I know that it is cliché to say it, but attitude really is everything. How a person thinks determines the success or failure of a day, a year, or even a life. The good news is that your attitude can change. Even the most ingrained ways of thinking can be transformed.
Most doctors are obsessive/compulsive fixers and I am no exception to the rule. We’re simply wired this way. Not being able to solve a problem leads to frustration and anxiety. When my son was little, he was a daredevil and sometimes it drove me crazy. After suturing several wounds and an ER trip for a broken thumb, I came to the realization that I simply could not keep him safe all the time. I was not going to change him but I could pray for him (and keep praying for him). God has kept him safe even through army helicopter training. His adventuresome nature has served him well although it was a mother’s nightmare when he was young.
Over time, my attitude had to adjust in the workplace as it did at home. If I’m honest, it took about a year to wrap my mind around what I really do on a day-to-day basis with my patients at the Raphael clinic. The shift from private practice to work in a community health center was much more dramatic than I ever imagined. I found myself in a constant state of frustration due to my own attitude. The obsessive/compulsive fixer could not change much of what my patients were facing.
As providers in the medical field, we are all held to certain “quality standards.” Government and insurance agencies set these standards to measure the care of our patients. In theory, quality standards are good, but in reality, they can be nearly impossible to reach. Keeping diabetes under control is one such quality standard. I can make recommendations to achieve this goal. However, a large group of my patients have totally different priorities for themselves than I have for them.
Rightly so, they are more concerned about where they are getting their next meal, not that it is a healthy mix of lean protein and fresh fruits and vegetables. Our clinic is located in a “food desert”. When transportation is lacking, there is no option but to go to the corner store that carries very little that could be termed healthy. Are my diabetic patients in good control? No. Until we find an answer to their food and transportation issues, it isn’t going to happen.
So our stopgap solution is providing free fruits and veggies on Fridays to any of our diabetic and prediabetic patients. It’s a little thing but it has helped. When our chickens are laying well, I bring in some farm fresh eggs too. This program is popular so usually everything is gone by early afternoon. Now I celebrate the small “wins” with my patients. If they have lost a few pounds, if their A1C (the measure of diabetes control) has gone down a bit, I congratulate them on their hard work. Progress must be celebrated even if it is far from meeting the quality standard.
At a recent conference I attended, a Family Physician from a community health center in Venice Beach California stated that their providers use a “Harm Reduction” philosophy. They have a large homeless population in their clinic who randomly come and go from their care. Anything they can do to decrease harm for these patients is a win whether it’s helping them obtain food and housing or providing counseling and medication for addictions and mental illness. This philosophy of care moves patients in the direction of better health and a better life. It let’s go of the idea that we are going to “fix” them. It encourages hearing the patient’s priorities and joining forces together to lessen harm.
This Harm Reduction Philosophy moved my thinking from being a fixer to being an encourager. I admit that it has been difficult and is still a work in progress. A dramatic change in attitude takes time. I’m still pretty intense most days as my co-workers and my husband will attest. But slowly I’m relaxing the drive to “fix” the people around me. Quality Standards of care are certainly important and I will be measured by them whether I like it or not. However, they will never be as important as caring for the real needs of the people right in front of me. Loving people where they are is a shift in attitude that changes everything.
