Eagles and Freedom

Becoming an attendier attending and fighting the system.

Have you ever witnessed a bald eagle in-flight?  This view is one of the many benefits to our new accommodations in the wintery north. I have also done double takes realizing that in place of expected turkey vultures, here, eagles feast at roadside.  Few words describe the animal as easily as majestic.  The first time you see an eagle in-flight, you’re in awe of the symbol of our nation’s freedom.  The wingspan can be up to 90in and the bird stands up to 3ft tall. 

Each time is the same; I stare with wonder.  I watch it soar through frigid air.  I watch it slowly beat massive wings against a blue sky.  Oh, to be so free.  The eagle does not know how it is envied. The freedom that it represents is envied. All for a price.

Everything is obtainable for a price.  The freedom represented by the eagle, the family, the education, the house with the picket fence, the car, the job….shucks sometimes even the love interest. We’ve all seen An Indecent Proposal. The price though, often comes in the form of pain.  Pain of work, effort, and hustle. I’m currently reading Leadership Pain, The Classroom for Growth.  Within the text, Dr Chand (doctor of philosophy, not medicine), states there is a concept called “liminal space”. This is a concept in theology and psychology that covers the in-between.  The “transitional state where you cannot go back to where you were because a threshold has been crossed, and you have yet to arrive where you are going”.  This is a very common state in medicine.  Once training is complete, you cross the threshold as an attending.  However, the common lay-misconception is that this is the goal.  The attending physician is not the final destination but another liminal space where often the attending is looking for “an attendier attending”.  We practice medicine learning constantly from other physicians, nurses, and patients in an apprentice-style model.  Until one day, without realizing it, we arrive and become the teachers.  

However, with the administrative pressures placed on physicians today, medicine is moving away from the apprentice-style model and focusing on business practice to ensure a happy customer, formerly known as a patient.  The price for happiness in customers is no longer just health, but inappropriate antibiotics and testing, inappropriate pain medication, and seeing more customers-faster!  This additional stress and loss of freedom has left many physicians in the liminal space unable to persist through and unable to turn back. In an effort to find my threshold between attending and attendier attending, this week has been a long one. A pseudocyesis, a threatened preterm labor, a preterm labor – all in a budding obstetrics practice.  A host of new patients and follow-ups in a developing family clinic.  Hours covering emergency rooms across our frozen tundra under a winter-storm advisory – IN SPRING!  Dr Chand states that “tenacity is laudable, but people, like cars, run out of fuel, need new tires, and sometimes need major repairs.”  How do we take medicine back across the threshold before it became a business to ensure that we are able to care for our caregivers?  The price that health care professionals are paying is too great.  The prices our families pay is too great.  Soon, we too will be the way of the eagle, threatened with extinction, if the business of medicine does not return to a focus on health. 

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