I think one of the most challenging aspects of practicing integrative care is to know when to manage symptoms, to really go after the cause, to do a combination of both, or to know that it’s time to refer someone to another practitioner. Not every patient is a good fit for me and I am not the best practitioner for every patient who comes to see me. There are times when I feel I have dropped the ball and failed my patients, and after 11 years of private practice I am beginning to focus on the things that haven’t worked- the failures- to see what I can learn from them.
I listened to a great Ted Talk on failure recently. (http://www.npr.org/programs/ted-radio-hour/487606750/failure-is-an-option) I think as a society we are so averse to failure- we hate the discomfort, we hate the shame, we hate to think that we messed up. We are not posting our perceived failures on Facebook. It’s so hard to sit with that feeling- what did I miss? What did I do wrong? And it’s even harder to sit with that feeling and then let yourself move into the even more painful question: What could I have done differently? When you know you can’t go back and change anything, your only option is the most painful: growth.
As a physician this feeling can be even more powerful. Someone in the podcast called it “The God Complex.” He was referring to financial analysts and investment bankers on Wall Street, which I most certainly am not. But physicians struggle with this issue often, and Naturopathic Physicians in particular tend to have a hubris about needing to be RIGHT. We are scrutinized by many in the medical field, and so the pressure tends to be a little higher when it comes to needing our patients to get better. We don’t want to let our patients down and we also don’t want to provide fodder for those who might already think we are quacks.
The truth is that there is so much more in medicine that we DON’T know than we DO know. We have some excellent, well-proven methods for approaching certain disease states. As naturopaths we have the advantage of having a nearly infinite number of tools in our toolbox- which is a blessing and a curse. The blessing is that- particularly in primary care- we have algorithms for how to manage most diseases. When these do not work, or do not work well enough, we have so many options for how to optimize health, improve the body’s ability to heal itself, support systems that might have been damaged by a disease state. But there are still many people who do not respond in an expected way to a commonly used treatment- and these patients often come to us because they tend to get pushed aside by conventional medicine when it doesn’t “work” for them. It is disappointing for me to see because it takes a long time to really establish a good working relationship between patient and doctor, and when their doctors brush them aside because they don’t know the answer to the patient’s questions, they throw away the time it has taken to establish good care. This is a perfect example of being unwilling to be present with failure.
And this happens in my (naturopathic) practice as well. I know that I have been guilty of this during times when I was overwhelmed by work and raising kids, and not feeling like I have enough time to put into the questions being asked of me. I sometimes have new patients come to me who have been to other naturopaths or MDs in the area and don’t feel their needs have been addressed. And I have lost patients to other practitioners- and lately more and more I am actually sending my patients to other naturopaths in the area- when they don’t feel their needs are served by what I have to offer. I do in some ways consider this a failure, and that is hard to swallow. When I am feeling small and angry I want to escape this feeling by secretly putting down the practitioner who I sent my patient to, belittling his or her skill set or approach. But the reality is, I have a great deal to learn from this, and from them. Everyone in this scenario wins when I can open my heart even wider than humiliation, wide enough to hold all of the messy feelings that come with this experience. Often when I send a patient to a colleague, I contact the practitioner to ask: What worked? What did I miss? It takes a swallowing of one’s pride, and I am not going to lie and say that I always do this with grace. But if the outcome is that we all learn and the patient improves, then the reality is we have all gained something.
Here is what I have learned: I will either be left with a feeling of something unresolved, which usually means I really want to expand my knowledge base on a particular subject and am frustrated by my own limitations, or I feel free, which means I was not a good fit for that patient and for this reason I was not serving his or her needs. So what does failure offer us? Sometimes just pain and discomfort. But sometimes, if we are willing, it might also offer an opportunity to learn and grow.