What I Wish You Knew: Dr. Kathleen Terry
Physician, currently in further training to be a psychiatrist
Written by Dr. Kathleen Terry
Edited by Laura Schaefer
I chose this field of medicine because I wanted to be at the intersection of clinical medicine and public infrastructure, specifically to work in the foster system. I chose medicine in general in order to use my interests and talents to tangibly give back.
There is little joy or delight. It is fulfilling – I may not feel on the day-to-day that I'm making a difference, but I can think of people who would have died to suicide by now but for the meaningful care they received with my team, or people who have been dealing with overwhelming illness who have said that I'm the first person who has made sure they understood what was happening, or the first person to help them not be afraid. Those experiences make it worth it.
The work I really want to do still lies 5+ years in my future, once training is done, and I expect that work – seeing kids and families clinically, but also working as a patient advocate in legal and policy arenas, to champion for the well-being of the most vulnerable in our society – will be hard, so hard, but so worth it. A lot of my professional satisfaction is deferred gratification. That's basically what a medical degree is – a doctorate in scientific knowledge, risk/benefit analysis, and deferred gratification.
The hours…that was known, but not understood until it was experienced
Even if you know it's coming, how do you anticipate the cumulative effects of 80+-hour work weeks? I basically didn't see my daughter awake for months. That's temporary, though, a peculiarity of training and not something doctors generally submit to when they're no longer residents.
Other challenges? The vastness of knowledge required. There is no mastery, because the field is always changing, always evolving. There's no room for complacency. Oh, and the documentation. The majority of my time is spent writing, rather than working with patients or actively making decisions about their care.
Do I have regrets? If I could do it over, I'm not sure I'd have gone into medicine. As a vocation, it demands more than I am okay with giving. But I'm in it for far more than just my own happiness, and I don't see myself leaving.
What I wish you knew
As a trainee, I'm astounded by the huge fraction of what we're expected to do all the time that is not for patient safety or improved outcomes, but because insurance expects it and won't otherwise pay the providers or facility. I easily spend at least double the amount of time writing as I do with patients.
Doctors hate to be running late even more than our patients hate it.
I love being an osteopath, and would like to see more use of therapeutic hands-on modalities in mental health work. This is a complicated issue.
Your providers, at least the residents and early-to-mid career attendings (doctors no longer in training), are by and large overworked, underpaid, and caught between multiple very intimidating rocks and uncomfortable hard places. We've got mortgages on our brains that outweigh those on our houses, in a system making it increasingly difficult to have any hope of paying them off. Probably related – though more telling of the culture within medicine, I think – doctors and student-doctors have the worst mental health and highest suicide rates of any profession in this country.
Maintaining professional and ethical boundaries does not mean we don't care about our patients, especially in mental/behavioral health. It rocks me how much my colleagues are impacted by their patients' successes and challenges, how deeply they care.
The best I can hope for is for the system to not get worse
I'm headed toward public service, some balance of clinical work seeing patients and policy/advocacy work to improve certain socio-medicolegal structures (foster system, juvenile justice, public schools). I'm hoping that the system(s) I'm aiming to work in doesn't become intractably inefficient or misguided in the coming political era.
I'm concerned about the implications for delivery of healthcare and the extent to which insurance companies and reimbursement regulations will hold a leash on providers if the Affordable Care Act doesn't hold. Saying it like this sounds like I've got a despairing outlook on my field, which isn't true – I enjoy what I'm doing and learning (and more importantly, I believe in it), and am looking forward to further specialization and practice.
As a discipline, this is a fascinating time to be in psychiatry, the knowledge base is expanding and neuropsychiatric science is advancing. But the public systems of healthcare in general and mental health care in particular…I was getting my Master's in public health while the Affordable Care Act was getting hashed out (also fascinating), and I think a single-payer arrangement would be beneficial. I suppose that's a pie-in-the-sky hope, but I don't think it's likely anymore.