There are so many sentences that really hit home for me. I‘ve seen both sides and I wholeheartedly agree with all this!
I only made it through a few months of ‚doctoring’ - working the stroke unit and hustling the neuro ER, at least 5 24hour shifts per month, and then my body and mind shut down. My own GP didn‘t recognize the massive burnout and wouldn‘t offer help for accommodating my autoimmune illness, or even sign sick leave, so I had to quit :(
these days I‘ve become the dreaded ‚difficult annoying chronically ill female patient‘ we all learned to hate, and am constantly hitting barriers for proper treatment.
I‘m generally a happy and rather positive person, but thinking about the whole medical system transforms me into a bitter, cynical, resentful hag. Always ready to step on my soapbox to deliver rants like ‚the medical system is a meat grinder that chews up its workers,‘ and ‚women are being failed by doctors‘ and ‚why don‘t med students learn how to take care of THEMSELVES‘…
Thank you for this post! I hope one day we‘ll see more compassion and empathy and humanity in the medical field!
Thanks Martha. I think the idea that we should all be able to thrive in similar conditions defies logic and yet that is what we expect of each other in medical training and practice. And yeah, you won't get any sort of accommodations without substantial objective evidence and often even then they are not given or people are pushed out.
Regarding the chronically ill female patient, it's interesting that the default is sort of a stance of disbelief and annoyance rather than curiosity and compassion. It might not change the treatments we have to offer, but it changes the relationship a great deal. If you haven't read it, you may appreciate my open letter to the chronic pain patient in the ER. It's from a few months back. I'll post it in the next comment below in case you're interested.
I think the return of compassion to medicine come from the return of self-compassion. Within our culture we've come to think of self-compassion as antithetical to self-improvement and that self-compassion is self-centered rather than that you can't love others more than you love yourself. (If you're that me that was a real gut punch of a realization).
Totally, I feel like society as a whole tends to see self-compassion as weak. We‘re supposed to hustle and suffer and be hard on ourselves to improve..my life changed for the better when I stopped doing that and began to really give my body time to replenish, but I had to hit rock bottom to understand, and it‘s still hard to practise such self acceptance..
And I liked your letter to the chronic pain patient. Maybe some doctors really are immature and hurt their ego when they can‘t ‚fix‘ a patient, so they lash out and put the blame on the patient? It would explain a lot! Why is it not acceptable to say ‚I don‘t know, but I will educate myself on this‘ or ‚this is not my area of expertise, so let me refer you to this other specialist‘?
There is definitely a subset of the patient population who has been raised in the age of the paternalistic doctor who expect a doctor to act all seeing and all knowing even when they are not. I think some doctors have assumed this is the expectation of many more people than it is in reality. There is also a lot of emotional immaturity as well. I think the challenge for many people with chronic pain or chronic illness is that within the house of medicine we only refer to others in the house of medicine, and really none of us are experts on these conditions. My heart breaks for folks who have done literally everything their doctors have told them to do, they've seen dozens of specialists, undergone dozens of procedures, spent tens of thousands of dollars, all without any improvement. I don't know that other healers would do better, but they certainly wouldn't do worse, so I think a bit of humility and open-mindedness would serve us all well. I also wonder on the part of patient and provider how acceptance of what is without the need to "fix" would change the relationship to each other and the relationship to the "problem".
Thank you for this perspective! I will agree that out of all the physicians I’ve treated (I’m a sleep psychologist in my day job), only one has been well-hydrated, a nephrologist. I agree that many errors and mistakes are a part of the system that keeps our healers exhausted, hungry, thirsty, and having to pee and therefore not at their focused best. It seems like more compassion, both for self and others, could be super helpful.
Thanks Cecilia, I think sometimes we receive the message that self-compassion is self-centered or self-satisfied rather than a necessary prerequisite for compassion toward others.
1. Has your doctor’s emotional blindspots or disconnection from their body impacted your medical care?
Yes, on several occasions. I've changed doctors over it. I do my best to go into appointments well prepared, questionnaires filled out, questions ready, and gratitude on hand. But I'm an educated, articulate, polite, healthy, older white male. I shudder to think how people fare who are none of the above.
