I’m just not thirsty right now.”
I don’t have a communication problem with my bosses, who want me to work faster, to the detriment of patient care. They’ve communicated that to me loud and clear.
They know damn well what they want. And they know damn well how unpleasant and exhausting it is to work with the minimal (and declining) resources which they provide me.
They want me to make them as much money as possible, and they’re happy to say or do whatever they think will be most effective to achieve that end, including lie to my face. And the fewer doctors, PAs, nurses, receptionists, and other staff members they have to pay in order to achieve their goals, the happier they are.
I don’t need to be “look within” myself to know that, any more than I need to be “look within” myself to know that I need to eat food every day and my wife’s horses need hay, the farrier, and vet visits.
I took Gross Anatomy. I’ve assisted in autopsies. I know what you find when you “look within,” and I know that it doesn’t smell very good.
As far as “self-actualizing,” I spent about a decade actualizing myself into actually becoming an actual doctor, so that I can have my actual boss, who can actually fire me, muse sarcastically about whether I actually could work faster if I wanted to, as she giggles to her RN sidekick. And that’s the sort of actual humiliation I have to deal with on a regular basis because I looked within myself and decided it was worth a big chunk of my life and a quarter of a million dollars to do something that helps people lead better lives.
I’ve spent enough time looking into my navel (even studied The Tao of Physics in High School) to know there’s nothing there but lint.
Thanks for the good vibes, though. They taste great between two pieces of dry bread.
“The System” will continue to thrive as long as business guys have a clear economic incentive to milk the various payors. Individual doctors will have no clout and groups of doctors are essentially forbidden from organizing under the Stark laws. This is why many MD’s are heading for the exits as quickly as possible, whether through DPC practices (probably the best option if one wants to keep practicing), retirement, or just putting in time like a prison sentence until the option to depart presents.