On Focus

29 April 2014


image

We live at a wonderful, amazing, stimulating time.

Our careers.  Broadband.  LTE.  Always on.  Hiking clubs.  Productivity.  Running magazines.  Tumblr.  Text editors.  iMessage.  NPR.  

Coffee.

For the contrast it offers, I love having lived my life with one foot in two generations.  I grew up with 2 or 3 favorite shows on a 7 channel no-remote black and white television.  We had a rotary telephone.  I played alone or with friends until sunset down the street or in the woods.  And now I am a young professional with an iPhone, a Kindle library, frequent flier clubs, and digital cameras , image processing, and publishing.  My stethoscope can amplify a human heartbeat by 18 times and eliminate all extra sounds in the room.  An amazing leap in a short lifetime. 

But given our good fortune, I think a lot of people my age struggle daily with an issue difficult to identify.  We have too much access and too many options.  

I watched the Eric Steel documentary Kiss The Water the other day- instantly, through iTunes, on Apple TV of course.  I was moved by the story of a Scottish woman, Megan Boyd who dedicated her life to the craft of tying fishing flies.  And not just general trout or bass flies- only salmon flies.  She did this from sunup to sundown in a riverside home with no running water or electricity.  She would go to the local community center for dance classes once a week and would go on a hike every Sunday so clients couldn’t find her on a day of rest.  That was her whole life and she loved it.  She was so good at what she did she was awarded the British Empire Award by Queen Elizabeth II.  

The movie is very PBS in it’s documentariness, with many meditative pauses, gorgeous animated interludes, and a thoughtful score  telling a clearly told story.  It was a brilliant setup for reflection.


image

Several days later I read Frank Chimero’s essay No New Tools- via Flipboard, rebroadcasting Twitter, digesting Tumblr and saved to Pocket of course.  In the essay he discusses the need for new systems versus new apps and a commitment to not reaching out and sampling every new digital tool that becomes available to get your writing, publishing, image editing or communicating done.  

And I’ve been reading too much Hemmingway lately with those damned crisp, distinct sentences.

I grew up reading the story of country GP’s- family doctors of old who settled into a community for the next 30-50 years delivering generations of children, setting the fractured bones the children they delivered.  They spent their yearly 5 day vacations on a lake within hours of their town and dedicated themselves whole-heartedly to their community and their craft.


image

Young doctors today are focused on our debt, building families, vanishing retirement strategies, maintaining a ‘balanced life’ with hobbies and friends, and are rewarded with careers as short as 6 to 11 years due to burnout and depending on our specialty.  Look at me-  an extreme example of professional ADHD- somebody whose medical community changes every 3 months to a year as the next adventure or mission calls.

Many of us on the webspace are consumed with minimalism, simplification of our material lives, and a thoughtful examination of our existence.  But I think the tools that allow us to do this, specifically the digital ones, can cloud our focus and distract us far worse than those things that are at best boring and at worse deleterious to work: a typewriter, a paper medical record, a notebook and pen, or the same coffee brand and percolator for twenty years.

I am grateful beyond imagining for the tools and resources available to me today.  But I’m also happy for some recent incentives that are giving me pause and making me reconsider focus and condensation in my profession, my art, and  my hobbies.  How can I increase mindfulness and purpose as a physician, a writer, a photographer, a hiker, a traveller, a fisherman, a cyclist?  How do I pare down the meaninglessness and immerse myself while living in the digital information age and taking advantage of these wonderful resources?  I need to make sure the answer isn’t a new meditation timer on my iPhone, another productivity Audible book,  or a new hobby.  Hopefully it can be reflection, discussion with my loved ones and peers, and being honest with myself while living an examined life.


image

All images by Em Cooper from Kiss The Water - A Love Story by Eric Steel.  Rent it or purchase it on the iTunes Store here.

Read Frank Chimero’s - No New Tools here.

On Focus appeared originally at HeartHandsEyes.com

Sad Like Leaving Kansas

This morning I’m drinking coffee, enjoying a beautiful Spring morning in the desert with the breeze blowing in through the window.​  In a few minutes I’ll start packing up the car and I’ll be moving out of my cozy little Navajo Best Western.

I’m really quite sad to be leaving Chinle.  Sad like I was when I left Kansas.  