2. How have you reclaimed a connection to your body or emotions in your life?
Yes, but it's been a couple of decades work. See "older white male"
3. Do you know anyone who strikes this balance between their body’s needs and the work they need to do well?
Very few, but one doctor friend is among them. He's an abdominal surgeon at a university hospital who does more research than patient work. He rides his bike with us most Sundays. My two ER doc friends, not so much.
Thanks John! I think it's tough because when you have unaddressed emotional stuff, really minor things can bring disproportionate reactions. My dad is an engineer so when he had a heart attack he had questions and the cardiologist got all defensive. I know for myself that I am enraged when I get done with a big resuscitation and the next person who is there for a much less serious problem complains about the wait even though they don't know what I'm doing (although I think in the ER you'll be a happier person if you assume there is a good reason your aren't being seen, because there is)
And I think you're onto something about your friend who is in research rather than clinical medicine being better at balance.
A close friend, a retired doc who was an ER trauma surgeon for years before settling into orthopedics, and who helped me hike off a mountain with a broken ankle among other things, is due for some major abdominal surgery shortly after his approaching 80th birthday. He's having a really hard time. In a group he's chatty, but alone in the car with me he's silent. When he explained the surgery to a small group of us, it was as if he was talking about someone else.
He has no tools. Being an older white guy doesn't help, of course. We were all trained that way.
Oh yeah, there's a lot of layers there, right. Death, and illness by proxy, are failures in medicine. And we live in a very death-phobic society so that at 80 you may have avoided wrestling with that angel. I also think that as doctors we attribute illness to personal failings more often than is accurate because it gives us the illusion that we can control what happens to us and our bodies. If we exercise enough and drink enough green smoothies and don't smoke, then we won't get sick and die. I caught myself doing that a lot when I was pregnant, I would hear of something tragic happening in someone else's pregnancy, then look for the ways we were different to reassure myself it wouldn't happen to me (only in my head, but still not a great look). Lastly, we assume that we are a burden if we ask for help instead of understanding that these networks of mutual aid are what turn us into community. Now how to untangle all of that when you are 80 in the middle of a health crisis, that's even trickier...
In our men's hiking group, we've helped each other through everything from addiction to health crises to bereavement, and no one has done more for us than this guy. We're have a huge thank you party for his 80th. But he can't trade places and be open to help himself. It's the doctor in him.
Theres is so much good wisdom here, I am saving it to come back to and share with our wellness committee at our hospital. And on a personal note, just the other day I was writing a post about being told a medical condition was in my head and knew it was because I was a woman!
Christine. I hope it makes some waves in your committee :) My friend sent me this article this morning that I think is an interesting counterpoint to some of what I wrote and made me realize that I am not the only doctor feeling old with the next generation :)
And yes, I don't really know why doctors have such a hard time saying I am not sure what is causing this, but I think it will get better on its own. Here's what to do if it doesn't.
This is so honestly and beautifully written, Amy. I can't even begin to imagine how tough it is to tune into your body and emotions when you've been taught for so many years that there's simply not time for that...or worse, learn that doing so would just "get in the way."
I have certainly been known to be very adept at overpowering pretty much all of my innate desires and needs in the past, as you know, but feel like I'm sloooowly but surely making headway. Journaling, quiet time, not overscheduling, becoming better at saying "no," and trying to listen rather than hide the sensations of my body and my internal joy compass have been helpful so far. :)
Thanks Karla. A friend and I were recently trying to imagine what an embodied practice of emergency medicine would look like. We didn't have much luck.
I think most of us power through at leat to some extent, as that is valorized in the culture at large. It's definitely a difference of degree than that others aren't doing it.
Thank you, Mahesh. I appreciate your kind words! I hope my writing brings that world into the light a bit more, because I think that patients demanding doctors are treated better so that patients will be treated better may be more likely to generate change. There are definitely many doctors, and I would guess Atul Gawande is one of them who work hours that I and most others would not be able to in order to write, teach, and practice medicine. Only he can know if that balance is healthy and fulfilling for him.
@Artemis Rose Archer Thank you for sharing!
There are so many sentences that really hit home for me. I‘ve seen both sides and I wholeheartedly agree with all this!
I only made it through a few months of ‚doctoring’ - working the stroke unit and hustling the neuro ER, at least 5 24hour shifts per month, and then my body and mind shut down. My own GP didn‘t recognize the massive burnout and wouldn‘t offer help for accommodating my autoimmune illness, or even sign sick leave, so I had to quit :(
these days I‘ve become the dreaded ‚difficult annoying chronically ill female patient‘ we all learned to hate, and am constantly hitting barriers for proper treatment.
