Tag Archives: leaving medicine

I’m baaaaaack…..?

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Happy New Year!  Nothing says a fresh start to 2013 like a closeup photo from The Shining.  :)

But I am back.  Part of me wants to hedge and say “well, I am back….but sort of”, or “well I’m just part-time.”  Until I quickly realize that those are old, familiar, ridiculous cultural scripts that I have been purging from my life for the past three years.  That crappy mantra that you spend a good chunk of your life training for a profession that you truly have no idea what will look like over the course of your life, and then you get a job and stay in it for the remainder of your career come hell or high water.

What a crock.

For those of you who regularly read my blog (and a very special Happy New Year to all 33 of you!), you know that roughly three years ago I essentially walked away from more than a decade in clinical medicine to reclaim control over my life and happiness as a consultant.  It’s been a wonderful and powerful growth experience, and a great exercise in trimming the b.s. out of my life.

So I was understandably surprised at myself when I decided last year to get back into clinical practice.  (For the gory details, feel free to visit my post “Dipping a Toe Back in the Pool“).  I’ve now been back in academic clinical medicine for roughly 3 months, and a few of you have asked me for an update on how things have been going.  So here it is:

Keeping in mind that I am still in my honeymoon phase and I have yet to experience all of the crazy politics and administrative pressure of being back in clinical practice……I am over the moon, deliriously, spectacularly happy.

http://www.sodahead.com/living/miley-cyrus-brother-braison-cyrus-lands-modeling-contract-will-he-make-a-good-model/question-3357417/?link=ibaf&q=images+happy&imgurl=http://upload.wikimedia.org/wikipedia/commons/e/ec/Happy_smiley_face.png

I don’t think this is an accident.  I think this is an amazing combination of right people, place, and time.  Specifically speaking:

1. My chairman is a god.  Ok, well that’s exaggerating.  Mostly he’s a simply fabulous guy who has managed to become a very skilled administrator while maintaining his coolness as a human being.  He hired me for a very specific role, and since my arrival has not for one minute started piling on “other duties as assigned”.  In fact, there is no such clause in my contract (this being my second time around at this particular rodeo).  In fact, the person who is putting the most pressure on me to be productive is me.  As far as he’s concerned, my first year of salary was a line item in his budget, and he is constantly reminding me not to put too much pressure on myself in my “ramp-up” period.  He also tends to hire lovely, energetic, passionate physicians, so I am surrounded by a department full of (mostly) amazing and happy colleagues.  Yes, I think he is part alien.  He also had a charming accent and likes to put “eh?” on the ends of his sentences, even when they aren’t questions.  Lovely.

2. I am protected from the aspects of clinical medicine I found most damaging in my previous existence.  Really this boils down to three things.  First, I don’t take any overnight call.  NONE whatsoever.  Some docs don’t really mind overnight call.  For me, it made me beyond miserable.  To be fair, my last incarnation of overnight call was in the most dysfunctional model you could ever imagine: in an outpatient practice that received 35,000 patient visits a year, we had NO nurse triage to screen overnight calls.  ANY parent https://www.neon-das.com/cgi-local/store/commerce.cgi?product=EFOthat called into the clinic was routed directly to the on-call physician.  Which meant we were answering parents calling us at 2 in the morning to let us know that their child has had a mild cough for the PAST THREE WEEKS and what should they do about it right that instant?  My favorite was a parent who called me at 4 am to tell me they had run out of baby formula.  Clearly, I went to medical school so I could direct people to look up their local all-night drugstore.

Second, since I don’t have any call, I HAVE NO PAGER.  For those of you who have never carried a pager so long it has actually melded with the flesh near your right hip, you won’t totally get how important this is.  I nearly broke out into a little dance in my chairman’s office my first day at work when he looked at me in his thoughtful way and said, “No, I don’t think you need a pager….not at all, eh?”  My colleagues and my administrative staff all know how to get hold of me through email or my cell if it’s urgent (which it rarely is).  Getting rid of that piercing electronic tumor at my waist has been a very liberating experience.