This was my first Indian Health Services(IHS) assignment.  When you hear people discuss working for IHS they talk about how depressing the experience can be.  I don’t know where those people worked, but I have no idea what they were talking about.  Working at the Navajo hospital here has been one of the most joyful experiences of my career. Chinle Hospital has attracted physicians of incredible quality and talent from around the country.  The hospital and clinic staff are approximately 99% Navajo and there is incredible investment into the community as a whole, and the patients are some of the most delightful people I’ve ever worked for.  

Chinle is what you would expect for a rural high-desert community.  It’s a one-horse town (it’s actually a seven horse town- those jerk horses run the place wandering through the streets wherever they want) but it lacks nothing in charm or sophistication.  There are only three restaurants, but there is always something to do, from potlucks to  yoga, trail running to ultimate frisbee.  There’s even the random dance party in IHS housing from time to time.  And if you look in any single direction you’ll see some of the most beautiful and sacred scenery you’ve ever seen in your life.  

So I’m heading out to Albuquerque for the night to visit with a friend, get the desert sand vacuumed out of the car, eat at the Frontier, and use some normal-speed internet. After those simple luxuries, it’s up to another Navajo hospital in Shiprock, New Mexico for a few weeks and then off to China.​

If you’re a physician or nurse who has considered IHS but has been scared off by people’s perceptions or comments, I highly recommend you rotate through some facilities as a contractor and get a feel for the system.  I think you’ll be pleasantly surprised at the opportunity to work with great colleagues and a wonderful patient population. 

​As for me, I’ll be back for sure.  I just have the curse of wanderlust to deal with first. 

​

Debt & Reward

Becoming a physician in the United States is an expensive proposition.  Nearly everyone has to take out massive student loans.  Some people get around this by making commitments to service agencies, the military or small towns for an equal number of years of service for years of medical school paid.

​I like the former, borrowed.  Extensively.  

​If you look up average medical school loan debt you’ll get an eyebrow-raising figure.  Well take that, and at least double it.  At least.

​This surprising amount of debt is one of the major things that keeps medical students from selecting Family Medicine as a specialty and pushes them towards more financially rewarding specialties like Dermatology or Radiology.

​But students should consider the  other aspects of Family Medicine that make it amazing. 

Being trained as a Family Doctor in 2013 means that if you graduate from a high-quality program you can take care of adults and children in the clinic or in the hospital.  You can deliver babies.  You can work in the emergency room.  You can work in the ICU. You can inject a knee, ultrasound an abdomen, or console a family as their loved one declines in their health and passes on.  And a wide range of skills means you can work in multiple settings, around the world, from a hospital in Boston, the Navajo reservation, or the ruins of a church in Haiti.

And the intimate relationship of seeing patients over weeks or months or years is a reward in itself.​

I think the flexibility to do so many things as a newly-minted or seasoned Family Doctor, combined with a short or long-term career as a locum ​tenens is the ultimate experience in reward and opportunity.  While anybody graduating from an orthopedics residency or a cardiology fellowship would also have the chance to avoid being locked down to a contract allowing 2 to 4 weeks of vacation a year from their 6am to 8pm days (not counting call), only a full-scope Family Doctor has the chance to work in so many settings.  A Family Doctor can do so many things, never be bored and still earn a living.  And they have the chance to set their own schedule when life and the world present the opportunity to do something amazing.

Last night while during call I managed a complex sepsis patient in the ICU, provided conscious sedation for another Family Doctor in the emergency room as they performed a procedure, counseled a recently intubated young man on alcohol abuse, and took care of a teenager with pneumonia.  

Today I finally paid off the credit card debt that I’ve carried since shortly after I started college.  Something I was never able to consider before.  And now I will focus on aggressively paying off the massive amount of student debt that hounds me, and keeps other physicians from being able to manage their own fates.  

​

What a change from only 9 short months ago.

​ A year ago I was miserable.  Now I work 60% less, make 100% more, have been around the world once already, and am nearly completely free of consumer debt.  I’ve even funded an emergency account for myself.  And I’m still doing critical care and obstetrics unlike many Family Physicians who feel they need to back off of these things to make their lives manageable.  

Life balance is too important, but it doesn’t have to mean sacrificing challenge or financial reward.​

I think any student considering a medical specialty should consider this.​

And I think any person who is in a personal rut should consider the things that are important to them and ask if they are moving forward towards those goals.  If you are not, consider what the next step is- from planning to quitting- and take it.

Being a Family Doctor is the greatest reward in the world.  And tonight I have this small but significant joy of paying off of 16 years of credit card debt to enjoy as well.  That right now is as much as I could ask for over 24 hours.

That and some nice scotch with a piece of good dark chocolate.​

​