I think a lot of it has to do with how emotionally involved you get with your patients' situations. In a sense, the interviewer is right: if you get wound up in every horrible patient story (ie, inability to afford care), you'll end up emotionally ragged in no time.
Developing proper boundaries and striking a good balance between compassion and self-preservation is incredibly difficult. How do you meet your patient's need to know that you are personally invested in their care, while at the same time remaining detached from their situation?
It's hard. It's definitely an art form, and one I haven't mastered. Some professionals deal with it by completely shutting off the switch that allows them to become stricken by the situations patients find themselves in. I think we all know the type I'm talking about. They're good diagnosticians, but they're not good people. They're not the type of doctor most people want to see. What's more, it's pretty much impossible to flip that "caring" switch on and off at will. If you completely check out emotionally at work, you're likely to be a zombie at home as well.
I do a lot of crisis counseling (victims of domestic violence and sexual assault). This September, I'll have been doing it for four years. It's impossible *not* to be profoundly affected by the stories you hear. I deal with it by taking good care of myself (long baths, shopping trips, pizza and a movie in bed, etc.) for the week-or-so after I take a shift. I check-in with a counselor at the Center I volunteer with regularly to decompress, talk about what I'm having trouble letting go of, etc. Counselors regularly do this--it would be great if doctors formed "check-in" groups as well. Do they do that anywhere?
Speaking to the other part of the interviewer's feedback (re: altruism), I can attest to that as well. I did a huge childhood obesity project. I got it off the ground, got international media coverage, won a ton of awards, etc. But my plan had a fatal flaw: I'd assumed that everyone would be as excited about my plan as I was, and just as willing to invest the time and money to make it happen.
Turns out, everyone was excited about my idea, but I was pretty much the only one willing to pump money into the project, or work for free to make it happen. I invested our family savings into the project (about $10k), as organizations kept promising money that never materialized. I don't regret the decision for a minute. Helping those kids is worth more to me than just about anything. But now, I'm so burned out on childhood obesity that it hurts my brain to think about it. And that's a shame.
All of this is to say, set boundaries. And stick with them. You have personal experience with struggling to pay for medical care, and have a heart for underserved populations (which is to be commended). Decide what you're willing to do to make a positive change in the world. Lobby the legislature? Being a vocal community proponent for change? See a certain number of patients gratis? Devote 'x' amount of time to seeing patients in a free clinic? Write grants? Make yourself available to mentor young doctors who share your ideals?
I'm so, so, so sorry for posting a novel in your thread. As someone who has been chewed up and spit out by an uncontainable desire to help others, I hope sharing some of my experience has helped you.
Oh, want to know the domestic violence call that still sticks with me, years later? I got a call from a young intern in an ER. He had recently seen a young woman who had gotten the hell beaten out of her by her boyfriend. The ER staff pulled out all the stops to help her. The police were there. Crisis response unit (includes officers trained to respond to domestic violence calls) was called in. They stalled her in the ER for hours, and hours, and hours, trying everything they could to keep her from going back to her boyfriend.
She didn't want help. She left with her abuser.
The intern who called me had followed the girl/boyfriend back to the dorm room where they were staying. When he called, you could hear people screaming, throwing things, loud crashes, etc. (over the phone and through the door). The doctor was trembling. He begged me to do something. Anything. Couldn't I do something to help her? Wasn't there *anything* he could do? He was a doctor! He could fix this! There had to be
something.
After listening quietly, I did everything I could to sooth his nerves and calm him. Finally, I told him that, sometimes, people make bad decisions. She made a choice. There wasn't anything he could do. He'd done everything he could, and she still chose to do something dumb. You can't make yourself responsible for other people's choices.
I could hear him choking back tears. At that point, he realized he wasn't calling for the victim/patient, but himself. He needed someone to tell him that it was okay to let this one go. And that's what I did.
I hope that story helps you understand the importance of striking that balance between investment in positive patient outcomes and caring for your patients and maintaining your own sanity. Sanity is a good thing. I think.