Third, I have SUPPORT.  A LOT of it.  I have an administrative assistant who handles all the scheduling and paperwork nightmare that I used to have to do for myself.  I have a coordinator who schedules all my patients, takes care of all the insurance approval, and vets me through the right offices for any need I have.  I have a dedicated nurse in clinic who knows exactly how I like to see patients.  And most importantly, all of them are HAPPY to do their jobs.  It’s a miracle.

3. I am part time.  I cannot stress enough how this has been the cornerstone of my happy return to clinical care.  I spent the last three years developing a thriving and satisfying consulting practice, and there was no way I was going to walk away from that.  I’ve started back clinically working one day a week.  Realistically, I work a little more than that in that sometimes I have to take care of some occasional communication or patient followup a different day of the week.  Which, when you love your job, is not a resentful situation at all – it’s part of building a practice.  But it allows me to grow at a unhurried pace and not have any anxiety about justifying my salary.  Plus we have already planned for adding in a second day if (when?) my practice gets too big for one day a week.  Mostly though, being part time protects me from the institutional and administrative politics that I found so damaging in the past.  Working once a week, there is no expectation that I will sit on multiple committees, attend numerous staff meetings, or get sucked into university service I have no interest in doing.  The things I get involved in I do by choice, and make sure they are projects I want to be part of.

4. I am valued.  In this disposable day and age, it is simply miraculous to work in a place where you get to provide a unique service that no one else does, and people actually tell you how grateful they are that you are there.  The fact that I view this as miraculous is sad, but it’s just a fact.

I know how fortunate I am to wake up pretty much every day of my work week now and look forward to what the day has in store for me.  I also know it’s not luck – a lot of work went into making this happen, and still does.

In the spirit of moving forward in a new year, I’m including a link to Kathy Caprino’s most recent article, “The 8 Most Damaging Excuses People Make for Their Unhappiness.”  I have always found her insights to be spot-on when it comes to getting unstuck and allowing yourself the opportunity to have a happy and healthy career.

As always, thanks for reading.

~lumi

Guilt is Not a Career Platform

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Recently, I read a very interesting Forbes.com post by Kathy Caprino, entitled “Why You Remain Stuck in a Career You Hate.” In it, she gives eight outstanding reasons why those of us who are unhappy in our careers remain paralyzed and unable to move. The first reason on her list (“You Don’t Know Yourself”) resonated strongly with me. It took me eleven years in primary care medicine to come to the conclusion that I just don’t like being a primary care doctor. It’s not a good fit for my personality or how I tend to function in a work role. I’m much happier in a “specialist” model – where I can take more time and function in a niche rather than trying to cover a broad range of things in a very limited period of time.

This is just a simple fact I had to learn about myself. It’s not a judgment about the importance of primary care versus other specialities. On the contrary, I have enormous respect for my colleagues who are primary care providers and do it well. I think they have one of the most challenging jobs on the planet.  I just needed to do enough introspective searching to finally admit to myself that I wasn’t in the right field.

But why did it take me such a long time? The immediate obvious answer is that for those of us who spend the better part of our lifetime training for a specific career, it’s a hard pill to swallow to admit that maybe that career isn’t exactly the best one for you. Especially if you are one of those types who was born knowing you wanted to become a doctor/lawyer/etc. But, as I’ve alluded to in some of my other blog posts, I’ve never been one of those people. I’ve also never really viewed being a physician as a critical part of my identity. I am a person first, who practices medicine second. I know that is not the case for everyone, and that’s the point. We are all different.

In really taking some time to figure out what makes me “tick” as a career person, I came to realize something very important in the months leading up to my eventual resignation from clinical medicine. It turns out that I am one of those self-masochists who loves to turn a career’s worth of guilt inward. I was the stereotypical worrier, wondering what would happen to my patients. If I left, who would take care of them the way I did? How would they get what they needed from someone who didn’t know them like I did?” Looking back, these “guilt scripts” held me hostage for years before I finally took a good hard look at what was preventing me from being happy in my work.

It was actually the fiancé of a friend of mine who inadvertently helped me break through the last of my career shackles. My friend was a nurse practitioner in the clinic I worked in, and the two of us developed a friendship borne out of commiseration. We would often get dinner or hit the local bar after clinic was over and just wallow in the injustices of our work environment. We even had our own little book club so we could have some kind of pretense for getting together. We’d talk about the book for about three minutes, and then the conversation would immediately devolve into a first-class bitch session.

