A discerning eye can help you see the big picture

October 9, 2009

I sometimes practice medicine with poor vision too. Here are some of my ailments.

One of my patients recently underwent brain surgery to remove a benign mass. The surgery was a success, and he appeared to recover without incident. But when the man called to schedule a post-op visit with his neurosurgeon, he was told he would need to see another doctor in the practice because his surgeon was out having cataract surgery. With a chuckle, the patient told me he hoped the surgeon didn't find extra parts lying around after putting him back together. Something in his strained smile made me think he was only half-joking.

Like the neurosurgeon, I sometimes practice medicine with poor vision too. Here are some of my ailments:

Myopia. I suffer from a recurring failure to look past myself. I view too many patient encounters exclusively from a selfish perspective: How much pain will this "train wreck" visit inflict on me? Why do infants' ear infections always start at 3 a.m.? Will this procedure make me late for my daughter's basketball game? While I see my priorities and needs with 20/20 clarity, myopia distorts my view of others. Diplomas and awards adorning my office walls testify to my medical expertise. But I've also picked up another distinction along the way: I'm a board-certified solipsist.

Many times, this scenario springs from my failure to see the central issue weighing on the patient's mind. I may provide a diagnosis that would make TV's Dr. House proud, but if I neglect to tell the patient he doesn't have cancer or that it's not Alzheimer's, I have failed. Sometimes a successful patient encounter hinges on my ability to peer around my blind spots.

Glaucoma. With the increasing demands of this profession, I often find myself losing sight of the big picture. Sometimes palpable and throbbing, other times undetectable, an insidious pressure threatens my vision. Dozens of voices clamor for my attention each day, only a handful of which are those of patients. Statisticians measure my worth in abstract increments called relative value units. Strangers veto my planned therapeutic interventions from ivory-tower insurance offices. Under the weight of these chronic demands, my empathy wanes and my perspective narrows. The reasons I went into medicine-those noble, compassionate, altruistic reasons-slowly begin to atrophy.

These visual conditions are chronic and often relapse; a definitive cure is not likely to be found in my lifetime. Is there any help for me now? How can I avoid going blind by the time I retire?

Prevention is one key. By identifying and understanding my unique risk factors (difficulty handling interruptions, perfectionism, need for reflective down time), I can structure my time to avoid excessive "I" strain.

Regular check-ups are valuable too. If I can consistently share my thoughts with my daily journal, other doctors, or my spouse, I may be better able to spot the warning signs that could clue me in to impending problems.

Fortunately, effective therapies do exist should I encounter a malady: Strategies such as delegating the non-essentials, learning to say "no," keeping up with hobbies and passions, ensuring time with family, making time to hear patients' stories (not just their complaints), and performing acts of service can help restore homeostasis to my life.

I'm in this profession for the long haul, for better or for worse. Like an unlucky family history, there are aspects of this job I cannot change. But I can discipline myself to practice medicine with an "other-centered" mind-set. I can carefully listen to my patients. I can keep the big picture in view and transcend the nagging annoyances I face each day. And in the process, I may be able to keep my vision clear.

Scott Conley, MD, is a family physician in Elizabethtown, Pennsylvania. Send your feedback to meletters@advanstar.com