I‘m generally a happy and rather positive person, but thinking about the whole medical system transforms me into a bitter, cynical, resentful hag. Always ready to step on my soapbox to deliver rants like ‚the medical system is a meat grinder that chews up its workers,‘ and ‚women are being failed by doctors‘ and ‚why don‘t med students learn how to take care of THEMSELVES‘…
Thank you for this post! I hope one day we‘ll see more compassion and empathy and humanity in the medical field!
Thanks Martha. I think the idea that we should all be able to thrive in similar conditions defies logic and yet that is what we expect of each other in medical training and practice. And yeah, you won't get any sort of accommodations without substantial objective evidence and often even then they are not given or people are pushed out.
Regarding the chronically ill female patient, it's interesting that the default is sort of a stance of disbelief and annoyance rather than curiosity and compassion. It might not change the treatments we have to offer, but it changes the relationship a great deal. If you haven't read it, you may appreciate my open letter to the chronic pain patient in the ER. It's from a few months back. I'll post it in the next comment below in case you're interested.
I think the return of compassion to medicine come from the return of self-compassion. Within our culture we've come to think of self-compassion as antithetical to self-improvement and that self-compassion is self-centered rather than that you can't love others more than you love yourself. (If you're that me that was a real gut punch of a realization).
https://open.substack.com/pub/thenettlewitchmd/p/an-open-letter-to-the-patient-with?utm_source=share&utm_medium=android&r=3mq65
Totally, I feel like society as a whole tends to see self-compassion as weak. We‘re supposed to hustle and suffer and be hard on ourselves to improve..my life changed for the better when I stopped doing that and began to really give my body time to replenish, but I had to hit rock bottom to understand, and it‘s still hard to practise such self acceptance..
And I liked your letter to the chronic pain patient. Maybe some doctors really are immature and hurt their ego when they can‘t ‚fix‘ a patient, so they lash out and put the blame on the patient? It would explain a lot! Why is it not acceptable to say ‚I don‘t know, but I will educate myself on this‘ or ‚this is not my area of expertise, so let me refer you to this other specialist‘?
There is definitely a subset of the patient population who has been raised in the age of the paternalistic doctor who expect a doctor to act all seeing and all knowing even when they are not. I think some doctors have assumed this is the expectation of many more people than it is in reality. There is also a lot of emotional immaturity as well. I think the challenge for many people with chronic pain or chronic illness is that within the house of medicine we only refer to others in the house of medicine, and really none of us are experts on these conditions. My heart breaks for folks who have done literally everything their doctors have told them to do, they've seen dozens of specialists, undergone dozens of procedures, spent tens of thousands of dollars, all without any improvement. I don't know that other healers would do better, but they certainly wouldn't do worse, so I think a bit of humility and open-mindedness would serve us all well. I also wonder on the part of patient and provider how acceptance of what is without the need to "fix" would change the relationship to each other and the relationship to the "problem".
Thank you for this perspective! I will agree that out of all the physicians I’ve treated (I’m a sleep psychologist in my day job), only one has been well-hydrated, a nephrologist. I agree that many errors and mistakes are a part of the system that keeps our healers exhausted, hungry, thirsty, and having to pee and therefore not at their focused best. It seems like more compassion, both for self and others, could be super helpful.
Thanks Cecilia, I think sometimes we receive the message that self-compassion is self-centered or self-satisfied rather than a necessary prerequisite for compassion toward others.
I saved this to come back to, and I'm glad I did.
1. Has your doctor’s emotional blindspots or disconnection from their body impacted your medical care?
Yes, on several occasions. I've changed doctors over it. I do my best to go into appointments well prepared, questionnaires filled out, questions ready, and gratitude on hand. But I'm an educated, articulate, polite, healthy, older white male. I shudder to think how people fare who are none of the above.
2. How have you reclaimed a connection to your body or emotions in your life?
Yes, but it's been a couple of decades work. See "older white male"
3. Do you know anyone who strikes this balance between their body’s needs and the work they need to do well?
Very few, but one doctor friend is among them. He's an abdominal surgeon at a university hospital who does more research than patient work. He rides his bike with us most Sundays. My two ER doc friends, not so much.
