“One damn thing after another”

I kept seeing this book, “Burnout: the secret to unlocking the stress cycle” by Emily Nagoski, PhD, and Amelia Nagoski, DMA, recommended everywhere. It’s been in my Amazon cart for a while.

I went to the doctor for the first time in a long time a couple of weeks ago. Decided I needed to take control of my health after COVID, now that my whole family has been vaccinated and I feel like we’ll live, at least from this threat. I didn’t realize how much in survival mode I’d gotten. And I realized just how unkind the last year of pandemic “just keep swimming” behaviors and thinking had been to my health. No big worries – labs are basically normal, and I’m getting on track to fix the rest.

So I finally quit avoiding thinking about it, and downloaded this book. The first part of it talks about the stress cycle- doing something to relieve the physical toll stress plays on your body – exercise, mindfulness, dancing in the kitchen – whatever works for you. Learning to reframe experiences to satisfy your “monitor”. And unlocking your why – your purpose.

The second part talks about how “the game is rigged.” Meaning, women in general don’t start on a level playing field.

The part I found particularly interesting today was talking about rat research into chronic mild stress. “Rats may be deprived of food and water for unpredictable, not dangerous periods of time; cages tilted at a 45 degree angle for a few hours; water poured on their bedding; strobe lights flashed for hours at a time. Everything is just a little bit too hard, so that every day, bit by bit, the survivable helplessness eats away at them.”

This is described in terms of patriarchy – the chronic learned helplessness of women who have to fight just a little too hard to make the same gains as men.

I’d submit this also describes pretty much all of medicine. I’ve called it “death by a thousand papercuts”. One small thing after another after another that adds up to making work unsustainable. It’s, as the authors describe, “a constant, low level stream of stressors that are out of your control.”

One damn thing after another.

“Just add this one click” in the EMR seems like not a big deal – until you have that added to your plate monthly for years. “Just add this one form” seems like nothing – until each visit has 10 forms associated with it, that change periodically.

So why do we get so upset about it? Because it’s been 15 years of “just one more thing” that have compounded to create a backpack full of bricks that weighs you down till you can’t move. The ever- growing litany of all the things that only the physician can do – in addition to the business of taking care of the patients- makes you not want to come to work anymore.

We used to have help. Our employees used to be able to take administrative tasks off our hands so we could use our hands and our brains to do what we were trained to do: heal people. Relieve pain and suffering.

What to do about it?

We won’t fix the system all in one week or month. Just like the straws were added to the pile one at a time, we need to remove them little by little (or at least keep more from being added). Get involved. Defend the viewpoint of physicians. Ask why this task has to be done by the physician. Suggest a workflow that removes administrative tasks instead of adding them. It’s exhausting. We won’t win every day. We won’t reverse things in a huge wave. But little small wins make me feel like I have some agency to keep things from getting worse – which helps me. The book describes this in the context of discrimination against women as “smashing the patriarchy a little bit every day”.

I have a partner in my practice who asked me why I spend my time doing the extras instead of just seeing patients which is what makes us money. My answer? Because it makes me feel like I have some agency to change things that I don’t like about my job. Perhaps if a lot of us in medicine work together, all of our little wins – our daily “smashing”- will eventually add up to progress over time.