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Grete Porteous, MD @docporteous
, 13 tweets, 4 min read Read on Twitter
Medicine vs. The Machine (thread)

For doctors, nurses, and other healers these are distressing times. The epidemic of depression, suicide, anxiety and burnout that consumes our profession is at least less hidden than ever before. I don't know anyone who is spared.
Let me share a mental model that has provided comfort to me. Perhaps it might resonate with you too. You see, I believe that we exist in two worlds: the world of Medicine, and the world of The Machine.
Medicine is why we are here, why we have worked, sweated, and suffered. Medicine is the calling, and it is an ancient good. There are good days and bad days in Medicine. The days when you save a life, comfort the suffering, support a colleague, make a deductive leap...
These days make it worth it and will sustain you. The bad days in Medicine come in equal measure: mistakes, fear, anxiety, death. The ghosts of those days, and those patients, haunt us all.
Over time and with reflection, support and friendship, many of the ghosts fade. With experience and acceptance, you are hurt less over time. Medicine cares about you, because Medicine is made of healers like you. Take comfort, especially those at the beginning of the journey.
The Machine is different. The Machine is new and ugly. The Machine is every increasingly absurd regulatory agency, every painful EMR, every corporation, every insurer, every pharmaceutical company. The Machine exists for its own purpose. That is the first rule.
The Machine does not care about you, and never will. That is the second rule. It will take everything you give it and demand more. It will bring you to your knees if you let it. It will crush you to dust. I know. I've been there.
I do not know how to change The Machine, but I know how to survive it. Keep your head down, stay off the radar. Pretend you are the hero in a dystopian future. Reread Catch-22 and admire the absurdity around you. Make a point of resisting a few small things The Machine demands.
This will do your heart good, and It won't notice. Laugh at The Machine, but laugh quietly because The Machine has no sense of humor. And then focus your energy and love on Medicine, your patients and your colleagues. The Machine does not matter, not one bit.
Dear ones, when you are in the darkness some day ask yourself: is it because of Medicine, or The Machine? If it is Medicine, then you reach out and take hold of the many caring hands around you. We are here, we are everywhere, and we will help. You will get through this.
If it is The Machine, you look that ridiculous beast straight in the eyes and give it the middle finger, both hands. Yell, use profanity, break things. Then you reach out to the healers around you and come back home to Medicine. We got you.
“If you know the enemy and know yourself, you need not fear the result of a hundred battles." - Sun Tzu, The Art of War
#crazysocks4docs #MentalHealthAwareness #wellness #medicine #FightTheMachine #RadioFreeMedicine
Thanks for staying with me this far. This mental model may not speak to everyone, but maybe it will resonate with one person out there, which is good enough for me. You are not alone.
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