Thanks John! I think it's tough because when you have unaddressed emotional stuff, really minor things can bring disproportionate reactions. My dad is an engineer so when he had a heart attack he had questions and the cardiologist got all defensive. I know for myself that I am enraged when I get done with a big resuscitation and the next person who is there for a much less serious problem complains about the wait even though they don't know what I'm doing (although I think in the ER you'll be a happier person if you assume there is a good reason your aren't being seen, because there is)
And I think you're onto something about your friend who is in research rather than clinical medicine being better at balance.
A close friend, a retired doc who was an ER trauma surgeon for years before settling into orthopedics, and who helped me hike off a mountain with a broken ankle among other things, is due for some major abdominal surgery shortly after his approaching 80th birthday. He's having a really hard time. In a group he's chatty, but alone in the car with me he's silent. When he explained the surgery to a small group of us, it was as if he was talking about someone else.
He has no tools. Being an older white guy doesn't help, of course. We were all trained that way.
Oh yeah, there's a lot of layers there, right. Death, and illness by proxy, are failures in medicine. And we live in a very death-phobic society so that at 80 you may have avoided wrestling with that angel. I also think that as doctors we attribute illness to personal failings more often than is accurate because it gives us the illusion that we can control what happens to us and our bodies. If we exercise enough and drink enough green smoothies and don't smoke, then we won't get sick and die. I caught myself doing that a lot when I was pregnant, I would hear of something tragic happening in someone else's pregnancy, then look for the ways we were different to reassure myself it wouldn't happen to me (only in my head, but still not a great look). Lastly, we assume that we are a burden if we ask for help instead of understanding that these networks of mutual aid are what turn us into community. Now how to untangle all of that when you are 80 in the middle of a health crisis, that's even trickier...
In our men's hiking group, we've helped each other through everything from addiction to health crises to bereavement, and no one has done more for us than this guy. We're have a huge thank you party for his 80th. But he can't trade places and be open to help himself. It's the doctor in him.
Theres is so much good wisdom here, I am saving it to come back to and share with our wellness committee at our hospital. And on a personal note, just the other day I was writing a post about being told a medical condition was in my head and knew it was because I was a woman!
Christine. I hope it makes some waves in your committee :) My friend sent me this article this morning that I think is an interesting counterpoint to some of what I wrote and made me realize that I am not the only doctor feeling old with the next generation :)
https://www.nejm.org/doi/full/10.1056/NEJMms2308228
And yes, I don't really know why doctors have such a hard time saying I am not sure what is causing this, but I think it will get better on its own. Here's what to do if it doesn't.
Oh this is great, thanks!
This is so honestly and beautifully written, Amy. I can't even begin to imagine how tough it is to tune into your body and emotions when you've been taught for so many years that there's simply not time for that...or worse, learn that doing so would just "get in the way."
I have certainly been known to be very adept at overpowering pretty much all of my innate desires and needs in the past, as you know, but feel like I'm sloooowly but surely making headway. Journaling, quiet time, not overscheduling, becoming better at saying "no," and trying to listen rather than hide the sensations of my body and my internal joy compass have been helpful so far. :)
Thanks Karla. A friend and I were recently trying to imagine what an embodied practice of emergency medicine would look like. We didn't have much luck.
I think most of us power through at leat to some extent, as that is valorized in the culture at large. It's definitely a difference of degree than that others aren't doing it.
Wow, that is a fascinating thing to imagine. I wonder how the whole medical field—and our collective health—might change. Perhaps someday!
Hello Dr Walsh
Thank you for your essay.
A true and invisible world subtly bubbling away in the background, in the medicine Universe.
It makes me feel so much awe for you, your profession.
Makes me wonder, how, for example, Dr Atul Gawande handles "day to day stuff", as he is a prolific writer.
I raise my hat to you and all of your colleagues 🌝👒🎩💙🙏🏻🧘🏻♀️🌌
Thank you, Mahesh. I appreciate your kind words! I hope my writing brings that world into the light a bit more, because I think that patients demanding doctors are treated better so that patients will be treated better may be more likely to generate change. There are definitely many doctors, and I would guess Atul Gawande is one of them who work hours that I and most others would not be able to in order to write, teach, and practice medicine. Only he can know if that balance is healthy and fulfilling for him.