19 November 2021

Clinical medicine: it’s over between us

Comment Mental Health

Dear clinical medicine,

I’ve fallen out of love with you.

There, I said it! But I feel so much guilt when I speak these words out loud or even when I admit it to myself. 

All of our medical training focuses on clinical work, it becomes our identity, so when you realise that you want, or need, something different, it seems treacherous. 

Immediately I feel like an outsider to my profession. Will I no longer be seen as their colleague? Will others shake their head when I walk by? It sure feels that way even if it isn’t in fact the case. 

There is a specific day that always floods back into my memory when I think of my clinical practice, because for me it highlights the multiple factors that I think contributed to my departure. On this day, I walked into my clinic, was told a few comforting words following the suicide of a young person whom I had occasionally seen in my rooms, and was simultaneously handed my patient list with what felt like an expectation to suck it up and get on with business. 

Instead, I walked straight into a colleague’s room, broke down and subsequently got the permission that I felt I needed to go home for the rest of the day. I was swamped with so many emotions, not just from the tragic loss of this young person’s life, but from other patients that I had treated in emergency departments and ICU following their suicidal attempts. It all came flooding back. No care was offered to me then and no care was offered to me now. So, I turned around and walked out the front door.

When I look back on this day I see three things: my patient, my work and myself. As a female GP, my patients frequently see me for psychological reasons. The desire to help is there but over time it can take its toll. 

Secondly, like it or not, general practice is a business and like any business it has its own complexities including the need to keep it financially viable. Providing patient care continues to get more challenging and more expensive yet funding models never keep up. I won’t go into the details as I am sure most would be aware of the struggles but I will say that it does add to daily grind. 

Thirdly, there is me. I have come to accept that I have a high level of empathy which may be good for my patients but can be terrible for me. This, coupled with both vicarious and personal traumas, makes clinical work harder than I wish it was. Plus, maybe my interests and passions have grown and changed over the years to now lie slightly outside of the purely clinical construct. 

Maybe there are others who have fallen out of love like I have. Maybe their reasons are different. Nonetheless, these were mine.

My last drive to clinic was the last time that my hands trembled and my heart beat far too fast. It was the last day that I counted the number of patients that I needed to survive to get to the end of my day. It was the last day that my body felt drained from the outpouring of empathy. It was the last night that my kids had a mother who felt emotionally drained and mentally absent because of her working day. 

That night I slept amazingly. My mind rested and healed from all of the stress and burnout that it had endured over the years. 

My next day was busy but a different kind of busy. I worked hard and accomplished a lot but I came home with a smile on my face and pep in my step, and I knew that I had made the right decision to step away. And yet, despite this, the insecurity and the guilt continues.

Several years ago a colleague likened her departure from clinical work to going through the grieving process. I now understand what she meant. Unfortunately for me, I feel stuck in a few of the stages. I don’t know how to completely let go. I don’t know how to truly accept and be comfortable in my new place in life. 

What I do know is that I feel stupid for feeling this way as I am so much happier and content with the work that I now do and the life that I now live. My roles allow me to make positive changes to healthcare systems that inevitably improve the working environments of my clinical colleagues and their patients. 

Surely this should cancel out the guilt of saying goodbye, but it doesn’t entirely. I still find myself explaining to others that one day soon I will restart clinical medicine. Interestingly, every night after I contemplate actually doing so, I find myself waking from nightmares of the worst clinical day imaginable. Deep down my mind and my body know that I have found my place and that I probably shouldn’t be going back – so I don’t know why the rest of me cannot catch up with this knowledge!

I am humbled by the work that my clinical colleagues do. But we need ambassadors that fight behind the scenes to improve the healthcare system. Their successes can have such far reaching benefits for us, our patients and our communities. I know this now and I am proud of this fact, and I like to see myself as one of these ambassadors. But while I already love the non-clinical work that I do, I hope that one day I can also love myself for doing it.

Kind regards,

Me

PS Maybe, in years to come, the clinical love will come back, but for now this is it and this is me.

The author has asked to remain anonymous for the sake of her clinic colleagues and patients 

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6 Comments on "Clinical medicine: it’s over between us"

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Jan Orman
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Jan Orman
16 days 16 hours ago
Thank you Dr Anonymous! You have articulated very clearly the things that I have been thinking and feeling for many decades. I knew a long time ago, perhaps even as a medical student when I realised I was doing the wrong degree but did not have the courage to change, that clinical practice would not be good for me. Despite that, social pressure (and possibly my own cowardice) kept me studying and practicing for a lot longer than I should have. I have loved my patients and felt privileged to hear their stories and help them when I could but… Read more »
Cornelius Nydam
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Cornelius Nydam
18 days 10 hours ago
A great article. It certainly resonates in parts with my journey. Although I have always worked for a salary in the public system. I figured out quite early that I didn’t need to pressure of running a private business. I had a mid career meltdown and it was looking back the best thing that happened to me. I learned to take a leaf out of Anton Chekhov’s play book ‘Medicine is my lawful wife, and literature is my mistress. When I get [fed up with] one, I spend the night with the other. ‘ For those who do not known… Read more »
Dr Michael Axtens
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18 days 10 hours ago

Dear “me”. You might like this piece I wrote a while ago when facing a similar “nervous breakthrough”. I felt the need to create “compassionate personality disorder” You too might be a “sufferer” http://hiddenmeming.blogspot.com/2012/12/compassionate-personality-disorder.html?m=1

Anonymous
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Anonymous
18 days 13 hours ago

Can I join you!!

Dr Zoe McInally
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Dr Zoe McInally
19 days 2 hours ago

So true! We are taught that empathy is necessary for patient centered practice but not given the tools to manage our own emotions. I just listened to a fascinating discussion between psychiatrist, Frank Anderson, and clinical psychologist, Mathias J Barker (Mathias has an excellent podcast, imaginatively called “Mathias J Barker Podcast”and it’s the episode from 23 Sept) that focuses on empathy vs compassion (they are not the same!) Highly recommended.

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