2022-04-08不要再告诉医生要更有弹性

I’ve come across several articles recently highlighting the Dr. Lorna Breen Healthcare Provider Protection Act. The primary stated intent of this is “to improve mental health among health care workers. It is named in honor of an emergency physician who died by suicide during the height of the COVID pandemic.

我最近读到几篇文章，重点介绍洛娜·布林博士的《医疗保健提供者保护法》。其主要目的是"改善卫生保健工作者的心理健康"。它是为了纪念一位在新冠肺炎大流行期间自杀身亡的急诊医生而命名的。

Although my very first thought was, “oh, thank God … they are finally listening,” that was quickly replaced with a sick feeling in my gut. Why? Because I realized that, like almost every other “resource” available to promote mental well-being in health care workers, the word resilience would inevitably show up. I looked at the official wording of the law and yep, it’s there. “Identify strategies to promote resiliency.” Sucker punch to the gut.

虽然我的第一个想法是，“哦，感谢上帝……他们终于倾听了”，但这很快就被我内心的一种恶心的感觉所取代。为什么?因为我意识到，就像几乎所有其他可用于促进卫生保健工作者心理健康的“资源”一样，“弹性”这个词将不可避免地出现。我看了法律的官方措辞，是的，它就在那里。“确定提高弹性的策略。”一拳打在肚子上。

I can obviously only speak from the physician’s perspective, but I feel the anger welling up inside me every time I see this word. If you want to find a group of resilient people. you don’t need to look much further than a gaggle of doctors. We spend seemingly endless years studying, four years in one of the most academically grueling settings and then we do residencies which involve anywhere from 3 to 7 years switching rotations every 30 days, constantly adapting to new surroundings and expectations.

很明显，我只能从医生的角度来说话，但每次我看到这个词，我都感到愤怒在我心中涌起。如果你想找到一群适应力强的人。你只需要找一群医生就行了。我们花了似乎无穷无尽的几年时间学习，其中四年是在最艰苦的学术环境中度过的，然后我们做住院医生，涉及3到7年的时间，每30天轮换一次，不断地适应新的环境和期望。

We are simultaneously learning and making decisions (though with oversight during residency) that can single-handedly change the trajectories of our patients’ lives. We do this at the expense of our personal lives. Many of us delay dating, marriage and/or childbearing due to the demands that come with medical training. But we do this because we have been called to this profession. We sacrifice many things to be able to walk alongside patients as they navigate serious illnesses and the complicated health care system. We spend days continuing to fight for our patients with the storm cloud of insurance companies, regulations, ever-increasing administrative burdens hanging over our heads. Resilience? I’d say we have that in spades.

我们在学习和做决定的同时(虽然在住院期间有监督)，可以单枪匹夫地改变我们病人的生活轨迹。我们是以牺牲个人生活为代价的。由于医学培训的要求，我们中的许多人推迟了约会、结婚和/或生育。但我们这样做是因为我们被召唤到这个职业。我们牺牲了很多东西，以便能够与患者一起应对严重的疾病和复杂的医疗保健系统。在保险公司、规章制度和不断增加的行政管理负担笼罩在我们头上的阴云中，我们花了几天时间继续为我们的病人而战。弹性?我敢说我们肯定有。

I recently spent some time doing practice questions for my hospice/palliative medicine board exam. I distinctly recall one question. The question stem presented a situation with a female physician who was suddenly becoming short with patients, angry with staff, and generally very cynical and jaded. I instantly recognized this physician. It was me. This was how I spent my last year in primary care, the most difficult year of my life thus far.

最近，我花了一些时间做临终关怀/姑息治疗医学委员会考试的练习题。我清楚地记得一个问题。问题是这样的:一个女医生突然对病人很不耐烦，对医护人员很生气，而且非常愤世嫉俗和厌倦。我立刻认出了这个医生。这是我。这就是我在初级保健中心度过的最后一年，这是我一生中最艰难的一年。

I was enraged to find out that the correct answer was “Approach her with your concerns and suggest that she take advantage of resiliency training.” When I realized that this was the correct answer, the tears immediately began to flow. Tears of both sadness and anger. This is an absolute slap in the face for all physicians who are just barely getting by, digging deep for every ounce of empathy and compassion they can muster in the midst of severe mental angst from dealing with a ridiculous health care system. The same system which puts inhumane demands on its physicians and then has the nerve to suggest yoga, meditation or a pizza party to improve morale.

我愤怒地发现，正确的答案是“把你的担忧告诉她，并建议她利用弹性训练。”当我意识到这是正确答案时，眼泪立刻开始流了出来。悲伤和愤怒的眼泪。这绝对是对所有勉强度日的医生的一记耳光，他们深挖每一分同情心和同情心，因为他们在处理一个荒谬的医疗保健系统而产生严重的精神焦虑。这个系统对医生提出不人道的要求，然后又有胆量建议瑜伽、冥想或披萨派对来提高士气。

I truly hope that this new law does make it easier for physicians to access mental health services without the repercussions of having to report this every time we renew our licenses. But, here’s a thought. Perhaps Congress could also spend its time trying to actually address the root cause of the problem.

我真心希望这项新法律能让医生更容易获得心理健康服务，而不是每次我们更新执照时都不得不上报。但是，我有一个想法。也许国会也可以花些时间来解决这个问题的根本原因。

Stop forcing physicians to see patients in 10 minutes. Stop incentivizing invasive procedures and testing and put more emphasis on giving physicians the time they need to properly address concerns. Force the insurance companies to stop practicing medicine. Allow us to actually put the patient first. Stop trying to fix the physician when the problem is the system.

不要强迫医生在10分钟内看完病人。停止对侵入性程序和检测的激励，更多地强调给医生适当的时间来解决他们的担忧。迫使保险公司停止行医。让我们把病人放在第一位。当问题出在系统上时，不要试图去解决医生的问题。

I have finally found a niche in medicine where I am allowed to spend time with my patients and to provide the care that I deem necessary. I am forever grateful for the convoluted journey that has led me to this place. I am so lucky, and beyond grateful, to work for a health care system that does very much value its clinicians. We have forward-thinking leadership who have gone far beyond the insulting suggestions of lunch-time yoga and meditation. But, I can promise you this. I will never stop speaking out for those who aren’t this lucky.

我终于在医学上找到了一个合适的位置，我可以花时间和我的病人在一起，并提供我认为必要的护理。我永远感激把我带到这个地方的曲折旅程。我很幸运，也非常感激，能为一个非常重视临床医生的医疗保健系统工作。我们有远见的领导，他们已经远远超越了午餐时间瑜伽和冥想的侮辱性建议。但我可以向你保证。我永远都不会停止为那些没有这么幸运的人说话。

Lauren Roth is a family physician.