Culture Medium

 

No, my first blog post is not going to be a discussion of sheep’s blood agar, even if I am an Infectious Disease doctor. The title is a reference to my theme for the years when I was Medical Staff President. My theme was cultural change. In picking a theme, I followed in the tradition of my predecessors who had chosen themes of patient safety and improved inter-provider communication. Physician culture is an unwritten contract between physicians and their hospital system that governs physician behavior. Cultural change means examining where we are now in contrast to where we need to be. My future blog posts will deal with the specifics of change through improving end-of-life communication, through narrative medicine and reflective writing, through improving resilience and self-care by incorporating the humanities into ongoing medical education. But the first thing for me to address in this inaugural blog is, “How did I get here?”

I once took a writing workshop in creative nonfiction. The first exercise was to describe how I got there. Ten minutes. Go! I scribbled furiously for ten minutes. Several exercises and a long weekend later, I had my first publishable piece of creative nonfiction. So, when I was asked to contribute a presidential welcome to the Medical Staff newsletter, that phrase popped into my head: “How the heck did I get here?”

I could tediously describe the five years I spent on the Medical Executive committee leading up to being president, but those years  don’t explain why I stepped onto this path in the first place. Why would anyone willingly subject herself to myriads of meetings and having to evaluate and sometimes reprimand the colleagues she likes and respects? And why, worst of all, would a shy person step into the public eye?

Well, for me, it’s about finding meaning in adversity. It’s only natural for us, as physicians, to use our personal history to relate to our colleagues. Even as a private person, I have no problem sharing the details of my recent treatments for breast cancer with someone else who has just been diagnosed. Eight years ago, my “diagnosis” was fatigue, overwork, and a complete joylessness in my work. I had no time for vacation, rest, and renewal. When I finally got to the end of my patient list, I couldn’t let go of the tension in my shoulders. I was close to being a burned-out and non-caring physician.

But with time, I found my own healing antidotes, including mindfulness and poetry and singing. Your antidotes are unique to you, but I’m sure they involve some kind of self-care. So that’s my vision, that as we move away from stressful but lucrative fee-for-service piece work, that the upside of the painful transition in how healthcare gets funded will be a rediscovery of how much we enjoy talking to our patients. What we give up in autonomy will be made up for by less loneliness and isolation as we share the responsibility for our patients’ health. How did I get here? I got here because I want you to have more good days than bad. I want you to remember the joy and mystery that made you want to go into medicine in the first place. I look forward to unfolding my story as the months progress.

[This essay appeared, in slightly different form, in the “AtlantiCare Medical Staff Update”, Summer 2011.]

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