Mind Matters

Wherein Board-Certified Dermatologist and Licensed Psychologist Richard G. Fried, MD, PhD considers the intersections of psychology and aesthetics.

A day in the life of a physician is littered with the good, the bad, and the ugly. We encounter patients of all types (happy, demanding, skeptical). In addition, we must interact with various staff members, including medical assistants, office managers, front desk staff, medical directors, CEOs, COOs, and medical colleagues. In addition, we're balancing personal lives involving family, significant others, and friends. Figuratively, this real time interactive collage of faces and faceless individuals constitute your daily and ever changing interactive emotional roller coaster ride.

While balancing these time and emotional demands sometimes feels overwhelming, we hopefully experience mostly positive moments throughout each day that keep us going: The intellectual and emotional satisfaction of a great diagnosis, excellent clinical-surgical result, positive KOH, incision and drainage of an inflamed purulent cyst can all bring pride, fun, and satisfaction. The obvious relief and euphoria evident on the face of a patient presenting for follow-up after biopsy that proved to be a benign nevus rather than the melanoma they feared. The gratitude and relief in the eyes of the asteatotic eczema patient who returns after three weeks of triamcinolone cream relieved of both his itch and the associated fear of cancer or infestation associated with it. These are but a minute sampling of the litany of good deeds and life changing effects of our day-to-day clinical practice.

However, I wish someone had told me that each and every day of our professional practice would be a ridiculously erratic and sometimes chaotic array of tension, anxiety, fear, anger, and despair intermixed with feelings of inadequacy, stupidity, excitement, embarrassment, conquest, triumph, victory, euphoria, satisfaction, and pride. I wish I had known and believed that all these thoughts and emotions could co-inhabit our minds and souls with some type of largely pleasant harmony.

LET'S BE SPECIFIC

Tension and anxiety: Free floating uncomfortable, disquieting, and sympathetically activating sensations that often occur in the absence of identifiable eliciting events. The inability to “link” these unpleasant, uncomfortable, and sometimes debilitating experiences to identifiable external life events can make them particularly troublesome. Fear is often more concrete and self limiting. Fear is feeling terrified when you can see the hungry tiger. In contrast, anxiety and tension are similar emotional and physiologic reactions differing in the simple fact that you can't find the tiger. This can lead to a persistent state of emotional distress, distractibility, and hyper vigilance.

As stated above, fear, anger, and despair occur more commonly in response to real time or anticipated events. Intensity and intrusiveness vary, sometimes predictably by the gravity of the situation and at other times, ridiculously out of proportion to the seriousness of the situation. And, so is the nature of all of us! Our emotional disclaimers should read “results and reactions may vary.”

Feelings of inadequacy and stupidity are extremely commonplace and “come with the territory.” Physicians are highly driven, high striving individuals accustomed to achieving command and mastery of subject matter and situations. Unfortunately, medicine can be a cruel master leaving us in doubt or even clueless regarding a diagnosis and an etiology. Learning to manage these inevitable feelings of self doubt and self depreciation is essential for safe emotional passage through the clinical day and the clinical years. Seeking second or third opinions and “admitting” uncertainty regarding etiologies or best treatment regimens are hallmarks of a competent and caring physician.

So, we are ever hungry for emotional and intellectual balance. Hungry for those morsels of evidence that feed our intellectual curiosity, need for mastery, humane strivings, and our egos. They are ever present: The objective great diagnosis, objective fine clinical outcome, subjective knowledge that we “did good” and made a difference in another human beings life. Any and all of these can culminate in feelings of excitement, embarrassment, conquest, triumph, victory, euphoria, satisfaction, and pride—all titillating and satisfying in their own ways.

I wish someone had told me about the ongoing duality of joy and misery. I wish I had known that it gets easier and harder at the peaks and valleys of medical practice and life. I wish I had known that it is the intensity of the joy and the angst of the misery that fill our treasure chest of experiences, memories, stories, and meaning.

Clinical practice devoid of this duality of emotion—the yin and yang—would be little more than a daily drone of monotony. On a fairly regular basis, remind yourself to take a fresh look at the skin and human being before you. Inhale deeply and slowly episodically throughout the day allowing yourself to savor the special moments. Try your best to believe that the difficult, stressful, and painful experiences will ultimately, together with the joyful ones, add richness and perspective to your personal and professional lives.