I happened across this old post on approaching retirement today and reread it. Of course, I am biased but it holds up well. It contains information about psychiatrists retiring that you will not see anywhere else – including why we are happy. I currently spend much of my day doing the usual chores, exercising, and writing. I have several writing projects going and am near completing one that is unique.
I don’t get out much and I like it that way. I am an
introvert and have been subjected to the usual jokes about introversion. The pandemic was a factor but not the only
one. I just got back from working out in a
gym that has Cybex machines. After that
I went to Target to pick up a supply of blueberries and frozen burritos.
On the way out – I stopped to get a mocha and 2
biscottis. The barista was young and we talked
about the closing time of the coffee shop relative to the store. I associated
to what I was doing at that age. I was a
janitor in a dormitory. It was a thankless job.
Luckily with increasing college experience I was able to move on to more
technical work as a lab and research assistant. I
wondered if she would reflect on her work as a barista when she got to be my
age and I sincerely hoped she would get to my age and beyond. I thought about writing a poem about that brief
encounter, probably because I had just read two Emily Dickinson poems and
have a history of writing free verse in the style of ee cummings.
On the drive home, public radio was playing election
coverage from South Carolina. It was the
GOP primary and I shut it off. I always have public radio in the background –
but listening to this is just too much.
I drove, drank my mocha and crunched on my biscotti in silence. I had
some thoughts about biscotti. A competitor
has a much harder biscotti. It is so
hard the almonds are cut sharply with the slices. The biscotti I was eating was not as hard but
still had an almond and vanilla crunchy taste.
I started thinking about a paper I was writing. Even though
it was about rhetoric, it seemed quite exciting. I have not encountered any papers like
it. I thought about where it should be
submitted and how I should modify the introduction. One of the most insightful and
informative books I have read lately was about rhetoric. It tied together so
many things. The author was gracious
enough to respond to two of my emails. I
need to incorporate more of his concepts into the paper – but his book is encyclopedic.
I thought about some advice I had given lately. Even though I am retired and people know it –
they still call me. I tell them that
technically I am not treating them or directly giving them medical advice
because we do not have a physician patient relationship, I don’t have a working
office setting or records, and I don’t have malpractice coverage. They understand that and it doesn’t deter
them. I am licensed and recently contacted
the Board of Medical Practice about continuing medical education (CME) credit
reporting this summer. The pandemic created a lot of confusion about deferred
CME reporting. I need to report 75 credits and I
currently have 74 with a 6 CME credit conference in March. I wonder how long I will keep that up in retirement.
On the home stretch, I think about the advice I have given
people over the years. The qualified
advice on the system over the past 2 years tells me how bad things have
gotten. Parents calling me about their
adult children who are not doing well.
Adult children calling me about parents who are not doing well. The occasional email directly from a person
who is dissatisfied with treatment. Many calls about what happens in emergency
situations. Many calls about what specific diagnoses, imaging findings, and labs really mean. Was the emergency department
trying to talk me out of being admitted? Why wasn’t I treated with
anything? It just seems like I sat there
a long time, nothing happened, and they sent me home. Are these side effects that I am getting from
this medication and what can be done about it?
Are there any resources out there that can help me? I don’t seem to be
getting any help?
I try to help people negotiate available systems and help
them prioritize what should happen first.
There is a general reluctance to call their clinic or doctor and report that
there are potential side effects. Overall, there is a lack of help for
people with psychiatric disorders. I know that is not strictly true and that
there are many large systems of psychiatric care nearby – but even when people
get in - there is difficulty getting what they need. I shock them with basic
information about when to call their doctor and what might be helpful to
discuss. I never second guess their doctor. I am focused on how to help them get the answers they need. It is not at all like practicing psychiatry. The most valuable product of that work is a patient who feels understood at the end of the session. None of the people calling me feel understood at even a superficial level.
Just a few years ago, I was an insider working in an intense
hospital environment. I was generally feeling the stress all day long. I had
the physical manifestations of that stress that were measurable – but I pushed
through every day and made it home to unwind.
In some cases I could not unwind and ended up calling my nursing staff
at 2AM to make sure that things were going OK.
I think about that right after thinking that I should still be working –
just based on all these systems problems that people are telling me about.
I come to the realization that I can’t do it anymore.
Cognitively and technically it is certainly not a problem. I have no doubts
that my diagnostic and treatment skills are still there. Physically it is an
interesting story. I just lifted plenty
of weights and will lift more tomorrow.
My aerobic capacity is very good. I have posted some of my chronic
health problems here on this blog to illustrate diagnostic, pathophysiology,
and treatment concepts. So generally my health is pretty good. That can always turn on a dime. I can’t work anymore because of the stress response. The mental and emotional demands of work
become physical demands and that creates significant problems. Doctors reading
this in those environments know what I am talking about and I wish them the
best because I know nobody is trying to alleviate any of that pressure. Nobody is trying to help them.
I finish off my mocha and biscotti as I am pulling into the driveway. It is 7PM and dark out here in Minnesota. I had over 30 years of pulling in my driveway in the dark after work and still feeling tense and in some cases jumpy about what happened that day. Things are different now. I can decide how much pressure I am under and when I can unwind. I wish I could do more for all these people who need help – but I can’t.
It is time to finally take care of myself.
George Dawson, MD, DFAPA
Supplementary:
@dahlle on Twitter read this post and posted the NASA Task Load Index - a workload measure that has been validated across a number of settings. Just looking at the scales - it is easy to see how physicians can max out almost every scale except for the physical demands (at least for non-surgeons). With enough stress - heart rate and blood pressure increase just like you are running.
It is also an illustration of how things can get rapidly complicated when there are people actively standing in your way and other people demanding that you do more. Work setting is critical here as well as adaptation to work. I have talked with hospitalists who told me their cognitive performance dropped off steeply on day 6 (of 7). On the other hand I have talked to physicians who were used to seeing 30 patients for a minute or two at a time in an afternoon who were not stressed at all.
Graphics Credit:
Biscotti is via Wikimedia Commons. https://commons.wikimedia.org/wiki/File:Biscotti_1.jpg
Mokkie, CC BY-SA 4.0 <https://creativecommons.org/licenses/by-sa/4.0>, via Wikimedia Commons