One day her fiancé happened to join us for dinner. He listened to us talk about how trapped we were working for an institution that refused to listen to its employees, and imposed all sorts of inappropriate constraints on us. We bemoaned how powerless we were to make change, despite the fact that we were two of the most outspoken faculty in the clinic. We complained about the unbelievable inefficiency and suboptimal level of care in our clinic due to administrative decisions that clinically left our hands tied.

After this went on for about half an hour, he looked at both of us and then asked quite frankly, “So why do you continue to work there?”

My friend and I of course had all sorts of excuses. Our patients needed us. No one else knew the issues our patients faced as well as we did. As I listened to myself spouting off 101 reasons why I couldn’t leave, I realized I had enough career guilt on board to fuel a Catholic mass for three weeks.

His question stuck with me though. He had planted a seed, and over the next several months it germinated into a big, blooming flower. Eventually I had to admit to myself that my patients somehow had found medical care before they met me, and they would after I left . Would it be the same medical care that I provided them? No. Would they get worse care after I left? Possibly. Or maybe someone would come along and do a better job than I had. Regardless, they would not be left lying in a ditch somewhere. Sure, they would miss me. I have several families that I still keep in touch with by email after having left clinical practice, and they do miss me. But they also are very pleased to hear that I am happy and thriving in my new work.

With due deference to Kathy Caprino, I respectfully submit Reason #9 for her consideration: Guilt Is Not A Career Platform. Certainly not for a fulfilling career anyway.

~lumi

RELATED LINKS:

A Good Way to Measure What Works for You

On Leaving Medicine Part 2: Passive Parenting

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It’s ironic that I left clinical practice for one of the very same reasons I entered into it in the first place: families.  Don’t get me wrong – I still love working with families. They are a key to successful practice in medicine, and are the cornerstone in clinical family and patient-centered care.  If you haven’t checked out the Institute for Patient-and Family-Centered Care, I highly recommend it.  (And I have taken all the work out for you by providing this lovely hyperlink.)  Families are a huge reason I specialized in pediatrics: I loved the idea of nurturing change and providing education to a group of people that have tremendous influence on a child.  Children do not grow up in vacuums.  Real change and intervention has to happen with the caregivers.  And many of the families I worked with over the years were gracious, kind, and motivated in caring for their children.

I wasn’t naive enough to think I was going to have a mind-blowing experience working with every single family in my clinic.  But there were some parents that really caused me to struggle immensely in my practice.  Surprisingly, it wasn’t the aggressive over-parenters that really got to me.  Sure, I had my issues with helicopter parents who would come in demanding some brand new test they saw on TV be run on their (healthy) child so they could confirm exactly what was wrong THIS INSTANT.   Never mind that the test cost $1500, took seven weeks to run, and was intended for identifying illness that only occurs in populations that regularly ingest raw brains as part of their diet.  Somehow, I always managed to eventually find a common ground with these parents and figure out a way to meaningfully collaborate in taking care of their kids.

My true achilles heel lay with the parents who were the exact opposites: The Passive Parents.  These are the folks who simply weren’t that actively involved with parenting their children.  It happened for a variety of reasons.  Some just weren’t interested in parenting (despite that they were, in fact, parents.)  Some decided to twist the Montessori educational method for their own purposes, and insisted that children learn from the world and each other, so that they were actually doing harm if they ever ran interference where their kids were concerned.  (Hey genius, if your kid learns that his old sister can bully the hell out of him and you will stand around and watch and never set any limits for anyone, you’ve done a fabulous job teaching your kid learned helplessness.  Way to empower your child.)

But my ultimate nemesis were the parents that were actually afraid of their own children.  Like somehow standing up to a pint-sized version of themselves and actually saying “no” once in a while was the most terrifying prospect they would ever face.  I’m not even really talking about parents whose children have already turned into teenagers run amuck and have developed Conduct Disorder and like to set fire to things – that is a very serious concern.  The parent’s I’m talking about are the ones who can’t face down their elementary schooler.

