Lots coming out around @danielleofri ‘s latest NYT piece. Everything she says here is gold and points to the ways in which the altruism of physicians has been taken advantage of. As a psychiatrist, I always like to take it a little deeper.... (A THREAD 1/10)

https://twitter.com/danielleofri/status/1137531455658237952

Last week in #mdedgechats abt physician suicide, I brought up how strange it is that the most highly educated professionals in the US somehow ended up not being in control of their own profession? Lawyers CEO's, politicians make the decisions about medicine not doctors. 2/10

What @danielleofri writes touches on this too. People who go into medicine are do gooders & givers at their core. Do gooders have bad boundaries. (Most of us) will choose taking care of the patient over taking care of ourselves. If not, we don’t survive training. #MedTwitter 3/

We go through years of indoctrination to solidify this. The resident who stays late & shows up early, who skips lunch, she’s the one who is praised. We come up in a system that glorifies overwork and self destruction in the name of “being a good doctor” #PsychTwitter 4/10

(Side note - the first time I went to therapy was as a medical student and no joke, my chief complaint was “I don’t know how to find hobbies and I don’t know what to do when I’m not studying”. ) 5/10

So we work and work because we want to be good doctors and we want to help people and we don’t want anyone to die because of something we didn’t do. #MedTwitter 6/10

But what’s going on in the shadow underneath that altruism? Is it that we’re so avoidant of conflict that we’d rather just take orders instead of fighting for better conditions? Is it that we feel secure and confident when patients need need us, and lost when we’re not needed? 7/

Is it that our identity is so tied up in the god complex that to no longer have the moral superiority of being the savior is just too much to bear? #PsychTwitter 8/10

So, these are internal, psychological forced that each individual working in medicine must face down in order to do the work needed to change our system. #MedTwitter 9/10

The only way change will happen is if the system changes. And the only way the system will change is if each physician goes out of their comfort zone. That may mean being less good and tolerating the feelings of guilt that come afterwards. 10/10

.@arghavan_salles @DrPoorman @drjessigold @WDeanMD @RecoveryDoctor would love to hear your thoughts re the convo last week about is this internal or external?

I think the answer is both. But that in order to change the system we must be able to work through the internal factors at play here...

.@alisadoc1 - this piece also reminds me what you brought up during the chat. Medicine as a moral calling versus physicians as employees.

Would love to hear #PsychTwitter’s thoughts on this too - @DrMarleyDoyle @NatsforDocs @amybarnhorst @DrHowardLiu @KazJNelson @chandan_khandai @shawnsidhumd