Dipping a Toe Back in the Pool

My apologies for falling off the face of the earth for the last few months.  Work has been very busy (hooray!), and quite a bit has happened.  Perhaps most importantly, 2 1/2 years after leaving a career in clinical medicine, I find myself dipping my foot back into the pool to test the medical practice waters.  (WHAAAAAAT????)  This actually comes as quite a bit of a surprise to me as much as anyone else.  Since I left clinical medicine, I have found more happiness and job satisfaction than I ever thought possible.  I had virtually zero intention of getting back into any sort of clinical practice.

So here I am, wondering what happened as I sit filling out a credentialing packet for a major academic medical center that is thicker than War and Peace, and am tentatively scheduled to start seeing patients in a few months.  Like the rest of this career process I’ve been through, I thought it would be helpful to really reflect on what has taken place over the past few months and break it down academically.

First, let me say right off the bat, I am in NO WAY leaving my current career track to suddenly shift back into clinical medicine full-time.  I seriously doubt I will ever let that happen.  I am going to start one day a week, and simply see where it goes.  I cannot tell you how many people have asked me if I’ll be going back to clinical medicine full-time when they find out about my new job.  It’s funny what a reflex assumption that seems to be for everyone.  People, I have drunk the freelance Koolaid, and there is no going back to turning over my schedule to someone else.

Here’s what I came up with when I really looked at what has tempted me back into the world of clinical practice:

1. This is the right department – even though I am trained as a generalist, I’ve actually been hired by a surgical department to function as a consultation specialist with a specific group of patients that I have quite a bit of experience with.  This so far appears to be a much better fit for me than trying to cram my work profile into a general pediatrics department.  I am thrilled at the prospect of leaving the primary care stuff up to my peers (who enjoy it and therefore probably do a much better job of it than I would anyway), so I can focus strictly on the specialist issues.

2. This is the right place – when my husband and I arrived here 2 1/2 years ago, we moved into a neighborhood that just happened to be located almost exactly halfway between two major cities, both with very strong academic medical centers.  I certainly couldn’t tell one from the other when I arrived.  Having worked in both communities over the past 2+ years, it’s become extremely clear which center my philosophies and ethics align with better.  Lucky for me, the one I’m going to be working for is a little closer and has a much better traffic pattern, among other things.  🙂

3. This is the right time – I’ve had over two years to establish myself and build my reputation in the community, as well as make strong connections with other resources.  This job is a natural segue into continuing to build on those connections, and establishing a bridge between the center and the community that currently doesn’t currently exist.  I’ve also had time to recover from the worst aspects of my previous job, and actually miss what I did love about practicing medicine.  This opportunity really arose very organically – I certainly didn’t force the issue when the time wasn’t right.

4. These are the right people – I suspect that this may be the most important factor of all.  The people who have hired me already had an interest in starting up a program, and just didn’t have the right manpower on hand to do it.  They clearly want this to work.  They recruited me (nice dinner with wine included), met all the requests in my proposal, and have already designated support including a dedicated coordinator, dedicated nurse, designated exam room, and corner window office, despite the fact that I have yet to sign my contract.  And just for the record, I signed on for 40% more than I was making at my previous hospital.  I realize it’s not exactly an “apples to apples” comparison since my job description will be radically different, but in the end it’s still me bringing home a paycheck that’s a lot less anemic than before.  My chairman is also very laid back – he’s the kind of guy who hires talented people to do their job and then backs off and lets them do it.  So far everyone I’ve met in the department is a clear testament to this, and have been nothing but lovely.

Of course, it’s still the honeymoon period – we’ll see how I feel when I’ve actually been working for a few months.  But it’s certainly a very healthy start.

More to come…..


On Leaving Medicine Part 2: Passive Parenting

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.



Rochester Sage: “I Want My Kids To Fail”

“Just”: The Ultimate 4-Letter Word

Over the past few years, I have realized that I have come to resent the word “just.” Certainly not in the civil sense of the word: social justice is the driving force behind virtually all the work I do these days. I am talking about using “just” as a qualifier. As in, “Oh, I’m just the medical student,” or, “He’s just a nurse.” We use it blatantly as an offense against others, and more overtly to undermine how we feel about ourselves. That word has come to mean that in some way, you are not educated enough, not qualified enough, or not worthy enough.

It has been really interesting for me in the two years since I left clinical medicine to pursue a decidedly non-traditional career path. I mean, who finishes high school, college, medical school, and clinical residency and then eventually leaves the job they actually trained to do? Here’s the secret about all that: your life experience is critical NO MATTER what road you take. I have been extremely successful so far in developing my new career, and I would not be doing nearly as well as I am and getting the high-profile work I am without my past clinical experience. It gives me credibility, knowledge, and perspective that make what I have to offer unique.

