Laughing at oneself

Link: NHS Blog Doctor.

I regularly read Dr. Crippen’s (about whom I’ve written before) weblog because it’s funny, always honest and frequently confrontational, and because, as this last post shows, he’s blatantly and unapologetically HUMAN.   He rails against "nurse quacktitioners" and others who are obstructing (or at least not assisting) the good, family-and-patient-centered care he can give as a generalist physician, but never seems to lose the ability to laugh at himself.  For all the times I worry about him burning out (read his posts concerning the NHS sometime…), I think this will save him…

As I have worked in the Evidence-based medicine field for a while and think a lot about how we know what we know and why we do what we do, I’ve seen doctors go one of two ways – either adopt a stance of unquestioning certainty about treatments and decisions (based on evidence, guidelines, or some other dogma) or, (as in my case) understand the mind-numbing complexity of the situations that physicians deal with as well as the real feebleness of our system of research and evidence and develop a bit of therapeutic nihilism.

My solution to overcome the nihilism is to value the things that I feel best at:

  • Developing a sense of humor to help me deal with an overwhelming sense of humility. 
  • Concentrating on relationships and "doing the right thing for the patients" (it’s amazing how that can get pushed off when we’re busy…Dr. Crippen clearly struggles with this also). 
  • Concentrating on the ol’ home life – especially the kids, from whom I never want to hear: "Dad was a wonderful doctor with his patients, but he wasn’t around very much when we were young" (Can’t I have both of those things?)

I try to integrate all these things with the knowledge and understanding of the biological, physical, mathematical and biostatistical data that it takes to describe and direct what we do, and put it forth in my best attempt at doctoring.

Hopefully, I can keep laughing at myself.