Welcome back to Serenity for the 2nd post, if you read the first post I talked about some of the difficulties that we as GPs face in looking after ourselves and why we are so bad at it. One of the main things is that we find if difficult to separate the identity of ourselves as a doctor from ourselves as a person – I thought I’d explore that a bit more on todays post.
In “Julius Caesar” , Shakespeare talks about the masks that we wear in our public and private lives. The idea that throughout our lives we wear different masks to face different situations and people, and rarely if ever do we take off the masks and show our true selves. We as GPs and doctors have many different masks that we wear, most people do in our modern world. Why then do we, compared to others, seem to find it so hard to take off theses masks? I’m not sure, but there is a difference, there’s an expectation by others and importantly ourselves, to maintain that mask of the “good GP”.
In Caesar’s time the above quote – ‘I love the name of honour, more than I fear death’ drove him through his endeavours. Something similar can be seen in doctors – we are seen to have ‘honour’ and we are expected to uphold this and we fear the loss of this honour. This fear, of loss of honour, permeates a lot of what we do and how we react to things. I’m not saying that this is the main thing that we fear. I think its more about doing the best for our patients, and doing no harm. We’ve all had that night you go home worrying if you’ve done the right thing? Started the right medication? If you should have done that other test? What if you missed something? These thoughts, and doubts are part and parcel of being a doctor and indeed, I believe, a good doctor. At the same time these self doubts shouldn’t paralyse us, this balance usually comes with experience and knowledge (except surgeons… they’re wired slightly differently).
So going back to the point of honour why is that important in this discussion? Lets replace that word with ‘respect’ – now think of how we as doctors need ‘respect’ in our work and private lives. Most of what we do as GPs and doctors is done with a relationship with the patient where they respect our decision and advice. They may not always understand all that we tell them or why, but they respect us, and that we are there to help them. Same with our dealings with other specialists, allied health, administration, and regulatory bodies. I believe that we get used to that respect and do whatever we can to maintain it, that we go out of our way to do things to maintain that respect, even to the extent that it takes our work and public life/mask over into our personal or private life.
One of the current trends in medicine and especially General Practice, is the growing dissatisfaction and disillusion we have with our work. There is growing angst, depression, early retirement, searching for alternative careers, substance abuse, and sadly increased suicide. Why?
I think it comes back to the ‘respect’ we spoke about earlier. That respect that the profession received has been whittled down over the last 40-50 years or so. Litigation, government policies and cut backs to health spending, patients perceptions and expectations, medical boards, increasing shift from clinical judgement, to ever growing paperwork and algorithm based decision making, have played their part. So what do we do ?
For one we need to change how we perceive ourselves, there are issues in our work life we can address, and how we go forward as a profession, but we need to start with ourselves. We need to separate that idea of ourselves as a doctor and always a doctor, from our private and personal self. That identity of a doctor has been taking a lot of hits over the last few years, and we’re taking those hits and transmitting to our identity of ourselves as a person. Yes we’re doctors and usually very good ones who do more then we have to, but we’re also more. Once we find value in ourselves outside the profession we can approach the work itself with more confidence and belief.
So start with yourself, in that person you see in the mirror, find worth in who you are. For you have worth, you have strength, you are smart, you are good at what you do, you have a purpose, and you are loved. Don’t be afraid of who you are, who you can be, and what you can achieve. Once you see worth in yourself as a person and not worth just in you as a doctor, then you can start making steps forward in other areas. Its difficult especially when we are at a low point, when people judge you, when you face challenges in your work. But you need to remember you aren’t alone. There are always people around you – loved ones, family, friends, colleagues, sometimes religion. So talk, don’t bottle things up, talk to those around you, and in doing so you might find that they see a lot in you that you didn’t realise, and that will help with that image we see in the mirror.
“Never forget what you are, for surely the world will not. Make it your strength. Then it can never be your weakness. Armour yourself in it, and it will never be used to hurt you.” – Tyrion Lannister, A Game of Thrones