Monday, June 23, 2008

Are you too critical?

If you're in medicine, have you noticed that there seem to be a lot of unhappy people around?

Maybe this is due to tunnel vision in the microniche that is a residency training program, but it seems like the faculty are also a relatively unhappy bunch. Well, maybe not *unhappy* per se, but pessimistic and cynical. (Note - this is in direct contrast to the visiting attendings who come around once a month and all seem to love their jobs/lives.)

Now, I think the real reason is much more complicated than this, and may include things like: poor reimbursement for trying to juggle a lot of different balls, disadvantages to working within a relatively inefficient system, bureaucratic/political issues, frustration with the perceived lack of work ethic in the current generation of trainees.

But humor me for a moment, while I digress on this hypothesis:

Maybe part of the reason why people involved in training programs are so unhappy is because of the way medical training is conducted in the United States.

What do I mean by this?

In medicine we are taught to see pathology. First year medical school is all about "normal," and then every year after that focuses on what goes wrong. We learn all about the pathological processes that can occur in the organ systems. Eventually we hit the wards and learn to fine tune our sense of what is normal and more importantly, what is not. We learn to eyeball a new patient and know that "things are not looking good." Each note we write reinforces this - the assessment and plan is a litany of different "problems" the patient has. We are trained to anticipate problems before they occur, to check labs for any signs of abnormalities or trends towards abnormality. With chief complaints, we are taught to think of the worst possible scenarios and rule them out. And make sure that bad possible scenarios numbered 2 through 14 are also ruled out. And all patients have multiple problems.

If one isn't careful to balance out this skewed view of life, it's easy to assume that all people are "full of problems." We forget that most live uneventful, healthy lives, and more importantly, we forget to look for the normal. That ability to hone in on the abnormal, while most useful in an acute patient care setting, becomes somewhat of a liability in our everyday lives. And while it may be easy for someone who works, AND has a life outside of work, suffice it to say that this is not the modus operandus of most residents (and most attendings, for that matter.) The end result? A group of high functioning individuals who have been well trained to look for what's "wrong" with the picture, who unfortunately become consumed with work and fail to see the forest for the trees.

Here's a completely different view of life:

A close friend works as a personal trainer. Her goal at work is to encourage clients to reach their maximum physical potential. This involves non-stop encouragement, which starts from "that's a great top you have on" to "you've improved so much since the last time we met." Her workday revolves around objectively evaluating a client's workout and using that for positive reinforcement. The day in, day out practicing of this positive mindframe spreads into her personal life.

I think we can learn a lot from how other professions think about things/carry themselves, and make sure that we only use the critical eye when it is needed. We owe it to ourselves to not drag ourselves (or the people around us!) down. Be on the lookout for normal today. Actively look for the positive. It's all around you - you just have to take it in.

Happy Monday!

photo credit


Blogger Pieces of Mind said...

This is so right on. So much of reality is based on our perceptions.

As a patient, I think it's OK if the doctor focuses more intently on potential problems, because this is one of the ways you can ensure you're being thorough. I would hope, though, that the doctor also takes the time to recognize the areas in which patients are doing well. I would like to think of myself as more than just a collection of problems ready to careen off the rails at any minute. ;)

P.S. I am glad to see you've found some time for blogging once again. You've been missed!

10:07 AM  
Blogger wandering visitor said...

Thanks for the comment, pieces of mind.

Have been intermittently busy lately, and have wanted to write some things down, but it's still a little too close to home (and too identifying) to write some of the stuff at this time. Maybe a few years down the road, if I still remember them.

I hope you've been well?

10:08 PM  
Blogger Moofie said...

WV, thank you for dropping in on me! I was delighted to see your "chat" in my shout box.

I can see that you still write deep and searching posts ... Hopefully I'll be able to find some time to do a bit of catching up ...

Be well!!!

6:18 PM  
Blogger naturewitch said...

Hey Wandering Visitor

Glad to have you visit my blog! Thought I'd check yours out.

Sounds to me that maybe you'd be happier studying naturopathy or homeopathy or herbalism or something similar. We are generally happy people (although we all have our demons (aka life lessons!)), but we try to study the whole person and work out how to help them be the best they can be (at least that's how I look st it).

Some good points regarding "conventional" medicine - I certainly enjoyed the read. xx

3:53 AM  

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