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
