July 20, 2016

People : Patients & Patience

When I thought about what I wanted to do in medicine, I thought about likely what everyone considers when choosing their career: what uniqueness can I share?  What is it about me that makes this job fit?  And I knew that for me, it wasn't going to be my stellar recall of medical facts (I always figure, I can look it up right?).  Or my ability to quickly calculate how much salt is filtering through a patient's kidneys (math is my worst subject). Or my fast processing in emergency situations (I hate emergencies).  In medical school and during residency, where there are a lot of very noticeably smart people, I always felt less capable. But it didn't bother me much, because there was primary care--something people didn't want to do and something I did.

I like primary care because it forces you to have a certain degree of patience in order to maintain sanity for yourself and passion for the job. Speaking to so many patients every day (a full schedule for me is 24 patients in a day, though they rarely all come so it's more like 18-20) and absorbing the complexity of their medical issues, the tragedy of their social issues, the depth of mental health intertwined with all else--it's draining.  But so far, the first year of full-time primary care has been dominated by feelings of satisfaction, enjoyment and gratitude. I feel like my training has given me the tools to stay patient and tolerant and forgiving--of the demands of our patients with many needs, and of my own limited ability to meet them.

Recently, I realized that there's another major factor in my capacity for patience with my patients--the privilege of being happy and fulfilled in other areas of my life. When you're incredibly lucky to have your own needs met, it's much easier to tend to others (which is one of many reasons to make medical residency less humane, but more on that another time).

Lately, going through some deeply personal sadness, I find myself being less and less patient.  Even though I'm not consciously thinking about life outside of clinic while I'm in clinic, the difficulties elsewhere seep beneath my skin and emanate to my patients.  I'm telling my patients to do things instead of collaborating. I'm sighing when I should be taking deep breaths.  I'm complaining to my colleagues about how so-and-so drove me crazy, when I used to make it a point not to skew judgment.  I'm listening less, interrupting more, and honing in on my own agenda more quickly.

It gives me much more insight into how the daily traumas and stressors of our patients affect their selves and dynamics with others. We all know that health is adversely affected by the learned fear of living in an unsafe neighborhood, the chronic stresses of financial instability, the way one unexpected circumstance can so easily topple an already fragile life.  These things can nurture the resilience of personal survival, but can wear down the resilience of dealing with anything that's not contributing to our own immmediate needs.

I think that on the one hand, we can't beat ourselves up for responding humanly to difficulties in our lives.  At the same time, going too long unaware of this response can result in a downward spiral of depleting reserve and empathy. It's been interesting to concretely experience my own fragility, and how it gives me one ounce of the heavy weight our patients bear.  I'd like to slowly work my way back to the patience that makes primary care more rewarding than draining, but in the meantime I'll try to learn from this vulnerability.


  1. I think it's incredible how supportive and empathetic you remain no matter what's going on in your life. So often when I'm consumed with something and don't feel like I'm being my best, others tell me they didn't notice any change in my outward behavior. I bet your patients feel the same. Later when we feel better, we can do even better. I hope that made sense. Love & hugs, dear.

    1. Thanks so much for the support and encouragement, lovely. It definitely makes sense, and is always good to be reminded of the difference between what we feel/perceive and what's visible/seen by others. I know you're crushing it as an attending!!


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