I am a board certified internist. I am Stanford trained and have been practice for nearly 25 years. I have a very busy practice. I love my patients. To help, heal and to love them every day is daily gift. I want to help them be healthy. I want to help them make sense of their suffering, to help awaken and empower the parts in them that have been covered over by pain and stress. I have also been a lifelong seeker. I seek to gain consciousness every day, with every life experience. I also seek to stay current with medical and scientific progress. I love science. I love Medicine. This is what I was born to do.
I have been in private practice for nearly 17 years. I worked in corporate health care straight out of residency, nearly 25 years ago. It didn't fare well for me. I found myself constantly struggling inside, conflicted by the dissonance between the mission of the vocation of medicine and that of corporate medicine. I found that the corporate mission saw patients as commodities for money and physicians as work horses to extract money from patients for quarterly gains. The boards of these systems merely used profit as the measure of the physician's success. Nearly two decades ago, patriarchal corporate mission had begun to grow in opposition to the mission of Medicine. After trying to work within 3 corporate health care systems all of which were attracted to my vision for facilitating health and wellness, I finally realized that I was a marketing pawn for them. I fit an image they were using to capture the market. They wanted me to run diagnostic tests, manage symptoms, admit patients and contribute to their quarterly profits. I reached a point where I could no longer live with the inner conflict, tossed between two missions. I saw my colleagues being swallowed up by the corporate machine and losing their connection to what was real for them. Many who needed to be hospital based had no choice by to capitulate and serve the corporate beast at the cost of their soul. My tether was cut when the hospital told me that I did not admit enough patients to meet their quarterly projections. This was the juncture point for my departure. The writing was on the wall. My vision of health was a conflict of interest with their mission, I left corporate medicine and never looked back.
As a physician in private practice, I need to interface with the corporate system. My medical practice accepts insurance, I am a part of an Independent Physician Network which is affiliated with a local hospital. I cannot be truly free of ties from this corporate beast. It is the way medicine is set up today. They base physician credentialing determined by a larger beast, the American Board of Internal Medicine (ABIM), a private self-appointed organization with an annual revenue of $55 million, that sets the standards for physician credibility. Their standards have been shown to have little correlation with physician competence and clinical expertise. Their requirements of physicians are inhumane. Physicians are weighted down to serve these two patriarchs. The corporation that pays their wage and the larger corporation that credentials them. As healers, they can't possibly serve three masters - their vocation as well as two patriarchs with all their demands.
On a personal level, my biography has been one where I have suffered many kinds of abuse. I carry a significant amount of PTSD in my brain and body. Interacting with the corporate patriarch is always difficult for me. The wound I carry (which I am continually working on) is my greatest vulnerability. It is also where my gifts of empathy and love flow through. It is our incurable wounds that make us trustworthy. When we are in the presence of our patients, they come to us with their deepest vulnerabilities. They entrust us with the privilege of helping them heal. Our wounds deepen our empathy for them. Yet we must also protect them from our wounds without them off. We have a responsibility to shield our patients from our unhealed parts. Yet, many times our humanness becomes our greatest gift to them.
I write this as a physician who can see through the façade and racket of what corporate medicine has created. My history of abuse gives me the sensitivity to feel it when it is present. The corporate system of health care is abusive. It is abusive towards physicians who are left vulnerable and dependent on a mission removed further and further away from the vocation of Medicine. We all work for this corporate beast at varying degrees at a great cost. We pay with our cell tissue and the sacrifice of our creative fire. Physicians are hurting. Drug abuse, alcohol and suicide rates amongst them is at an all-time high. Their morale is at an all-time low. They are afraid to admit they are hurting. They are supposed to be the strong ones. They are forbidden to complain or show vulnerability. What does this say about the health of the healers within the system itself? How do we begin to bring healing to them?
The most recent experience I had with this beast is when I took my Maintenance of Certification exam. An eight hour long exam encompassing all of Internal Medicine required of Internists every 10 years, for which I prepared for nearly a year. The exam tests us on minutia that is irrelevant to our practice in a way that we do not practice. It is theoretical for a good memorizer and left brain analyst but not for a practicing physician. None of us make differential diagnoses in 2 minutes, the manner in which 240 questions, many which are complex cases are presented. This is what maintenance of board certification means. Many see board recertification as a badge of credibility. They look for physicians who maintain it. But what they don't know is what physicians have to endure to get this stamp from the larger patriarchal, corporate parent.
