15 years ago I applied for my California state medical license and began moonlighting in my second year of residency. Until 20212 I was excited about clinical work and felt challenged in all the right ways. These days, I mostly have a feeling of aversion towards the practice of medicine. I dread clinical work and have reflected on it even more recently.
Dreading Clinical Work
I just finished a month of clinical work. Nothing crazy, just a couple of hours per day. In fact, the work is quasi-clinical – I didn’t have to prescribe any medication, I just answer clinical questions.
I got paid around $3,600 for that work and though the money is good I have very little desire to do more of it. I don’t look forward to it and the idea of doing more gives me a negative feeling. I feel burdened by it.
It feels like something I have to do and if I don’t do it there might be consequences. It’s like getting dragged as a kid by the arm to somewhere or from something against my will.
The Practice of Medicine
The other work I do is telemedicine. That’s even more hardcore in my mind. And I try to avoid that even more. The only times I think about doing clinical work is when I worry that I have been away from it for too long.
I also feel the need to do it because of the income – the income and the job security. It feels somewhat better knowing that I have income opportunities. If I didn’t do any clinical work I fear that someone will come knocking and take my license away.
So, you see, a lot of my drive to practice medicine comes from fear of losing something. Nothing bad has happened and I can’t say that the work is even hard for me. I dread clinical work because of all the other feelings which come up in association.
Clinical Work
Clinical work to me isn’t figuring out someone’s clinical condition. I wish that is what medicine was to me. Clinical work is being responsible for the health of the patient and having to deliver a strong customer service experience.
That feels like a heavy burden. Definitely something I’m putting on myself – no doubt. But it feels dreadful nonetheless.
Clinical work should be only about gathering clinical information from the patient and helping them choose the best next step. It might be prescribing medications or giving them advice.
Burnout in Medicine
I don’t think anyone will argue that what I’m experiencing is the burnout of medicine. Some will call it having PTSD from some bad experiences but perhaps that’s a bit excessive.
Being burnt out means you just can’t cope any longer with the negative feelings you have about the profession. You likely aren’t getting much from the work and you feel overwhelmed by it.
I have taken a lot of time off from clinical medicine and have even discovered other good careers in healthcare. And yet I still feel burnt out from medicine. I didn’t expect that.
Addressing the Fear
The fearful thoughts and feelings I have are just thoughts. Nothing real is happening when I have these fears of being sued or having a patient complaint or losing my job. They are made up in my head and I react to them as though they were real.
I fear that…
- I’ll lose my medical license
- I’ll be publicly humiliated by a bad patient encounter
- I’ll be left without an income
- I would not be able to be a productive member of society
- I would become homeless
- I would be peniless
There isn’t anything wrong with me having these thoughts. But the fear, the feeling of being afraid, comes from me believing these thoughts. A part of me, in fact, has already decided that these are real things.
I know they aren’t real. I know that I fear these things but the chance of them happening are very low. And the chance of bad consequences are low even if any of these bad events happened.
Accepting the Feeling of Dread
This morning I woke up and got to work. I started taking a few more questions and I am planning on completing a few telemedicine visits.
I feel the anxiety in me and I still dread clinical work in some ways. But it isn’t enough to keep me from doing this work.
I realize that I have to be a little kinder to myself when I feel this way. After all, I am beating myself up when I have these fears. My natural instinct is to be hard on myself. Instead, I want to acknowledge the fear and confront it in a safe space.
I know that I am capable to deal with any negative consequences of performing any kind of clinical work. I have the right support structure and skills to eventually be okay.
Looking for Blame
In the past I was preoccupied with finding blame in healthcare. Was it the insurance companies? The medical boards? The patients? The profession itself?
I’ve written about it and I’ve discussed it with colleagues. There are so many theories out there and yet none really explain the exact problem. Nor do they help me come up with a realistic solution.
If I felt that this practice of figuring out who is to blame was fruitful I would continue with it. But it hasn’t been. My mission to diagnose the source has led me back to me.
It’s not to say that I’m to blame but I am the ever-present variable in every part of the equation. Since my goal is to enjoy my time on this planet it doesn’t make sense to keep looking for more blame.
I don’t enjoy clinical medicine and maybe the time will come that I will need to exit the field altogether. In the meantime there I feel liberated knowing that I can suffer less if I avoid looking for some entity to blame.