Friday, July 1, 2016

What the SRPC wants struggling new doctors to know

Two of my colleagues have had rough years. They asked the online forum available through the Society of Rural Physicians of Canada for help. This is an organized version of what was said by many wise voices. It's also a sanitized version to make sure nothing is identifiable because all of these folks allowed themselves to be vulnerable. I honour that and appreciate what they have shared. If anyone wants to be named and credited, I'll happily edit this post. 

Philosophy

  • it's normal to feel like we don't know everything in our first year of practice
  • lack of confidence is preferable to over confidence, and safer
  • expect moments of doubt, feeling inadequate and incapable
  • medical training focuses on the criticism of our skills, it makes it difficult for us to trust ourselves
  • "It's family medicine, you don't need to have a diagnosis, you just need a plan."
  • you can bring patients back if you need or keep them in the ER to observe them, rural medicine gives us that flexibility
  • you have nothing to prove to anyone but yourself and your patients, it's not a competition any more
    • even if you are the only female
    • even if you are the only minority
  • perfection is the enemy of good - done is better than perfect
  • being a rural doc isn't easy, but it is amazing
  • allowing ourselves to be human makes us strong doctors for our patients
  • listen to your heart about where you should be spending your time
  • "at 72 ... I would say I'm glad I worked less not more."
  • evidence changes constantly, it's ok to give yourself a break on not having everything memorized
  • rural docs expect to have to sacrifice themselves for their practice - our patients and colleagues don't

Generalism
  • just because family medicine is flexible doesn't mean we have to do all the things to be a good family doctor
  • skills can be relearned
  • there will always be something that you think you could be adding to your practice or missing from your community, let it go
  • we need hands in rural Canada, these may be full or part time hands
  • it's more important you are able to help with what you can, even at a reduced rate, than to get into a situation where you can't do anything at all
  • being a generalist can mean different things to different people; pick the way you want to go;  reprise it as needed
  • generalism is a very flexible field
  • doing less rather than stopping something, means that your skills will keep up
  • "there is no proven evidence based minimum number of times you do a procedure to be competent"
Practice Advice
  • a part time practice is OK
  • if you don't need an MD to do it, delegate it
  • stop the pieces of your practice that cause you too much trouble
  • money will come, don't let it drive your practice
  • sometimes the reason we come to hate what we are doing because we are doing too much of it, try scaling back
  • adapting what is considered to be "the way things are" to suit your needs is reasonable
  • covering your practice during times of illness (yours or your loved one; mental or physical) is important, but spending time with your family getting healthy is much more important
  • in Ontario, when you need time away, call Health Force Ontario to arrange a locum
Building your Village
  • find a supportive group of colleagues that you can ask for advice
    • we end up knowing as much as our specialist colleagues
    • others will have dealt with what you are dealing with and be able to offer advice on getting through it
    • discuss emotional, philosophical topics in a non - judgemental atmosphere
  • have a mentor who represents where you want to go in your practice, someone at the same level who will understand how much things suck sometimes, and a mentee or learner who will remind you how far you've come and why you went into this crazy business in the first place
  • look for your mentor outside of your practice group so they are able to offer advice without being personally invested in your choices
  • know that once you are through your hard times, you will be an amazing resource to your colleagues
  • "There is a special place in hell for women who don't defend other women." Secretary Albright
  • the SRPC is there for you
Self Care
  • the first 6 months of any new job are the hardest and put you at highest risk for burnout
  • the entire first year is brutal, be kind to yourself and each other
  • we won't always be on our A game, it's OK for us to get the help we need
    • get your own family doctor and use them
    • use your PHP
    • you are allowed to let others care for you
    • what an honour and sign of respect to your colleagues to accept their help
    • you are not your own doctor, don't self diagnose, don't self medicate
  • self care isn't selfish, caring for yourself is important
    • taking time away for your health is forgiveable
    • follow  your own advice and stick to a schedule that includes exercise, eating well, mindfulness
    • see a counsellor
    • do the non-medical things that you love (hockey, reading, playing hopscotch...)
    • rest is not a 4 letter word (going to have to beg to differ on that one, but the sentiment is strong)
  • self forgiveness is essential for self healing; forgive yourself for not being everything for everyone
  • once a week go out on a date with your partner sans children
  • don't use alcohol to make the day better
  • arrange your house so it's easier to live in - big baskets for your bits and pieces can help
Parenting
  • maternity leave can be hard on us, talk to those who have done it about what you can expect
  • check out www.mommd.com
  • lack of sleep affects our brains (babies, stress, work); make sleep a priority
  • post partum depression is a real thing, respect it and yourself enough to ask for help
  • letting your partner parent can be a blessing
  • check out positive parenting
  • trust your parenting skills
  • "Babies don't need a lot of things - they need carrying and feeding and sleeping and diaper changing. And extra attention when they are sick."
Resources
  • it's OK to not know things and have to look them up
  • First 5 years of practice Facebook groups  - one national and a whole lot of provincial
  • Physician Health Program in your province
  • Other MD mommas
  • get an UpToDate subscription
  • buy an Rx Files
  • the Orange Book
  • ask a colleague
  • consider a small notebook or an app like Evernote to keep things you are always looking up