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July 1

Supposedly, July 1 is the worst day of the year to be admitted to the hospital. The first of July is the day everyone in the doctors’ world moves up the ladder: It is the first day of work for interns (brand-new MDs), the first day for residents (just completed intern year), and it is the first day doctors who have just completed residency training begin practicing medicine without supervision.

On July 1 there are more inexperienced doctors at every level than at any other day of the year.

All of that inexperience deserves some advice, and now that I am almost twenty years in, I would like a try.

Dear New Doctors of All Kinds:

Doctors like to complain. They complain about long hours, insurance companies, difficult patients, school debt, and hospital management. They complain about work stress, burnout, and physician suicide. Some of the complaining is legitimate. Some of it is doctors feeling, out of their own sense of self-importance, that the misery of medical work is unique, not understanding that all jobs everywhere have their own griefs.

None of this is to belittle the hardness of the work doctors do. But it is to remind us of two things. First, unhappiness is not limited to physicians. Everyone who has a job has to put up with many of the same problems doctors do, and a lot of them don’t have nearly as much power to fight back. And most do it for a lot less money.

Second, most people in non-medical jobs don’t have a secret resource that doctors do: patients. Unlike other professionals, doctors have human beings in their work lives who will appreciate what they do — if, that is, they do their jobs with care. This is true no matter what the medical malpractice system is like, no matter how badly the insurance companies treat doctors, no matter how unreasonable hospital managers choose to be. The patient is the doctor’s friend.

The doctors I know who get burned out all have one thing in common. They stop caring about their patients. As long as a doctor sees that his patients need him, medicine will never be intolerable. I could quote psychological research but common sense suffices: the happiest people are those who think themselves useful to others. As doctors lose touch and empathy with their patients, seeing patients feels less like usefulness and more like drudge work. Patients become problems, obstacles between now and the trip home, the afternoon off, or the three day weekend. The patient becomes the enemy. The moment a doctor thinks of patients as enemies, as a drain on time and energy he or she would rather spend elsewhere, all is lost. I have, in my time, known many lost doctors.

This doesn’t mean doctors don’t have a right to personal time. They do. A physician has a right to a private life as much as any patient has, and ought to protect it jealously from the stresses of work. But that, of course, applies to any job in any profession. But it does mean that the patients a doctor sees deserves complete attention. In the exam room, a patient should be the complete focus of work. If we give that to our patients, if we listen to them instead of listening to our own worries, we will always find enough inside us to get up in the morning.

Giving is a gift that mitigates many sorrows. Medicine is one of the few careers in which giving to others is built into the job, every day. Not just serving, as a waiter serves a person a meal or a banker serves a the finanical needs of a client, but true giving -- healing illness, according support and dignity to the suffering, walking with the dying in their final days, providing life-saving advice and counsel. True gifts. The doctor who fails to take advantage of that giving is on the path to depression and burnout.

The Second Book of Kings tells the story of how the prophet Ellijah was inspired by God to go out into the wilderness to seek divine guidance. He saw a powerful wind blow, but God was not in the wind. An earthquake came, but God was not in the earthquake. Next there was a great fire, and God was not in the fire. Finally, after the fire, there was a stillness. God was in the stillness.

Even someone not religious can see the value in this wonderful parable. God is an ethical force. God is truth. Ethics and truth cannot be found in the fire-and-earthquake drama of the doctor’s life. Truth is a gentle voice in the stillness, and it speaks only to those who stop and listen. That voice can be found in the words of patients. The voice of a patient can bring a doctor back to the purpose of work, no matter how miserable and unfair the rest of it may seem to be.

The doctor who remembers this will never go too far astray. I say that from experience.

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