FP Finds Resilience in Reflection on Setbacks

November 20, 2017 11:25 am News Staff

Not every setback is cause for distress; in fact, one family physician was inspired by setbacks to rededicate himself to his practice.  

[Fire extinguisher spraying word Stress]

David Loxterkamp, M.D., described in an article titled "Caring for the Tribe: From Addiction to Zen"(www.annfammed.org) in the November/December issue of Annals of Family Medicine how he found strength after two physicians he had recruited left the practice this year. The physicians were considered to be among the best in the practice, and filling the void was difficult.

"For a rural family practice such as ours, such losses are not easily absorbed," he wrote. "The financial costs are enormous -- by some estimates between $250,000.00 and a million dollars when recruitment fees, lost revenue and retraining are taken into account. And there is little chance of quickly replacing young family physicians."

The departures triggered a period of self-reflection in which Loxterkamp asked himself why the young colleagues left while he chose to stay. Stepping back gave him perspective to refocus on patient care and teamwork.

He saw that recent expansion in the wake of his practice's sale to a federally qualified health center had created a sense of isolation, with administration housed elsewhere and physicians no longer feeling as close-knit.

"The growth of our health center has led to a loss of intimacy; we no longer know, let alone greet, each other by our first names," Loxterkamp wrote.

The challenge led him to draw inspiration from Sebastian Junger's book Tribe: On Homecoming and Belonging, which describes the sense of loyalty a tribe fosters among members who choose to remain in a community based on support rather than define themselves by whom they exclude.

Loxterkamp noted several changes that could help engage all members of the medical team. For instance, everyone should have the authority to solve problems independently and use their time flexibly, and should receive frequent, specific feedback. Regular mindfulness breaks or group walks could help reduce daily stress.

Loxterkamp wrote that it also helped to remember the point of practicing family medicine, and he reflected on the care he provided for a patient who was recovering from addiction.

The patient had gone to the ER in acute withdrawal from heroin, but Loxtercamp did not know enough about addiction and initially misdiagnosed the withdrawal as gastroenteritis. But he was determined to help, and one year later he and a colleague received waivers to prescribe buprenorphine. They created a recovery program that incorporated behavioral therapy, care management and medication-assisted treatment. He came to recognize how much more than medical treatment addiction patients required.

"Sometimes it falls to the primary care doctor to help restore the lost connections of those who are marginalized." he wrote. "While our first priority is the illness, we know that recovery often requires adequate health insurance, safe shelter, reliable transportation, affordable nutrition, visitors to the home and a job within their reach. Doctors work at their best -- alive and fulfilled -- when we address the whole needs of our patients and see their problems, their lives, as like our own."

By getting more deeply involved in his patients' wellness, Loxterkamp restored the kind of personal interactions that physicians seek when they enter practice.

He wrote that being mindful of these interactions helps him stay resilient.

"We must use our authority, empathy and courage to extend the benevolence of community to every neighbor and neighborhood we touch, especially our own."

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