Chapter 16. How to enjoy medical practice?

Dr. Yeshwanth K. Amdekar, DCH, MD (Pediatrics), FIAP

The best way to enjoy your job is to imagine yourself without one

                                                                        Oscar Wilde

When you enjoy what you do, work becomes a play –

                                                                        Martin Yan

What does the word “enjoy” mean to you?

Enjoy means to receive joy while joy isa feeling of happiness and cheerfulness. In order to enjoy, one has to act before you experience joy. Thus, enjoy is an action, joy a feeling, an outcome of enjoy. Joy is a momentary but intense feeling of positive emotions. Such little moments experienced repeatedly lead to happiness. It is clear that joy is not dependent on external influences, it resides in your own mind that needs to be exposed and perceived by your own action. When mind is pure, joy follows like a shadow that never leaves, said Gautam Buddha. Joy is the emotional dimension of life that is well lived. Once you experience joy with your own action, in turn, whatever you do with joy will make you enjoy further. This cycle will continue and sustain as a habit. Joy has one characteristic – once you feel joy, you will strive for it again and again. Secret of joy is contained in one word – “excellence” and to know how to do well is simply to enjoy what you are doing.

Medical practice is stressful

Medicine is a science of uncertainty and hence doctors use art of probability to arrive at a diagnosis. Every individual reacts differently to same disease and even same individual responds differently at different times to a same disease. However, patient expects best outcome irrespective of several variables that are beyond control of a doctor. Stakes are high as minute error may result in major consequences. In no other profession, risk-outcome ratio is so screwed. Teacher is not expected to produce good results in every  student and is not held responsible for failure of student. But doctor is expected to “cure” every disease, otherwise held accountable for the result. Every other professional can think over time and decide best possible action whereas medical practice demands “thought in action” – you think and act at the same time. Hence it is natural that medical practice is quite stressful.

What are the compounding factors to stress?

Besides undue expectations from patients, burnout (60-80 hours a week with forever “on call”) leading to physical and emotional exhaustion, alienation from personal life and peer pressure are other factors responsible for stress. However, we need to realize that stress is inappropriate or exaggerated response to situation that may be beyond your control but we need to modulate it to a tolerant level so that it has no negative impact on our work as well as life. It is possible with deliberate practice and meditation helps to destress. If unduly stressed, our performance goes down resulting in more stress. One can understand anxiety when you face serious situation – anxiety is the appropriate response and has a positive impact on outcome. Can you enjoy medical practice in spite of stress? Don’t forget that you have chosen to be a doctor and now let your life be well lived as a doctor. It is in your hands. No  profession is all roses and even roses have thorns. So, we need to enjoy fragrance of our profession, coping up with thorns. There is a silver lining to our profession. Medicine is the most touching scienceas it involves caring, healing, soothing, reassuring, understanding and offering hopeswith empathy, compassion, commitment, communication, counselling and documentation. This represents art of medical practice and is as important as science. One without the other falls short of desired outcome. Many of us have lost touch with this reality, ignoring how valuable it is and not cultivating it. Patients don’t care about how much you know but they want to know how much you care. If you follow art of medical practice, care that you take becomes evident and even poor outcome is accepted as a part of destiny. As doctors, we are aware that disease heals not just because you chose the treatment right but also because patient responded correctly. It is not rare that correct diagnosis and ideal treatment fails to cure a disease. However, when we do our best and patient gets better, it brings joy to a doctor and much more so if difficult problem is solved rationally, it gives a thrill. Good deed is remembered by patients and as a doctor, every one of us have experienced it. So, if you do your work well, you will enjoy medical practice. It is possible.

How to ensure you enjoy medical practice?

Care always, cure if possible” is our motto. Let us acceptthat perfection in medical science is impossible but it is possible in art of practice because it is entirely in your hand. Start practicing “holistic” care by using all the faculties  endowed upon human beings by nature namely body, heart, mind and soul. When translated to medical practice, body refers to knowledge, heart to compassion, mind to commitment and soul to your own conscience. While knowledge is important, other three domains are most vital. Medical science is developing fast and one needs to keep updated. I have dealt with this issue in one of thearticles. Try to see the problem from patient’s perspectives and you willbe compassionate. You must feel the pain that patient experiences though you should learn not to suffer from this pain. Commitment should be at the level when you are treating your own relative. And finally, whatever the outcome of treatment, you should be answerable to your own conscience that you did utmost whatever you could. Be humble, don’t run down peers and follow ethics. Such behavior results in peer acceptance, respect in the profession and faith amongst patients. Once you follow these principles, there will be abundant joy in medical practice.

Balance beyond bank balance

Besides art of medical practice, don’t forget balance between profession and life to remain healthy and enjoy practice as well as life. Don’t go after bank balance only because it may provide financial security but not ensure healthy and joyful life. Most doctors ignore health due to irregular eating time, lack of exercise, sleep deprivation and “rat race” in practice. Train yourself and your patients in such a way that you are able to look after your personal life. One ideal solution is to establish group practice so that you can modulate your work as well as personal life. You must find time for the family and take a break from practice. There can’t be any excuse about busy practice as most busy people are never short of time because they manage time well. Develop some hobbies that can distract you from stress and makes life enjoyable. Finally learn to balance between time, money and energy. When you start practice, you have time and energy but no money, at the peak of your career, you have money and energy but no time and at the end, you have enough money and time but no energy. So, enjoy life as much as you enjoy practice. When you have money and energy, find time to enjoy life.

Personal notes

One of my colleagues once told me that he had startedenjoying practice ever since he started making and documenting a provisional diagnosis and to find that it was  subsequently confirmed by relevant teststhat gave him athrill. He continued to do so in every patient that made him learn that every patient was different even when suffering from same disease. That is how he started enjoying his practice and looked forward to attend the clinic. It is the bestway, otherwise practice becomes monotonous and stressful.I started a group practice as work load increased and every ten years, one colleague joined our group. We are now four in our group. It has given me and my colleague’s time to enjoy life. Besides practice, we all spend time in voluntary teaching that is another source of joy and repeated joy brings happiness.

Take home message

Medical practice is stressful but turn this stress into an enjoyable stress –eustress. Follow the art or medical practice to ensure “care always, cure if possible”. Avoid burnout and learn to balance between work and personal life. Manage time so that you can devote attention to your own health and family besides practice. You cannot enjoy practice without enjoying personal life. Manage time, energy and money well. If you follow this, you will look forward to work and life every day.

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