
When doctors can't afford to feel - jonjlee
http://www.thedailybeast.com/articles/2017/04/30/when-doctors-can-t-afford-to-feel
======
rrggrr
This related and enormously powerful and touching article advises new doctors
on how to break the news of a child's death to their parents. Unfathomable
responsibility for those distant from performing it:
[https://www.nytimes.com/2016/09/04/opinion/sunday/how-to-
tel...](https://www.nytimes.com/2016/09/04/opinion/sunday/how-to-tell-a-
mother-her-child-is-dead.html?_r=0)

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golemotron
The real answer to this might be: more doctors. The amount of emotional and
psychological trauma any one doctor encounters in a shift in a large city
hospital might be 100x what a doctor in a more rural situation might.
Undersupply of doctors, higher population density, and cost-cutting have
engineered a psychological crisis for the profession.

There are ~29 physicians active in patient care per 10K people in the US [1].
What would it take to make it 290?

[1]
[https://www.statista.com/topics/1244/physicians/](https://www.statista.com/topics/1244/physicians/)

~~~
pmoriarty
I'm not sure why doctors would need to wait for more doctors to be available
before collectively putting their foot down and refusing to work these
incredibly insane hours.

It still boggles my mind that the medical profession puts up with this this
horrible practice that costs the lives and physical and mental health of both
doctors and patients.

~~~
golemotron
> I'm not sure why doctors would need to wait for more doctors to be available
> before collectively putting their foot down and refusing to work these
> incredibly insane hours.

Many get paid by the hour.

~~~
pmoriarty
If they volunteer to do it, that's something else, but I'm not sure how much
choice they have, individually.

From the article:

 _" The therapist’s first question was about my sleep schedule--the likely
cause of my distress, but also absolutely beyond my control."_

If this guy had control over his hours, he could get more sleep if he wanted
to. But he talks as if he's helpless.

I've also spoken to residents who seem to be totally abused and effectively
forced to work crazy hours. I've read the same from others. So I'm really
skeptical of how voluntary those hours are, though I'd love to be corrected by
someone with more direct knowledge.

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ancaster
Thank you for posting this. I'm just starting out on a career in medicine
myself, and I often wonder how to make it through this with my sanity intact.
The idea that the career demands "the subsuming of my inner life" seems cruel
and, I hope, not inevitable. Isn't there room to feel our feelings in this
job, and not necessarily be ground down by them?

~~~
ghufran_syed
Some of the best advice I ever read on this subject, which _really_ helped me
through residency training was from the little essays at the beginning of the
Oxford handbook of clinical medicine [1]. The one I particularly remember was
called "On being busy", and taught a generation of UK medical students and
residents about "Corrigan's secret door" (the link hopefully shows that page
on Google books). My favorite quote from the book was about how to recognise
"stress" in yourself: "stress is defined as arguing with more than one nurse
in 24 hours".

The book was affectionately known in England as the "cheese and onion book",
because the colour of the cover matched what at the time was the traditional
colour of packets of cheese and onion flavor crisps in the UK [2]

[1] [https://goo.gl/6Pz1Z1](https://goo.gl/6Pz1Z1)

[2]
[http://www.dailymail.co.uk/sciencetech/article-2293465/A-che...](http://www.dailymail.co.uk/sciencetech/article-2293465/A-cheese-
onion-crisis-How-colour-crisp-packet-affect-taste.html)

~~~
mrkgnao
Thank you for the link to that book.

I sometimes ponder, against my own experience from experiencing the
mathematical side of things, how the "folklore" wisdom in the medical
community is almost certainly something that the rest of us might benefit from
(this probably started when I read _The Emperor of All Maladies_ a couple
years back) considering the issues that the mental part of it deals with:
ethics, conduct in a power-unequal relationship, consent, the moral imperative
to evaluate risk competently (and the recognition that the former can never be
done perfectly), telling the truth and intention/effect differences ("you're
almost certainly going to die"/"this is a miracle!"), not to mention the
elephant-in-the-room question of living with death as a close acquaintance and
learning not to become consumed with either anger or despair at what one
considers personal failings.

(I suppose the late Oliver Sacks's work is an instance of what I'm talking
about.)

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jankotek
> _When in 2001 resident work-weeks were reduced to 80 hours, for example, it
> was hoped that we might be less likely to kill ourselves._

> _When Your Doctor Is on a 30-Hour Shift_

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killjoywashere
Finishing residency soon, graduation is in two weeks. The program has about a
50% graduation rate. Big fan of the Stoics.

~~~
epmaybe
50%??? That seems crazy to me, like something from decades past. If you don't
mind me asking, what specialty are you pursuing?

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timwaagh
i have to say free ice cream does not sound like a bad idea for these
overworked doctors. wisdom is useful but ultimately not something you can eat
and it wont give you any pleasure.

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jancsika
I don't understand the problem.

Why can't residents just check in with a therapist each week to ensure that
they're mentally healthy?

~~~
kansface
You are completely missing the point - they aren't suffering for lack of
therapy.

~~~
jancsika
Right-- they are suffering because they entered a training regimen during
which, as the author stated, wellness is not an option.

The point is a therapist is trained not only to look for high levels of work-
related stress, but also for signs that the patient is at risk of causing
serious, long-term damage to their psyche.

It's certainly not fool-proof. But the author seems persuaded that the stress
is so high that it requires a new, idiosyncratic moral system for residents.
Before doing something that drastic and so obviously prone to confirmation
bias, I ask why checking in regularly with a trained, objective third party
observer isn't an option.

