Richard F. Mitchell, MD,
For many clinicians, the path of medicine is a comfortable one—well-worn, made by many feet before your own. From college to residency and beyond, the courses to take, exams to pass, and applications to fill out have been laid out for us in a nice, orderly path. There is some room for brief excursions off the path, but the route to our prescribed life of clinic medicine, hospital medicine, specialty care like sports med, OB, or geriatrics, or some combination thereof is a well-marked trail with lighted signs to guide us all the way.
Until the day you decide to teach. I recall talking to our program director on the first day I had administrative time and asked, “What should I do?” His response: “I don’t care.”
Kathleen Rowland, MD, MS
Change is here, and more is coming. In medicine, we often perceive change, especially external change from hospital systems or payers, to be a threat. We feel a loss of control, which can lead to anger, resentment, and burnout.1 A survey of 3,000 US physicians done by a staffing company found that 58% of physicians who left medicine in 2013 reported doing so because they didn’t want to practice in an era of health care reform. This is more than stated they left because of economic factors such as malpractice insurance or reimbursement concerns (50%).2 The changes we face can feel overwhelming, and we have to take measures to make the changes less daunting.
Being resilient does not mean that we become pushovers. The goal of teaching resilience to change is to increase the sense that we are able to react to, triage, and adapt to changes while maintaining the core of who we are: physician teachers and healers. We can fight unwinnable battles or choose good ones. We can hold out on changing until the demand to do so is punitive, or we can adopt the change at a comfortable pace. We often do not choose the changes we face, but can choose the way we respond. As we restore that independence, we can reduce our risk of burnout and increase our satisfaction with practice.
Richard F. Mitchell, MD, MS
“Did you discuss prostate cancer screening with your patient?”
“I did, but…”
“Well, it was strange, but as I was discussing the risks and benefits, the patient just looked at me and said, ‘This is confusing, can’t you just tell me what I should do? What would you do if it was you?’”
Has something like this happened to you while you were precepting residents? Has it happened to you when you were talking to your own patients? In this age of patient-centered care, we teach our residents to involve patients in shared decision making. How do you counsel a resident working with a patient who doesn’t want to buy into that program? How do you teach your residents to respond to the question, “If it was you, what would you do?”
You might find the answer in an invisible bag.
“There is an invisible bag right in front of you. Think ‘Santa Claus sack.’ Would you like to reach in and take something out?”
“Why would I do that?”
“It’s full of $100,000 bills.”
“Yes! Can I take two?”
“No. But there’s something else you should know. The bag also has blank pieces of paper that feel exactly like $100,000 bills.”
“That’s OK—can I put my hand in now?”
“One last bit of information before you do—it’s also full of razor blades.”