Renewal in the practice of medicine

Abstract

Entombed at the bottom of Barents Sea in the dark, torpedo-shattered hulk of the once mighty Russian attack submarine Kursk, 27-year-old Captain-Lieutenant Dimitri Kolesnikov blindly wrote to Olga, his bride, a note of love. Dimitri’s message, magnified by its poignancy and undiminished by his tragic death, demands our attention as to what is fundamentally important in our lives. Indeed his perspective, which we will explore, provides the bedrock upon which balance and renewal must rest. Substantial pressures, intrinsic to the care of patients, are amplified in an era of increasing regulation, heightened expectation and decreasing professional satisfaction. These distortions exist throughout all levels of medical education with painful impact on patient and practitioner alike. In a recent study of stress surveying nearly 200 Canadian women physicians, three major themes were identified: perfectionist attitudes toward professional and personal activities; the reality of multiple roles, especially caring for small children and competing demands . . . that compromised time for personal activities or rest; a work environment not always flexible or hospitable to the needs of women physicians [1]. Similar studies catalogue the factors which impact house staff as well as medical students and contribute to depression, disaffection with patient care, cynicism and burnout [2]. The so-called ‘hidden curriculum’ with its troublesome influence on idealism and empathy is unfortunately quite visible in its formative impact [3]. These elements coupled with our own compulsive traits (useful in attending to detail, potentially crippling in fueling the beliefs