For me, preparing for this exam entailed studying for nearly 40 hours a week in addition to my working hours for months. My brain does not work like a memorizing machine that can spit out facts onto a test for high grades. I am a synthesizer and a sensitive. When I am with my patients, I utilize both my intuition and medical knowledge to access the information I need to construct a differential diagnosis and provide solutions. I am also an educator and teach my patients what they can do in addition to my medicaments for deep and lasting healing. A brain like mine does not know how to answer questions under time pressure, and come up with a differential diagnosis and a life or death solution in 2 minutes, sitting in a cubicle under florescent lights for eight hours. Before we enter the cubicle, we are patted down and searched. We are then isolated within it with a computer and a clock that is ticking on the side of the screen. The questions are not numbered. We mark the questions we are unsure of to review later and cannot go back to any one that we may realize we answered incorrectly, downstream from it. It is impossible to find in the maze of unnumbered questions during and after completing the questions under tremendous time pressure. we may never even get to it. There were many questions I could not go back to and correct. I knew the answer but could not change it as it was impossible to find. I fail this exam, I will have to start over, preparing again to retake this to maintain my certification to which my reimbursements are tied.
I left the board exam, feeling dehumanized and very out of body. My sense of disempowerment and the lack of ability to provide correct answers after the fact under time pressure resulted in an implosion of PTSD from the process, and the format of this exam. My brain froze trying to keep up with the clock, read fast enough, to not miss a clue in the maze of the page long cases. My performance anxiety was at an all-time high. The voice in my head, my inner persecutor, the critical parent within aligned with the larger parent - the ABIM. Their voice was shaming me for how my brain worked, or didn't under this kind of pressure, under fire.
I remember leaving my body many times during the exam, feeling my brain being hijacked many times. I was watching this happen in the cubicle...an out of body experience under extreme stress - fight and flight and freeze. Many may be able to function under this kind of pressure, but with my history and biography, I cannot.
Can a standardized test have so much power over one's life? Passing, failing?
Does failing a test like this negate everything we know in favor of being evaluated by a system that has lost its soul? The board? Who is this board? What gives them the power to do this to physicians who have been out in the trenches for decades, helping, healing and loving their patients and their work?
Does this happen to me in the exam room with my patients? Never.
Can I access the information that I need and synthesize the information to diagnose, treat and heal? Yes.
Does a standardized test measure this?
No.
What I am discovering is that my own inner persecutor has the face of a patriarch, shaming me for not capitulating, for not being complicit with his code of measure. His standards are the standards of the larger parent - corporate medicine and its ally, the ABIM. These kind of standards have made a mess in the world. We all carry this persecutor within. All physicians do as well. He awakens during childhood as the critical parent, who expects us to adapt to him in order to be loved and accepted. He never goes away and intercepts the innocence and wildish nature of the inner child who longs to create, to play, to intuit and sensate. When we enter medical school we put these parts of ourselves to the side. The critical parent becomes a driving force. It becomes one of the voices that demands perfection. Our performance becomes the neurosis we perfect for acceptance. This kind of perfectionism is normalized.
When we leave our training, exhausted and worn, we are vulnerable to the demands of the outer patriarch, who has patiently waited for us to enter into his belly to practice our craft - corporate medicine. He is satiated by the money we make for him. If we adapt to his demands, we are rewarded. If we don't we are abandoned.
This patriarch has grown into a ravenous beast, one that has a bottomless hunger for power and money. Physicians have become the vehicles to satisfy his greed and serve him without question for their own survival. Today, the physician collective is held hostage to this ever growing beast. Many other heads have grown out of its belly, the ABIM being one of them.
My experience of demands from the exam were nothing short of torturous. The Board has become the external critical parent energizing the critical parent within. It has hooked him, personally and collectively, empowering him to run roughshod over our sensitivity, creativity, heart and intuition.
Now comes a deeper process for me and the physician collective- of letting go of the outcome, of rewriting the inner script, of meeting our Wildish nature again - of breathing life back into her. She was swallowed up by the Borg. She needs to emerge and come back to life again.
This is what is upon physicians today. Their creativity, their 'wildish nature', that which makes them human, is not even seen. They are herded together like hostages, serving this angry patriarch but running blindly on a treadmill. If displeased, the patriarch will abandon them at any cost.
I am questioning what we have created here on Earth. What kind of systems are these where is no room for process? Fast paced, material centric, product oriented, side stepping the heart - where are we all going with this? The stress these systems have created are the highest risk factor for all diseases.
I write about this because I must. I too was a hostage of this system. In many ways I still am. The persecutor that lives within me, that all of us humans wrestle with, has assumed the voice of the corporate beast.
I have not slept well in weeks. Anxiety, worry, fatigue, weariness, nausea....all symptoms arising because of the persecutory patriarch, triggered by the boards. And this is me we are talking about, a physician who empowers others. This is what I am experiencing.. I have heard and held the pain and anguish of my patients, many whom are physicians. I know this part of our shadow is real.
We don't talk about these issues, but we need to. We need to take back our sacred vocation of medicine. In the words of Paul Teristein M.D., ..."many physicians are waking up to the fact that our profession is increasingly controlled by people not directly involved in patient care who have lost contact with the realities of day-to-day clinical practice. Perhaps it's time for practicing physicians to take back the leadership of medicine."
I think it is time we do.
What do you think?