I wil never forget one family in particular I took care of in my clinic for several years.  ”Jack” and his mom came into my clinic for the first time for Jack’s six year-old well checkup.  I heard about Jack before he ever got back to my exam room.  The nurses actually came to warn me that he was terrorizing the front waiting room, and that the toys (that were actually there for all the children who were waiting to be seen) were scattered to the four winds.  Jack apparently didn’t do very well during the nursing screening either when he was getting measured and weighed – I heard the screaming all the way down the hall.

Eventually, Jack finally made it back into an exam room.  The frazzled nurse, who was actually quite experienced with “demanding” children, handed me the chart and wished me luck, saying that the mom was going to be no help.  I took a deep breath, turned the handle, and entered the room.

It was the “feeding after midnight” scene straight out of Gremlins.  Jack had dragged a chair across the floor, used it to climb on top of the sink, and had proceeded to pull all of the plastic basins, boxes, and gowns out and throw them all over the floor.  His mother was sitting like a stunned sheep in the corner of the room, too petrified to say anything to her son.

I immediately addressed her, and let her know it was dangerous for her young son to be standing on top of the sink, and she should probably retrieve him.  She stood up, walked across the room and picked up her son, and timidly said something to the effect of, “now Sweety, you really shouldn’t be climbing on top of things.”  Whereas Jack promptly turned in her loving arms, looked at her, and smacked her dead in the face.

I realized that I was going to get absolutely no help from this woman during the visit.  So I asked her to please put Jack down.  She did and scurried back to her chair in the corner. I squatted down so I was eye level with Jack, and we just looked at each other for a long moment. I then addressed him in a gravely serious voice, but making sure that I snuck in several glances at his mother to let her know I was addressing her too.

“Jack, I don’t know how you do things at home, and maybe no one explained the rules about the clinic here to you, so I’m going to do it now to make sure you understand.  In my clinic, we never, ever, hit another person.  Got it?”

Jack stared at me with a curious look, like this was the first time in his life he had ever heard something resembling a limit, and was trying to digest it.  We sat there like that for a few seconds while he processed.  Finally he nodded and said, “I got it.”  The rest of the exam was a piece of cake.  If Jack started getting rowdy while I was getting information from his mom, I would simply remind him about the clinic rules, and he would stop.  His mom kept apologizing profusely for his behavior, looking all the while like she had seen a ghost (perhaps the Ghost of Christmas Parenting?)  At the end of the visit, she appeared so mortified that she could barely make eye contact as she hustled him out of the clinic to the car.

The best part was that apparently, all Jack’s mom needed was a bit of modeling to realize that she needed to get more actively involved in parenting her son, or he was going to end up jumping off a bridge when she wasn’t looking.  Six months later, Jack came in for a followup visit.  I saw his name on the schedule and admittedly cringed a little.  But something had happened in the interim.  When Jack came in to the office with his mom, I happened to be standing close to the front desk and he spotted me.  Wasting no time, he marched right up to me and said, “Dr. St. Claire, today I’m going to be really good.”  I high-fived him and he proudly went with him mom to the check-in desk.  His mother was beaming as if she had just won the Boston Marathon.  There were no reports of waiting room warfare that day.

Sadly, success stories like Jack were few and far between.  Most of the passive parents I saw in my clinic never really gained a sense of active parenting, and it certainly wasn’t a problem a physician was equipped to solve in a fifteen minute visit.  I suspect on some level that these kids might not have gotten as optimal medical care as they might have, had I felt I could actually collaborate with their parents and give them a care plan that they felt comfortable taking home.  I also worry about these kids growing up.  In the 1980s, Psychologist Diana Baumrind identified distinct parenting styles, with the “permissive” parenting style being most often associated with children eventually developing Conduct Disorder.

I have no delusions that I may get some blowback from some offended parents reading this blog who see themselves in my words, and that is perfectly ok.  I am not really interested in lecturing anybody on how to raise their kids.  Plus I don’t have to: the research and the outcomes speak for themselves regarding how our kids grow up these days.  The bottom line for me is that as a physician, I worked very hard for many years to partner with parents in order to provide the best possible care I could for their children. The parents who couldn’t, or wouldn’t, meet me halfway were the ones that unfortunately made my job impossible to do well.  I wish them all the luck in the world.

~lumi

RELATED LINKS

Rochester Sage: “I Want My Kids To Fail”