* * Anonymous Doc

Tuesday, April 5, 2011

Requested post-- how people maintain relationships when they're so overworked. Like I'm the right person to ask. I've blogged about this a little bit. There's at least one resident I know of that's gotten divorced since residency started. But is it worse than lawyers or finance or other jobs where people work long hours? At least we know our schedules in advance, so people can plan. For the long hours-- and they're often long, absolutely-- at least there are seldom surprises. You're on overnight, you're going to be there overnight. You're not on overnight, you will not be there overnight. There are hours here and there, sure-- you want to get out at 5 and you get an admission and you're stuck until 7. A patient's going downhill and you're there until 9. But it's only on some rotations, and it's not every day. You often know when you're leaving. That's a good thing. From what I know, lawyers don't, bankers don't. Plus, when you're off, you're off. There's not really any working from home, aside from some reading you feel like you ought to do, or studying for boards when that's going on. But you're not working surprise weekends that haven't been scheduled, you're not going in on your days off, you're not logging in to the computer system after dinner to check on things. Attendings have different responsibilities, sure, but being a resident is not a 24/7 job, thankfully. You are not tethered to a Blackberry.

So in that way, it's hard to complain. Also no business travel. No Monday-Thursday at a client site, no airports, no suitcases. Look, people live crappy lives. I mean everyone. I look at what other people do and I can't imagine how they get up in the morning. I know a married couple that lives a thousand miles from each other and the wife flies back and forth every weekend so they can see each other. That is terrible. I know consultants who work all week at client sites and are almost never home. I know people who have to pull unplanned all-nighters at the office-- people with kids. That is really terrible. And in pursuit of what? Money? Is it worth it? I don't know, I don't know how we've created a society where work-- and often not even socially useful work-- is the only piece of a lot of people's lives and it's all about that paycheck. I don't know how people motivate themselves to do it, how the money can seem so important. Or how they have the focus to be motivated by an end game that's very far away-- I mean, the end game is retirement with no money worries, no? I can't imagine what else it can be for a lot of jobs.

I've gotten way off topic. People maintain relationships in the same way anyone maintains a relationship with anyone doing anything. They make it a priority. And, I don't know, I think people go into this-- or at least they go into medical school, I'm not sure if the feeling can persist all the way through to residency-- thinking that there's some magic to being a doctor, some feeling you're going to have while doing the work that's going to carry you through. And maybe some people have that feeling, but I'd be surprised if anyone has it in the moment. You can look back and say, sure, some of that was useful, some of that helped people. But in the moment it's not special, it's just work. In the moment it's typing notes and looking up drugs and entering orders and arguing with the translator phone. And looking at the clock.

And hopefully staying busy enough to distract yourself from the reality that what you do doesn't really matter all that much, most people could do it just as well as you can, most patients aren't getting better, and this is what you've signed up to do for the next forty years. Day after day after day after day.

5 comments:

  1. Oh, please don't make the mistake of letting yourself fall into the belief that what you are doing does not make a difference. It does. A huge one. I can recall the full names of several of the residents who cared for me years ago after a complex operation that required a few weeks' stay in the hospital. They each had their own special qualities---don't think such things go unnoticed or that they don't matter. I recall these people often and hope they are doing well. Yes, patience, technical skill, cheer, the willingness to hunt down extra medical information for me all matter. But even the exceedingly well-practiced manner in which a certain week-two intern introduced himself as Dr. So and So amused me, and that had its own value, and the fifth-year surgical residents who reeled me in when I hit a bad patch in ICU matter too.

    Who cares if some other resident could have done a certain task? The one who did it for me is the one who matters.

    And you, the doctor who writes this blog, matter a whole lot too. Thank you for your posts. I've never commented before, but I really look forward to reading them.

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  2. second the commentator above - even though rounding on patient after patient may seem routine, boring, tedious to you and despite the fact that the sea of patients you look after come to resemble an anonymous, forgettable mass after awhile, on the other side -- the patient's side -- the situation is most likely quite different, where your presence can make a crucial difference--even if that difference can't be measured as a quantifiable hike in their health--in their lives. also you've been through a ton of training, years of education and apprenticeship, hoop after hoop, one screening process after another that most people would not be able to get through, let alone have the courage, desire or goodwill to start

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  3. other relationships that are difficult to maintain because of high stress jobs, long hours etc. is LEO's (law enforcement officers) I can't tell you how many times we have had things planned on "days off," but had to cancel because my spouse has court. Or they are supposed to get off at a certain time, but are dispatched to something 30 minutes prior to their shift ending and end up having to stay several more hours to gather information and have a detailed and accurate report written. The stress of the job can be hard on families. Generally LEO's are seeing people on the worst days of their lives. And then they get to see people do very stupid things. Days off are hard, because my spouse can be downright exhausted and want to check out, from being hypervigilant all week. Going out to dinner? Well there is the possibility of running into a contact, someone you have arrested and threatened not only you, but your family's lives as well. So sometimes they just want to stay put at home.

    BUT... he loves his job. We communicate. He uses me to debrief things ( what he can share), so it doesn't bottle up inside. And, I know he is making a difference in our community, and he knows that as well. I let him know when he looks like he is checking out. And like you said, we make it a priority! This is how we focus on life outside of his job and having a relationship.

    So, what you are doing as a Dr., even though you feel like you aren't making a difference - you are. Even if you are not curing someone, if you are making that connection with another patient and communicating in some way to them that you are trying to ease their burden, whether it be a physical or emotional one, it makes a difference. Just make it a point each to connect with another human being in a meaningful way, and then you have made a difference. Then journal that small interaction. It might be a little thing that gets you through your long days.

    (side note- word verification was "ptosis" - an actual medical term! too funny.)

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  4. very nice and sweet comments above..

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  5. I don't know how we've created a society where work-- and often not even socially useful work-- is the only piece of a lot of people's lives and it's all about that paycheck. I don't know how people motivate themselves to do it, how the money can seem so important.

    Maybe that's why taxation bothers them so much more than normal.

    Or how they have the focus to be motivated by an end game that's very far away-- I mean, the end game is retirement with no money worries, no? I can't imagine what else it can be for a lot of jobs.

    Status -- the $ you get every year is your points, your Double Word Score. And you can spend it on your kids to ensure their status. Retirement is a powerful motivator, though. I may dream of getting fired and I may have double the median net worth but I'm not quitting till I'm sure I have enough to make it all the way.

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