I have learned

I have learned again that I have a great group of colleagues and friends from around the world and that I can call them at any time and know that they will listen and help me with any problems I might be encountering.  In retrospect I’d be wiser to reach out sooner rather than stew and worry and jury rig solutions on my own.  I know I have friends close to home but these friends I’ve known and shared with for 20 years have insights into similar problems and concerns. In one case what I thought was a local insane administrative problem reflects some ideological move which is happening far and wide and causing untold suffering for patients and doctors. Yet it’s an idea that has infiltrated the wee pee sized brains of the stupid and taken root like the holy words of Marx.  Some as yet unidentified health administration ‘prophet’ has infected these folk causing sickness in middle management, a kind of arrogant brain fever.  I am not alone. I felt so alone.  Yet British doctors and Australian doctors and doctors all across America and Canada are seeing the same insanity and the victims of the mental aberration don’t even perceive themselves as having this idiocy.  They collectively lack insight and react aggressively to anyone who tries to point out their derangement. They are definitely not willing to change and in the precontemplation phase regarding any willingness or motivation to change. So we do best to detach with love. Most of us can’t leave or don’t want to.  All of us seem most to love helping patients and serving our fellows so its a bit of a muddle right now for a wide variety of reasons, mostly the lack of education of management, their faulty models, aging populations, chronic disease and unfunded political promises. The tendency to ‘blame’ the individual doctor for systemic flaws simply reflects their own fear and aggressiveness.  It is best to stay safe.
I have learned that there are new medications that are indeed curative despite their side effect profiles and well worth a trial where all else has not been working. The costs of the new research are high but the cures are indeed amazing. There is hope for much with modern medicine. In the field of addiction where the reward site of the nucleus accumbens and dopamine tone are identified genetic studies and new medications are coming along. Some 10% of the population, maybe as high as 20% are affected severely by isolation and shaming. The existing legal approaches to the disease are wholly counter productive and politically there is a need to educate politicians, judges, and various others to appreciate the effects of shaming and isolation.  Primitive administrative models which rely on shaming and isolation, focusing on making individuals feel less than, are indeed the social mechanism that fuels addiction.  The monkey models of the effects of isolation and making one feel less than are amazing. The animals have no desire for cocaine before the mistreatment but after exposure to such regressive management become rapidly addicted.  The cost of addiction is simply widespread and misrepresented because of the tendency to see different organ or illnesses as separate when they have the same underlying abnormality of the reward mechanism.
I have learned that there is much benefit in exercise and that mobility should be more the focus than being free of pain.  Mobility is central to the human condition and once mobility is loss a wide range of illness follow.  Addiction is tied to loss of mobility so work with pain must emphasize mobility foremost.
I have learned that street fentanyl is a misnomer compared to the pure fentanyl used by anesthetists. The nature of the ‘fentanyl’ or ‘down’ used by patients is more akin to animal tranquillizer than opiate. I feel remiss in not being on top of the chemistry of these agents and will when I am home research this more as there may be insights to be had regarding addiction and substance.
I have learned more about the models of health care delivery and that there is a political buzz word ‘universal health coverage’ which doesn’t mean anything like people think it means. I have learned that Americans in general have no idea what the Canadian health care system functions like. It is apparent that the various health care systems around the world including the American handle emergencies and acute illness well but the problems arise in chronic care and rarer diseases.  It was truly fascinating talking with front line workers like myself about what would actually be done for individual cases and how similar the deficits were for the homeless and that access to medical care varied dramatically especially for the rural folk,  It was a wholly different discussion than the political disinformation and misinformation ideologically driven by media.
I have learned that I really like having discussions with colleagues about religion, politics and health care, and all manner of matters because not one of them belittled or abused me for an opinion different from theirs.  It was interesting that there were so many differing political opinions regarding the present President, those who clearly hated him and those who loved him but no one became violent or offensive but instead stated simply how the regime change was affecting them personally.  I was fascinated by how down to earth the people were and how gracious, more than me by a lot, those were who had been exposed to the 12 step. I found the parents and grandparents even more gracious and just a true joy to be around.
I have learned that the vast majority had benefitted from 3 to 5 year monitoring and that a restrained approach consistent with other socially affected models which didn’t demonize patients was truly effective.  Given that many diseases affect performance it was enlightening to see alcoholism and addiction compared with other illness and the kinds of monitoring which were appropriate for these.
I have learned once again that I learn more talking to colleagues with similar experience and training in a hallway than I do in a lecture theatre at my level of experience and age.  I am so thankful for the many conversations I had with senior colleagues, most now retired, two of my favourite psychiatrists sharing about their retirement this year, what they are missing, why they left, what their plans are.  I also learned that several enjoyed cutting back their practices and continue to work. I noted that most had moved away from the soul sucking models of management and were less driven by monetary concerns as by respect. I laughed at a colleague describing reducing his day because he realized he was too old to live long after treating more than one ‘death star’ patient a day whereas in his previous model of care he was treating a half dozen of these unmotivated chronically angry and demanding patients which he aptly named ‘death stars’.  I liked that together we could talk honestly and that political correctness was eschewed because we all were in the front lines and our compassion wasn’t just the matter of fancy word, virtue signalling and sound bites but reflected years of compassionate care and service.  Among ourselves no one derailed the conversation with the stuff that duels dealt with in the past but rather we discussed better what to do with ‘death starts’ and how best to survive and manage the experiences.  Interesting to me they were not limited to psychiatry but a common concern of specialists, if not more so than generalists.
I have learned that my colleagues are accepting care from their colleagues and many have had really good medical care, knee surgeries and heart surgeries and investigations and are alive today because of the success of medicine today.  That gives me hope as I age and fear the politics of health care and am afraid of dependency.
I have learned that I have been short and inconsiderate at times, allowed myself to be over extended and been insensitive to others. I have learned that I must review my own behaviour and responses daily and that I must apologize for my omissions and errors more quickly. I am aware that the deaths of my brother, my best friend and another close friend plus the severe illness and insanity of two close friends, the surgical removal of my dogs eyes has all caused me to be less attentive to those around me but that while I feel I'm running on 6 cylinders rather than 8 I'm not alone. Those others around me are normally equally stressed though differently. I have examples around me and an idea of the person I would most like to be and while the demands have escalated exponentially, and the number of angry and threatening and entitled people is disproportionate there is much I can do about my response. Daily review is something I have let slip and I need to be more proactive about this self reflection. My greatest mentors have died or are sick themselves so I must do more about shoring up my defences. Meditating more and praying more are showing benefit but I must exercise and surround myself with more positive relief from work given the death and disease where I am.  I must if I am to continue say no to the outrageous demands of the needy and co dependent and accept the adage physician heal thyself and be proactive and say no more not less. I have to put a premium on my spiritual well being and on my life because the truth is there are too many today who have not been socialized and they exist in low and high places.
I have gained so much hope and appreciated most the examples of my superiors and the laughter.  I loved learning all the personal challenges friends had and that they carried on. I am left wanting to emulate these men and women who have so often as indivduals and doctors set the example that has helped me carry on when I’ve been overworked, stressed, lonely and afraid.  I have learned that if they can carry on, so can I so I’m near the end of this conference looking forward to return.