Prescription for Parenting Skills
A few months ago one of my patients brought her three-year-old son in to see me. Although little Genghis had only recently begun attending daycare, the workers there were so alarmed by his pervasive aggression and impulsiveness they insisted he be assessed by a physician ASAP.
I walked in to find the rambunctious little fellow gleefully dismantling my examination room. His mother seemed oblivious to the crime scene unfolding around her. After reining him in a bit I obtained a history and wrestled my way through a physical. By the time I was finished, ADHD and suboptimal parenting were highest on my list of potential diagnoses. I spent several minutes reviewing my findings with his mother, gave her some reading material and made arrangements for a follow-up visit.
As I was about to leave I remembered Genghis had a five-year-old brother who had always struck me as being excessively busy. The last time I saw him I had suggested we schedule an appointment to explore the matter further, but his parents hadn’t taken me up on the offer.
“Did Anakin start school this year?”
“Yes, he did.”
“How’s he making out?”
“Super!”
“I’m glad to hear that.” I began leaking towards the door.
“At first we were getting a lot of notes from his teachers about his behaviour, but a few weeks ago I figured out a way to stop that.”
“How?”
“I just give him some Gravol right before he leaves for school every morning. It works great – he hasn’t brought home a single note since!”
Introspect/ Apologia
Lately I’ve been reviewing my medical narratives. Some are autobiographical, others reflect patient encounters, and most of the remainder relate to parenting. One thing I’ve noticed is that a few of the narratives depicting my interactions with patients are slightly cynical. Usually it’s just my warped sense of humour at play, but once in a while there's a bit of an edge to it. Some of this can probably be attributed to representational bias. I'm no neurobiologist, but I suspect difficult experiences engender higher rates of memory protein synthesis than neutral events. In addition to that, stories involving conflict are intrinsically more interesting to write about and analyze than their more peaceful counterparts. Who wants to read a book about unicorns frolicking in the sunset? For the purposes of discussion, though, if we suppose that I do in fact have an embryonic case of misanthropy gestating, is it being nourished by my patients, my job, or me? I think it’s probably a combination of all three.
For starters, I am definitely not the touchy-feely type. I tend to favour a linear, problem-solving approach to medicine. Within the first few minutes of most interviews I’ve usually assigned my patient’s presenting complaint to one of four categories:
1) I can fix this.
2) I can’t fix this myself, but I know someone who can.
3) I’m not exactly sure what’s going on here, but I get the impression it’s something fixable.
4) Jesus and Gandalf combined couldn’t fix this.
The instant I realize I’m probably not going to be able to help the person I’m seeing in any meaningful way, I start getting fidgety. The way I see it, every morning I arrive at work with a finite amount of expendable energy. Once it’s used up, I’m pretty much done for the day, psychologically speaking. This means I have to ration my resources wisely in order to try to do the greatest good for the greatest number of people. There’s nothing esoteric about this - it’s basic Utilitarianism 101. Unfortunately, a small percentage of patients are like black holes – they’ll pull you over their event horizon and suck all the energy out of you in a single sitting if you allow it. Trying to help them is akin to watering the Sahara with a garden hose. Over the years I’ve treated a number of these unusually needy people. It’s been my experience that no matter what I do for them, no matter how much time I spend, they never seem to get significantly better. Working with this challenging subgroup requires a lot of patience. Unfortunately, patience is not one of my strong suits. In fact, some days it seems I have none at all. This regrettable character flaw of mine undoubtedly contributes to the frustration felt on both sides of the desk from time to time.
I also have some difficulty dealing with the fraction of patients I classify as canaries. What's the story behind the term? Coal miners of yesteryear often brought caged canaries underground with them for use as low-tech early warning systems. Canaries were known to be disproportionately sensitive to methane and carbon monoxide. This made the birds ideal harbingers - if a canary suddenly stopped chirping and belly-flopped off its perch, the miners knew it was time to get the hell out of Dodge. Poor canaries. Always the first to keel over whenever the environment is anything less than perfect.
Another obstacle stems from the fact that although I’m always hoping to receive a reasonably concise, coherent history, sometimes all I’m offered is a vague mishmash that meanders all over the place. At the end of some of the more tangential interviews I leave the room wondering if I just went through the looking-glass again. I need to work on not getting so bent out of shape when the story being related to me is more circuitous than I’d prefer.
According to the True Colors personality test, I’m off the scale at the gold-green end of the spectrum. This means I’m analytical and organized to the max. The good news is that these are both useful traits when it comes to things like running an efficient office practice or maintaining control of an ER that’s trying to go nuclear. Unfortunately, my high scores in these areas come largely at the expense of the orange-blue characteristics, namely impulsivity and empathy. I can manage just fine without the impulsivity, but a little more compassion would certainly be a plus, especially considering my chosen profession.
What else am I guilty of? Misdemeanours, mostly. I’d probably quit my job tomorrow if I won the 6/49 jackpot, so I’m guessing that means I’m no Mother Teresa. I’m chronically late. I biorhythm down to zero at about 10:00 every morning. I get crotchety when I’m tired. I’m set in my ways. I’m a tad OCD. I get antsy when I can’t logic things together. I have a tendency to display exit-seeking behaviour during futile patient interviews, particularly those of the asymptotic variety. And sometimes I can’t help but wonder if my helping keep certain individuals healthy and reproducing is a direct violation of Darwin’s law of natural selection.
Lastly, there’s the matter of my smouldering cynicism. For the past couple of years it’s been quietly modifying my worldview. I don’t think cynicism is chic. I agree with Bruce Mau, founder of the Massive Change Network, when he says that anyone can be cynical, but it takes guts to be optimistic. Nevertheless, I suspect I’m losing the battle. I think part of the reason I’m getting jaded stems from the fact that every day I observe people taking advantage of the system. To make matters worse, not only do I have to witness it, I’m often conscripted into helping them do it. How does this happen, you may wonder? Due to the nature of my job, I have the power to grant certain things. I never asked for this privilege – it comes with the title and there’s no way to divest myself of it. Modern-day family physicians have somehow been transformed into living cornucopias expected to generate an infinite supply of sympathetic off-work slips, welfare letters, disability pensions, tax credit papers, insurance forms, subsidized housing recommendations, accessible parking permits, travel grants, etc. This, of course, is in addition to the usual prescriptions, tests, referrals, and so on. After a while the endless stream of requests starts to wear you down. Usually the things I’m asked to provide are fair and reasonable. Sometimes…not so much. I try to be as accommodating as possible, but I do have to draw the line somewhere. Whenever I say no, conflict ensues. Here are some of the less reasonable requests I’ve had to deal with over the past few months: