Volatile Mood Swing Syndrome (VMSS), or as my husband would proclaim "just being a woman" (and I don't think he's kidding), is definitely a condition from which I suffer. It has been more apparent these days with the shortening of daylight hours as we approach the winter season. Don't get me wrong, I love the fall season, when the leaves turn brilliantly russet and yellow, and there is a crispness to the air and everything just smells good. There is nothing more breathtakingly beautiful than a sunny yet cool fall day when Mother Nature proudly displays her palette of colors. But I don't like the shorter days, and I'm about to get crankier with the end of daylight saving time today.
I'm also what I privately call a "secret worrier". On the outside, I appear to be a well-adjusted carefree individual who doesn't excessively worry about small things. Though I may project an image of serenity, I worry secretly. I obsess about small details, especially about patients who have undergone recent surgeries. I feel a tremendous sense of responsibility for any patients who are at the hospital because I operated on them. It feels very different than having an inpatient who was admitted because of diabetes, heart attack or a stroke since the reason most of my patients are in the hospital is because I did a procedure to put them there. Needless to say, the surgery they underwent was something necessary and related to a medical condition that is beyond my control, but once I take a scalpel to that patient, I am completely and inherently responsible for them and their post-operative care.
There is a definite link between my secret worrying and my VMSS. Recently, I realized that my mood was inversely related to the creatinine level of one of my inpatient. In other words, the higher my patient's creatinine (a kidney function test, where higher levels means declining function), the lower and crabbier my mood. I performed a very big and invasive operation to get rid of cancer, and her post-op recovery period was slow and somewhat rocky. Thankfully, her creatinine normalized 3 days after her surgery, but those three days were not happy. I would obsessively check the hospital computer every hour to look at her vitals, and even on the weekends I was not on call, I would call the nurses to give orders.
I have found it really very difficult (maybe even impossible) to come home and leave my work at the clinic or the hospital. Thoughts of my patients will permeate through my mind at random times, and will insinuate themselves into my subconscious and my dreams. It is the price you pay for being in medicine, and it is truly part of being a doctor.
Sunday, October 29, 2006
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15 comments:
So true. I still remember a colorectal surgery attending's words. We were discussing career things and how big surgeries were more fun. He said that big responsibilities come with big surgeries. I don't even think the residents really understood that, because although they were the main ones taking care of the patients, in the end, it was still the attending's patient...
We secret worriers should start a club--we could all sit around smiling while we develop ulcers :). I would like to think that all docs care as much as you do. I bet your patients appreciate you very very much!
I totally understand and share your syndrome. My mood was very directly related to how my patients were doing. So much so that there were times when I wondered if I was psychologically suited to be a surgeon. Of course, being completely unconcerned would signify a potentially dangerous surgeon. One of my senior partners had the ability not to stew, saying "I did my best," and he was not uncaring. I wish I'd had more of that. I might not have burned out so young. So you gots to find the balance somewhere.
So it is true that many docs have an obsessive compulsive personality... especially surgeons?
Thanks a really interesting blog
nice
***It is the price you pay for being in medicine, and it is truly part of being a doctor****
Or maybe it's why you were attracted to medicine and it's part of being a good doctor! : )
Like Sid said, there has to be a balance, but I'd sure like to think my doctor "worried" about me like that!
: )
I truly envy those docs who can just relax knowing they have done their best, and don't spend their wakig (and sleeping) hours second guessing themselves or being wracked with guilt for any mistake they have ever made. I love to think my worrying (or is it anticipatory guilt?) makes me a better doctor, but I'm not sure that it does. Some of the best docs I know seem to have it all handled so much better than I (and I know they are not just covering it up).
As much as we wish we can leave our work at the hospital it never truly goes away
If you know a doc who doesn't do a lot of secret worrying, I'll call him/her a bad doc to his/her face. It's good to care.
This post mirrors my emotional state after doing a major surgery. And here are lots of comments from other docs who also react this way. Then how come nobody ever mentions it? This is the first time in 14 years of doing surgery that I've heard this discussed and realized I'm not the only one obsessed with how my postop patients are doing. I take that back, I know a great ER doc who used to be a general surgeon but could not deal with the possibility of postop complications.
Excellent insights, and the above shows you are an excellent physician. I'll echo what a lot of ppl have said above, and if you hadn't have written the last sentence, I would have. I especially ditto what FatDoctor said -- a doctor that doesn't worry is a bad doctor. Period.
I'll even go one step further--show me a surgeon that isn't significantly a perfectionist, and I'll show you a butcher.
I think worry and obsessiveness are part and parcel with the job, but there are diminishing returns worrying more after a certain (personally defined) point. I don't have patients yet, but in so many other areas of my life, I'm still searching for that point. Let us know when you figure it out to help clueless ppl like me. :)
Gosh, I'm glad to know that I'm not the only one who calls in to find out about patients on my days off. But the knowledge that burn-out will hit me if I carry on like this scares me. And even more so, the fact that I'm only 3 months into working as a doctor.
Hello,
Are any of you considering leaving medicine? I am a licensed Social Worker collaborating on a documentary with a doctor who is board certified in emergency medicine. We are both deeply discouraged with today's healthcare system and are leaving our careers to film this most important documentary. It is our hope to educate viewers that many of today's physicians are suffering for a myriad of reasons (insurance,malpractice,documentation, defensive medicine, etc., etc.). If you are a discouraged physician, we'd like to meet you. I can be reached at npando@pandoassociates.com
Thanks.
Nancy
This is not something reserved for women. In my house it is the other way round. I worry, my wife tells me to chill and to not put myself into and early grave.
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