Saturday, March 29, 2014

I was re-reading a portion of Atul Gawnde's book Better: A Surgeon's Notes on Performance and was struck by a couple of sentences in the afterword:

Ours is a team sport, but with two key differences from the kinds with lighted scoreboards: the stakes are people's lives and we have no coaches.  The latter is no minor matter.  Doctors are expected to caoch themselves. We have no one but ourselves to lift us through the struggles.

I imagine this is a widely held view, as Atul is a gifted observer of the conditions within which doctors work.  But what a tragedy if the statement is true or if doctors believe it to be true.

If it is is true that doctors have no coaches, that represents an utter failure of the profession.  After all, there are people throughout a doctor's development and career who could serve as coaches--teachers, colleagues, chiefs of service.  Is Atul saying that none of these people view it in their role to be coaches for their students or colleagues?  If so, what a terrible indictment of the profession.

But there are also those in ancillary services like nursing and social work, and, yes, even administrators.  Beyond that, there are lay people who could often play this role--spouses, friends, clergy, and the like. Is Atul saying that doctors do not view it as possible that these people could serve as coaches? If so, what an unnecessarily lonely life must these people live.

All of this reminded me of a portion of this week's letter from my pal Gene Lindsey, in which he quotes a note to him from Rob Jandl, the CMO of Southboro Medical Group,

I have thought too about . . . the non-humane medical system we work in that does not support reflection, or personal growth, humility or even curiosity. Far too many physicians end up overvaluing their technical proficiency and under-valuing their wisdom, intuition, and compassion. I have concluded that while the system of care and even our training leads us in this direction, it will require significant personal growth not as a doctor but as a human being for the world to be different. A person such as this is frozen emotionally, is deeply disconnected from his feelings, and from what it means to be human. The best path I know of to pierce the fog of disconnection is to go right to our greatest fears and vulnerabilities: death, failure, loneliness.

Every day we have a choice. It is hard to see or feel sometimes but it is always there, and that is the choice to look for the opportunities, the potential good, the upside. But for physicians as individuals currently in practice I believe we must help them go inward, help them to grow as human beings, and the language we use as leaders and the work we do must support that journey which may have its dark moments and its losses.

This sure sounds like a profession in need of serious emotional counseling, or what I would call coaching.  After all, the key to good coaching is empathy.  In his afterword, Atul himself offers some good coaching about things doctors can do to make life better for themselves and their patients.  But both his words and Rob's comment left me deeply saddened.  Why should doctors be trained to believe that they are on their own?  While I understand the need for decisiveness and individual action and responsibility in the face of some clinical emergencies, I do not understand why the profession cruelly puts upon itself the expectation of isolation and a lack of support for the emotional well-being of its members.


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