Challenging Questions to Help Physicians Reflect, Grow, and Find More Joy Practicing Medicine
Release Date: 12/15/2022
Poems about the wretched illness experience when your doctor is“clinically detached”
On Becoming a Healer
Writing about the illness experience, medical sociologist Richard Frank described an unspoken agreement with his doctor that if he adopted their detached and clinical language when discussing his illness, "I would have at least a junior place on the management team." Initially it seemed like “not a bad deal," until he experienced the toll it took, concluding that, "No one should have to stay cool and professional while being told their body is breaking down, though medical patients always have to do just that." Through three poems selected by our repeat guest, English professor Laura...
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Assisted Dying: An End-of-Life Care Option or a Line Physicians Should Never Cross?
On Becoming a Healer
A growing number of US states and other nations are legalizing either voluntary euthanasia in which a physician (or designate) administers lethal drugs, or physician-assisted dying in which the drugs are given to the patient to self-administer. Our guest, Erica Baccus, tells us about her husband’s determination to end his life rather than die of Alzheimer’s disease, and the journey they took to Switzerland to make it possible (US laws don’t apply to dementia). His wishes were unquestionably honored. At the same time the procedure has implications we find troubling, especially for...
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Why are we addicted to talking about opioids rather than helping people with chronic pain?
On Becoming a Healer
For years, doctors and those learning to practice medicine were told pain is “the fifth vital sign” and to treat it aggressively – including with opioids, "if that’s what it takes.” A consequent rise in opioid prescribing contributed to the devastating opioid crisis. Then the pendulum swung in the opposite direction, hard, with physicians cutting off opioid prescribing to patients, often without their consent. That too led to suffering with many deaths by suicide. What do these two seemingly opposing trends share in common? Both reflect a failure to embrace current knowledge about...
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Despite It All: stories from women who found joy in medicine despite joining a less than welcoming profession
On Becoming a Healer
From the 1940 to the 1970’s, medicine went from an almost exclusively male club to a profession in which women physicians were commonplace. Our physician guest is Dr. Anne Walling, who has written a book about the experiences of 37 women who attended a Midwestern medical school, Women in Medicine: Stories from the Girls in White This was a time when pornographic images appeared in lecture slides, and sexual harassment and discrimination in the job market were ubiquitous. Despite the misogyny, the women interviewed nearly all expressed gratitude that they were able to have...
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The biopsychosocial model: What would it take to really replace the biomedical model?
On Becoming a Healer
Medical educators generally acknowledge the importance of training doctors who care for the whole patient rather than just treat the disease. Most medical school curricula attempt to teach to that philosophy, but how successful are they, really? Our guest, Robert C. Smith, is a physician and author, who trained with Dr. George Engel, founder of the biopsychosocial model. In his new book, Dr. Smith argues that medical education mostly pays “lip service” when it comes to training physicians who are ready and comfortable serving patients who struggle with...
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“Disability is part of the human experience”: So why not treat it that way?
On Becoming a Healer
Soon after Lisa Iezzoni MD was diagnosed with multiple sclerosis during her first year at Harvard Medical School, from which she graduated in 1984, faculty and administrators discouraged her from practicing medicine. And in her final year they made it impossible for her when the dean’s office refused to write a recommendation letter (now called a Medical Student Performance Evaluation). This week marks the 35th anniversary of the American Disabilities Act which was signed into law on July 26th, 1990. Much has changed since but -- as Dr. Iezzoni, who went on to become an...
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The Extraordinary Dr. Richard Clarke Cabot
On Becoming a Healer
It is difficult to overstate the achievements of Richard Clarke Cabot (1868-1939) a relatively little-known, old-moneyed physician of the early 20th century who was far ahead of his time in how much he contributed, and how willing he was to question his own limitations. Cabot's achievements include: creation and self-funding of the first medical social work service and establishment of the fields of clinical pastoral care and medical ethics. His work offered seminal contributions to the fields of hematology, cardiology, infectious disease, and medical education – including the clinical...
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Emboldened Bullies Come for Medical Education
On Becoming a Healer
In an April 23rd executive order (EO), the president of the United States alleges that the Liaison Committee for Medical Education (LCME) and the Accreditation Council for Graduate Medical Education (ACGME) are requiring medical schools and residency programs to pursue unlawful discrimination through DEI policies. The EO calls for the US Department of Education to “assess whether to suspend or terminate” them, and to “streamline the process” for recognizing new accreditors to replace them. In addition, medical journals, including the New England Journal of Medicine, are getting...
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Physicians and Authoritarians: Are We Too Obedient?