What I have quickly come to realize though, is that while I am extremely comfortable with having taken on a new job identity, a lot of my colleagues are not. The “just” word gets batted around constantly.

“But aren’t you bored being just a consultant?”

“Isn’t it weird being just an interpreter instead of a doctor?”

First of all, I never stopped being a doctor. There are thousands of us who have completed medical school and earned our MD degree (and many who finished clinical residency) who have taken detours to explore other areas of work. Usually they are related in some way to medicine, but don’t necessarily involve direct patient care. And guess what? The M.D. Police have still not shown up at my door to take away my degree. The last time I checked my business card, those two little letters after my name were still there.

Secondly, and perhaps this is the social justice beast in me rearing its ugly head, I can’t think of a single meaningful job that I would ever feel comfortable putting the word “just” in front of. Think about what the act of gainful employment provides for us as individuals. It gives us a sense of worth and need. It puts food on the table. For some of us who are struggling with temptation, it keeps us honest and clean and helps us resist activities that might lead us to a place of total self-destruction. Doctors would be nothing without nurses to actually put their plans into real action and physically take care of patients. And just because you don’t like someone’s job or think that it is particularly challenging, imagine what your life would be like if the trash collector simply stopped coming to your house. Not pretty.

I’ve been thinking a lot about “just” in the past couple of years since I switched my career horses in midstream. Not because I’ve had to wrestle with it at all on a personal level. I have more peace and joy in my career now than I can remember over the last decade. It’s really more about the reaction it draws out of other people. Usually it’s people who have made decisions for themselves that they don’t necessarily feel great about. But for whatever reason, they feel compelled to stick with their decisions. I tend to make these people really uncomfortable. I think it’s because my decision to follow an unorthodox path and find my career happiness again forces them to examine their own decisions more closely. And sometimes they don’t really like what they find. Sometimes they are truly stuck because of financial obligations, and are miserable but just don’t see a way out. I make them unhappy just by being me and feeling fulfilled and standing in the same room with them. Sometimes people are stuck out of fear, and my lack of fear and my willingness to embrace risk-taking makes them feel bad about their own paralysis. We are natural comparers as human beings. We are always looking at what the other guy is doing, and constantly trying to see if we measure up.

Mostly though, it’s other physicians who have the hardest time with my decision to leave clinical medicine. I think a lot of this has to do with the fact that there is a strong tradition of hard-won success in medicine. The educational road to becoming a practicing doctor is very long and very hard. For many people, there is also an enormous identity piece. Some people are doctors 24/7. I don’t mean that they live in their offices and never go home. I mean these are the people you will meet at a party (where there are no patients, no white coats, and everyone is drinking wine and eating little puffy hors d’oeuvres), and they will introduce themselves to you as “Dr. So-and-So”. I don’t have particularly strong opinions about whether this is appropriate or not, but it’s something I have never been able to relate to well. I did not come out of the womb knowing I was going to be a doctor. I am not one of those people who absolutely cannot imagine themselves doing any other profession. (Clearly – I have imagined myself right into another line of work.) For some people, being a doctor is the end-all of their identity, and they are not complete people without it and the respect and honor it (rightly) deserves. So these folks are the first ones to ask me how I can possibly be happy just being a consultant, when I could be a doctor?!?

I just came home from a conference where I had the opportunity to escape for lunch with a colleague who is a wonderful friend, and someone I don’t get to see as often as I would like. We were having a very energetic conversation about all the work that lay ahead of us and how motivated we were to be doing it with committed and passionate people. At one point, I was telling her about some of the new opportunities that had come up for me through the conference, as well as some exciting new job opportunities at home, and the fact that I also have been seriously committing time to writing, which has made me eternally happy. I must have looked like some blissed-out kid who had just eaten an entire box of Twinkies (before the vomiting started anyway). My friend looked at me for a long moment, paused, and simply said,

“My dear, clearly you were never meant to be just an MD.”

There it was, that “just” word again. Except this time it had a completely different meaning. It was obvious she hadn’t used it in the sense that being a physician is a lowly occupation, and I could certainly do something more quality with my life. No, she meant it in the purest form of the word. She was talking about scope and self-limitation. Why only be an MD? Why not use your skill set in new and unique ways to address issues of social injustice? It was such a pleasant shock for me to hear someone use that word in such a positive and fitting way, it was all I could do not to leap across the table and tackle her with a huge hug.

Betty Friedan, the famous early feminist trailblazer and author of The Feminine Mystique, once spoke about how different our lives would be if we simply knew early on that we were going to have three or four different careers throughout our lives. If somehow that were the norm, how liberating it would be knowing that at any time, you could go ahead and start gaining the skills and education to do something new and exciting with your life.

I know just how she feels.