I spent 2017 deep in resistance. I fought against systemic injustice, inequality, and oppression, both in my personal life and in my work as a psychiatrist in training. That fight, coupled with the stresses of residency, brought me to the end of the year knowing I would need to make changes for 2018.
I’ve decided to say “no” more often. I’ve decided to examine the bad habits and the behaviors that cost me time but give me little in return. I’ve decided to make mindfulness a continuous practice. And I want to read more, so that I can further learn about empathy and understanding. And I’m doing all this so that I can continue to fight for equality, in and out of the hospital halls.
But in the goals I set for myself as a doctor, and as a person, comes the realization that much of my experience comes in the system that employs me, and that my efforts to change in some cases, depend on structural changes to how medicine is practiced.
I’m making every effort this year to do my part. Here’s where I think medicine, could, and, sometimes, is trying to, meet me halfway.
In a system built on decision-making, sometimes calculated and sometimes split-second, comes my stark experience — making decisions is tremendously difficult. Some of my patients are paralyzed in their fears of making the wrong choice, whether in a therapy session debating the merits of changing careers, or in intensive care when deciding to withdraw life support for a loved one.
I have trouble with decision-making, too. When having to rank my residency choices, the internal and external debates over minute differences in reasonably equivalent programs was agonizing. I wasn’t just making a choice for myself, but for my husband as well, and my choice had to make us both happy. Happiness is a moving target — it’s hard to take aim. I wasted a lot of time second-guessing myself.
With my next big decision, instead of asking if I’m making the best choice, I want to ask myself if my needs are being met.
Medicine needs to empower our patients to think like this, too, and getting them to fill out advanced directives is one way to do it. Outlining goals in advance will help doctors and patients and their families make hard decisions with the happiness and confidence and of knowing their choice is good enough.
In 2017, I wrote about a friend who is affected by Deferred Action for Childhood Arrivals— every major choice she’s made in her career as a primary care doctor has been looking over her shoulder in fear of being asked to leave a country she entered as a child.
American health care is sustained by the efforts of immigrants at every level — from doctors to nurses to people who work cleaning the halls and serving food in the cafeteria. The medical system has invested heavily in the education and training of doctors like my friend Raquel. The American Medical Association has spoken loudly against efforts to end DACA.
Last year, hospitals rallied to keep their immigrant doctors and scientists free of visa dilemmas created by the president’s executive order. This year, administrators and staff need to rally again on behalf of noncitizen Americans whose livelihoods they have invested in. If Hollywood actresses can build a legal defense fund for women affected by sexual harassment, I think the medical profession can do the same for our colleagues who might be affected by changes in this law.
I have never had to negotiate a salary — in medicine, we go from school, where we don’t get paid, to residency, where our pay is standardized. Yet, I know what comes after. Women, especially black women, are underpaid in medicine compared to men, and I will soon be looking for work, needing the confidence — and experience — to advocate for myself and my financial equality.
Meanwhile, in dental school, my husband took courses on negotiating. He learned some of the basics of running a business. He left school not just a dentist, but a dentist who knows about things like overhead and negotiating lab fees, which he might need later to manage his own practice.
Medicine needs to do the same. It needs to teach its young doctors about the financial side of being a physician. When I first started writing, I gave my words away for free. I didn’t want to be seen as demanding, but this was work, and I wasn’t being paid for it. I need to get better about talking about money. Medicine needs to do the same.
I am an optimist. I became a doctor to help people. Most of us did. But, when you treat patients who hurl insults at you, call you demeaning names, assume you are not a doctor, or refuse to be treated, as much as you try not to take these barbs to heart, they do hurt. It’s exhausting to carry around this anger and bad energy, especially with no outlet.
A few weeks ago, I learned to run a therapy group and we started with a simple meditation that was supposed to promote mindfulness. It did, and now I carry the words of this meditation with me as I treat my many different kinds of patients.
The mental health of medical professionals is a major concern, and I know that hospitals are trying to find ways for doctors to relieve stress and decompress from the most brutal aspects of our jobs. I hope this continues in the new year, with more space and structure to validate the toll of stress and trauma on the people who try to heal.
Last year, I was invited to a conference at Harvard Law School by one of my mentors. I was honored to go, but didn’t realize she had invited me to provide expertise in mental health care to judges and lawyers who encounter people who are mentally ill through criminal justice. I felt like throwing up. Despite my education, experience, and pedigree as a Harvard Medical School-affiliated doctor, I thought I wasn’t qualified to speak with these legal professionals.
I want to overcome “imposter syndrome,” this idea that I don’t have the expertise, the experience, and the knowledge to be an authority of some sort in my profession. But I also recognize that imposter syndrome thrives in a medical system that puts white male doctors first — it was intentional on the part of my mentor to put me in the position of expert.
In 2018, I want medicine to continue to look for ways to prioritize women and minorities as experts and as leaders, and to work down the pipeline to reform the thinking and subtle acts that keep female doctors from reaching their potential. After all, in 2017, more women entered medical school for the first time than men. Our profession is changing, and at the highest ranks, we need to prepare.
Time, talent, energy, and money — these are precious resources neither I nor the medical profession can afford to waste. I hope that in 2018, these resolutions can both drive my efforts at resistance forward, and medicine’s efforts to treat people with dignity, all without burning up these precious resources and causing burnout.