On Becoming a Healer
The record of physicians standing up for their values as healers under authoritarian regimes is not good, whether it’s Nazi Germany, the former Soviet Union, or Iraq, with behaviors ranging from assisting in torture, to psychiatric hospitalization for political reasons. And sadly, it’s often without any coercion. More subtly, physicians may go along with authoritarian regimes' demands, thinking they can just "stay above the fray." But is that possible? Already, other professional institutions, including academia and law, have struck deals in the hope they they can move on,...
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Caring for Patients or Policing Them? Prescription Drug Monitoring, Doctors and Opioids
On Becoming a Healer
Prescription Drug Monitoring Programs (PDMPs) were originally designed for law enforcement to monitor patients and physicians for criminal behavior before it became available to health care professionals. Physicians and pharmacists often find PDMPs helpful because they can verify what a patient tells them and will often decide not to prescribe or dispense opioids if they discover their patient has been going to multiple providers and pharmacies. But is that health care or policing? Who benefits and who is harmed? Those are questions we consider with our guest, Elizabeth Chiarello, PhD,...
info_outlineMedical training and practice habituates physicians to a culture that narrows the possibilities we see for finding joy and meaning in our work. We often become efficient task completers, stuck in routines, and prone to burnout. Saul and Stefan discuss a set of questions that challenge physicians to look at their work and themselves in fresh ways, can be used for mentoring or teaching purposes, as prompts for reflective writing exercises, or to engage thoughtful colleagues (perhaps over a beer).
10 Questions (selected from On Becoming a Healer: The Journey from Patient Care to Caring about Your Patients)
- Think about a brief account of a patient interaction you recently had in which you think you functioned as a healer rather than just a task completer – meaning that you were able to help the patient beyond the narrowly biomedical aspects of care? Was there something you learned from this visit that you could apply more broadly?
- Think of interactions with patients that are rewarding and meaningful? Are they rare or common? Can you think of a specific one? Was there something you did differently that made the encounter memorable? If so, can you think of ways you could modify how you practice and interact with other patients so that more of your interactions are as satisfying?
- Do you see yourself as someone friends turn to when they are in distress or need guidance? If so, what is it that you offer them that enables you to be such a valuable resource? Is that part of you accessible to your patients during medical encounters? Can you think of an example? If not, why do you think that is?
- If you couldn’t be a physician, what would you most want to do instead? How would it be similar or different from what you have sought in a medical career? Can you draw connections between your second choice and medicine to gain perspective on what you most love to do? Assuming you stay in medicine, how can you be sure you are most likely to find it?
- What’s happened to your curiosity during medical training? What are you more curious about? What are you less curious about? Specifically, what questions do you find yourself asking or wanting to ask as you go through the day? How do you think your curiosity or lack of curiosity affects how you relate to and care for your patients and how you feel about your work?
- Do you feel your patients are benefiting from the distinct qualities that make you the unique person you are, or is that uniqueness not really a part of the way you relate to them? Do you feel you are interacting with patients in a manner that gives you a window into what makes each of them unique? Are many of your interactions rewarding? If so, in what ways?
- Are there certain types of patients who “get under your skin,” making you cringe when you see their names on your appointment calendar? Consider what might be going on during your interactions with them, utilizing the framework described in this chapter. Is it that you can’t engage with them? Do you struggle with maintaining boundaries when they make incessant demands? How might you alter your behavior so that these encounters become opportunities to model healthy interaction and to provide them a brief respite from the chaos that is likely present in their other relationships?
- Have you ever felt resentment that a patient didn’t show appreciation after you significantly helped them? If so, why do you think their show of gratitude is important to you? Does the doctor-patient relationship include an expectation that patients make their doctors feel good too? Could their indifference reduce your investment in their care? What if you learned from a patient’s family member that the person actually does appreciate you but just isn’t able to show it?
- Given what you know now, do you think you can have a career in medicine in which you find patient interaction rewarding and meaningful much of the time? If yes, are you on course to experience those rewards, or do you need to make some changes? If the latter, what are you going to do to make those changes? Are you going to live with low expectations or look for something more rewarding?
- Many, if not most, work environments have a fair amount of hassle, meaning you spend a good deal of time doing nuisance work and coping with difficult colleagues and bosses. These are manageable challenges, and they even provide an opportunity to learn to negotiate and adapt. Sometimes, however, workplaces become too dysfunctional to do your job effectively or facilitate meaningful change. They are beyond repair. How would you know when that line has been crossed? Have you experienced either or both of these situations? How did you respond? What did you learn?
Saul J. Weiner, MD; sweiner@uic.edu