Perry

Two days ago, I read something online that concerned the things that have changed during the past two decades for the worst.  They were listing things like the amount of cream in the middle of Oreo cookies.  A whole lot of things that just aren’t as good as they used to be.  One of them was the sense of health care professionals feeling that they were responding to a calling rather than looking for a well-paying job. This sense of calling no longer is prevalent.

Mark

Apropos to that, one of my earliest memories was of a first or second grade friend called Paul.  I went to his birthday party. I was from a lower middle-class family. I never thought of social class. You know you were fine if you had food, clothing, shelter.  But I went to his birthday party, and it was the first time I ever saw someone who lived in a home with a backyard that was as big as a park with forest and everything like that. I hung around with him every day when I was young.  And then one day he said that he was going to move to Philadelphia. And I asked: “Why?”  He said: “my dad got a better job.”  Even as a five year old, it didn’t compute. Was money and job that important? Who was in control?  So, early on in my life I wondered about control.

I Remember when I grew up and was a math teacher in an inter-city school that I had little control. I was mostly a disciplinarian.  One of the forces that drove me to medicine was that I would be able to somewhat control my work environment.  Of course, that has changed.  I was fortunate enough to have considerable control during most of my career; however, I remember when managed care came into our hospital where I worked for many years. A prevalent joke concerned managed care and limitations in time to meet with a patient. A hospital administrator dies and meets St. Peter at the Gate to heaven. St. Peter says: “I have good news for you. You made it. You are admitted” Then there is this pause. “You are admitted for three days.”  That was the running joke, because we were really upset about control. We were told what lab tests we could order or not order.  We needed a special chit from Sacramento to get a certain drug order for certain patients.  The entrance of managed care was a real shocker.

Mitch

I want to comment on one thing. As we are growing older, the idea of control has taken on a different meaning.  If we are talking about spiritual principles, or depth psychology issues, the idea that I still have quite a bit of control is based on the assumption that I have control over what I attend to.  What I attend to is very important.  Furthermore, I can always choose my response. I find that my stress varies tremendously. When I am paying attention and am aware that I am paying attention my stress level goes down. I can choose how I see the situation.  I can change my expectations. I can change the parameters by which I look at a situation. And then I can change my response. What’s interesting now is that I can choose an internal response that is commensurate to that assessment—even though my job as a physician is different from what it was many years ago.  There are more internal mechanisms for finding Peace, for finding whatever it is when we are in control.  That might be where mentoring comes in.  It is important to have people who are able to shift their internal milieu. They have a different way of seeing or being regarding whatever is happening out there—where there is really a lack of control in a social sense.  This is something that is developing in my own personal purview, more and more.