Is Happiness a Value?

Glancing at my blogroll tonight I came across a recent post by Kent Bottles entitled, "How to Practice Medicine in a World We Can Never Truly Understand". While it is a little esoteric for this family doc's brain, reading it jogged my thought processes. He begins by discussing the pursuit of happiness, an ofttimes elusive goal in life. Is it unusual that happiness was never something for which I aimed? The closest value for me was satisfaction. As my children grew, I encouraged them to give the best they could in life--whether that was grades or friends or sports or art. Never once did I suggest they try to be happy. For me, happiness is something one may find, but when you make it a value, now there's a recipe for disaster.

My patients will tell me "I just want to be happy". They believe they will achieve that goal if they marry the right man, find the right job, get the right grades or buy the right ______ (insert necessary object here--car, house, dress, purse). Doing the best job in the job they are in, making the best grade in the most challenging class they feel competent to take, being the best friend to the friends they have...these are not enough. If they are not happy in their job or class or relationship, it is of little value, unless it can be justified as bringing happiness in the future. They search in chemicals to achieve happiness, be that legal (Prozac, Paxil, Adderal, etc) or illegal. If they are not happy, then something must be terribly wrong, even if they are unhappy for legitimate reasons; their mother just died, they lost their job, their boyfriend broke up with them. Their friends encourage them to take medications to be happy again.

This can be a type of cultural divide in an exam room. In the same way that language barriers can reduce good care, value differences make for dissatisfied patients who may intellectually understand that exercise will improve their health but if it doesn't make them happy to do it, it may not get done.

Happiness has followed me in my life many times. Most would consider me blessed. I wasn't looking for it. It's nice to have. But at the end of the day, I don't want to be happy, what I want is to believe that today's accomplishments were the best that could be done under whatever circumstances I found myself.

In other words, satisfaction without regrets. Happiness may follow.

The Three "P"s of Mayo--Patient-centered, Physician-led and Collaborative Partnership

Last week I attended the Mayo Clinic's Annual Social Media Summit in Rochester. What most impressed me had nothing to do with the conference. On Tuesday afternoon before the Summit began I toured Mayo Clinic. It was supposed to be for an hour but lasted more than two because our group, consisting of one doctor and nineteen PR professionals, was so interested in the information being fed to us. I don't know why the publicity folks were so intrigued, but for me Mayo's philosophy of "patient-centered, physician-led" care hearkened back to a time when the patient-physician relationship was inviolate. It was stimulating to realize that my instincts of how medicine is best-practiced are right on target.

My myopic opinion regarding the fragmentation of healthcare sees the destruction of the patient-physician relationship by multiple entities, who are primarily interested in a piece of the economic pie, as central to our healthcare mess. At Mayo, no project moves forward unless there is a physician who champions it and it is the physician's responsibility to ensure that every project is dedicated to improving some aspect of patient care. Physicians are salaried so they spend the time necessary to care for patients and are not incentivized to increase the numbers of patients seen or do procedures to enhance the bottom line. 

Every person I met who worked for Mayo reiterated the importance of putting patient care and comfort first. It was incredibly refreshing. The Mayo logo emphasizes a patient-first policy as well. I'd seen the logo multiple times but somehow never thought about what the three shields represent. Our tour guide explained: Patient care, research and education. The educational aspect was obvious as we walked multiple floors of patient care areas. I noticed no TVs in patient waiting rooms but many had computer screens where patients could learn about their conditions. It is a refreshing and calming atmosphere without the cacophony of media noise. There is art everywhere. Waiting rooms are spacious and well-lit. Meditation rooms and educational spaces abound. 

Children's waiting area

Mayo has always represented excellent healthcare in my mind. Patient reports that come to me after a visit there are extraordinary due to the extent of the integrative care the patient experiences from multiple medical disciplines coming together. I expected to be impressed. I did not realize I would also be reassured. Putting patients first is what I'll continue to strive to do, despite insurance interference, governmental policies or EHR dysfunction.

Burning Out on Friday Afternoon

Recently a Mayo Clinic sponsored study reported that the rate of physician burnout was much higher than other careers in the US[1], especially among front-line specialties like Family Medicine. This Friday afternoon in preparation to seeing my last patient it hit me "Is this sensation burnout?" Inwardly groaning--a new middle-aged woman with obesity and several psychiatric meds, my thoughts ran to "Who put her on my schedule damn it. It's Friday afternoon. What did they think they were doing? Doesn't anyone care about MY needs when they're scheduling" or words to that effect. For a few moments I pondered my office life.

Lately, my office looks cleaner, because EHR (electronic health records) hides the mass of unfinished charts instead of having them all stacked on my desk. Now there is no obvious sign of all the work I do--no notice to my employer that I am an important, busy and valuable doctor. Despite the reduction in mess, I rarely leave the office before 7, often am there until 9 and everyone keeps telling me that it will get better, since we're only four weeks "in". This is exhausting me but at least my husband frequently meets me at the door with a glass of wine in hand. For this I am grateful since sometimes I finish up my charts on-line from  the couch.

Then there's House Bill 1, the irritating and unfriendly-to-patient-care narcotic bill that takes up extra time and deprives my patients of therapeutic medications and remains a thorn in my side.

Add to those aggravations the everyday frustrations of practicing medicine in today's fragmented healthcare system and maybe I needed to worry. This line of thought hit me as  I took a big breath, walking in the door expecting the worst and spent the next thirty minutes with a delightful woman who was already taking steps to improve her health. She was working with a trainer, she'd already started losing about twenty pounds. She was upbeat and interesting and I walked out of that room energized.

This Friday I got lucky. Maybe next Friday I'll be drained. Reflecting on the end of my day I realized that's just how the rhythm flows in Family Medicine. Like most professions, some days are better than others, but looking at the averages, my curve is mostly on the up. I still like what I do.

1. Shanafelt, Tait D. Burnout and Satisfaction With Work-Life Balance Among US Physicians Relative to the General US Population. August 20, 2012. http://www.webcitation.org/6AtdqOc4p