Last month a patient sent me an essay from The New York Times ("How Mindfulness Can Make for Better Doctors," Oct. 15, 2009) which cited a study showing that meditation and mindfulness can help combat physician burnout. The columnist, Dr. Pauline W. Chen, spoke of an older colleague whose love for what he does was being drained by paperwork, e-mails, and other sundry joys of modern medical life.
It's only natural to compare yourself with others close by in time, place, and situation. Nobody ever says, "Times are tough, but I'm a darn sight better off than if I'd been a peasant in 16th century Belgium or if I were born in Burundi."
Still, comparative perspective is readily available. All day patients troop into our offices who can describe how things are in their respective careers. Just ask.
There's Janice, a 50ish attorney who left the law firm where she had been a long-time partner to work in-house for a corporation. How come?
"They expected me to spend my social life schmoozing potential clients. That wasn't going to work, so I grabbed this new opportunity," she said. "It is not really what I wanted, but at my age, I figured it would be the best I could get." Janice said she never had to generate business before. "Other people made the rain, and I did the work. But now everything is so competitive."
Then there's Larry, just past 60. He does insurance work and has been trying to develop a retirement consulting business. During the recent financial meltdown he had some success selling annuities to people fleeing what they had thought were safe investments, only now his leads have dried up. "I offered to give talks for free at the local library, but they weren't interested." he said. "Too many other people have already talked about the same thing. Do you know anyone I can approach?"
Marian's been a teacher for more than 30 years. Asked how things have changed, she shakes her head. "We used to use creativity," she said. "Now there are rigid standards and statewide exams the kids have to take, and we have to teach to the test. No leeway at all. I love the children, but frankly, it's not fun anymore. I don't know how much more of this I can take." (Clinical algorithms anyone?)
Stan, himself, is almost retired. "We own a string of doughnut franchises," he said. "But I have younger partners who mostly run it."
Sounds sweet: people line up for doughnuts and coffee, and the owners carry bags of cash to the bank. "How is the economy affecting you?" I asked.
"We're off a little," he said. "And there's theft to contend with."
"What do people steal, doughnuts?"
"Cash," said Stan. "I have had high-tech surveillance equipment, so I can keep tabs on the staff and watch the registers from my living room. Now I leave that to my partners--it takes a lot of hours to watch those tapes. When I started out, I used to sleep in the store. It wasn't just theft, but lots of times the staff just doesn't show up, including the baker. And like the ad says, somebody has to get up to make the doughnuts."
Small business people can do very well, but there's a reason why so many of their children become professionals. As for professionals themselves, conversations with those in law, accounting, and education suggest broad social trends affecting every profession across the board: increased bureaucratization, more government regulation and oversight, less flexibility, more paperwork, tougher competition, more financial pressure, and less of the easygoing collegiality people like to think they remember. And of course there are more faxes, voice mails, e-mails, and other Internet-aged intrusions that blur the line between work and leisure, and reduce the expectation of privacy to near zero.
I haven't even mentioned, of course, those who are out of work altogether, with few or no prospects.
For us physicians, then, it's perhaps worth a moment of mindful reflection on the comfort of working in a respectable and respected profession that will probably never compel us to troll for trade into our seventh decade, or throw us overboard in midlife because we're too expensive or our wisdom is undervalued and deemed expendable, or our services have been re-engineered or outsourced, or because our whole industry has been eaten by Google.
As the old Latin proverb has it: Times change, and we change with them.
We don't have to change, of course. We can always leave or meditate, I guess.