Written by Dr. Wendy Schofer

We live in an age of advocacy. Grassroots initiatives are all around, from firearm control to educational support for our children, to environmental protections, to orphan disease research and treatment.

What about us? Physicians.
What are we advocating for?
Oh, absolutely… the patients.

We are always advocating for our patients… prior authorizations, becoming the case manager when there is none, calling in prescriptions, and calling schools to obtain the accommodations that our student-patients need to work at their best.

But how do we advocate for ourselves?

Our professional organizations have advocacy missions and resource centers. The AMA has a full Health Care Advocacy Center outlining all the ways that they are advocating for key healthcare issues impacting patients and physicians.

It’s time that we take an active role in our own self-advocacy.
What does that look like?

It starts with taking care of our individual needs, not waiting for someone to change the system, not waiting for someone else to act on our behalf.

Taking pee breaks

News flash: doctors have physiological needs too.

I’m guilty: “I can’t go pee right now, I have to see another patient now.” Yes, this is an advocacy issue. As physicians, we often overlook and flat-out rationalize why our needs aren’t as important as others’ needs. Taking a legit lunch break, a pee break, any break: our bodies are not meant to run at full steam all the time. We have different gears, and we get to use them when we give ourselves the opportunity to do that.

What does that look like for me? I take a lunch break. I go pee when I need to, and I enjoy the long walk down the hallway to the bathroom. I take a deep breath before I go into the next patient’s room – it “centers” me, but quite honestly, it changes my physiology. It calms me and helps me focus on what’s right in front of me now.

Saying no

“Mrs. Schofer was late. Can you fit her in over lunch?”
“Oh, by the way, I almost forgot to mention this itchy rash I’ve had for 3 months, what is it?”

“As a part of your institutional service, all physicians serve on a committee that meets after hours. Oh, we didn’t have to include it in your contract. It’s just what we do.”

What is important to you? How do you make sure that you have the time, bandwidth, and, quite honestly, the energy to make it happen without burning out?

These are questions that we do get to ask of ourselves and start defining how we want to live and practice medicine. And I’ve found that having a very strong set of boundaries helps.

It wasn’t always this way. Dr. Schofer would add on patients and tasks because it was easier to say yes to the patient and the staff, but all the while, I was saying no to my needs and my priorities.

I have created boundaries on the amount of time that I spend with patients. “That’s a great question, which we will have to address during your next visit.” I trained my staff to follow protocols: “Their late arrival, unfortunately, cannot be accommodated in today’s schedule.” Protocols are brilliant boundary-setting exercises, as well as self-advocacy tools. If this, then that. No emotions, no squabbling. It’s just what it is.

The opportunity that we have as physicians is to see how creating protocols and boundaries is more about saying yes to our needs than saying no to the patient.

Time and chart management

Are you an author? Are you writing the next novel in your patient’s note? Patient advocacy does not mean having to fight your case in a note. And self-advocacy means identifying just what needs to be included in the note and then leaving the creative writing for a different publication.

I realized that I was able to advocate for myself when I identified the basic requirements for a note: What happened today? Can I prove it in a court of law? Is there continuity of care for the next physician seeing the patient?

Niceties about Mrs. Schofer’s dog, her recent trip, or the full blow-by-blow differential were taking a toll on me, as I wasn’t able to complete charts in real-time.

Leaving work at work

This may be a shocker to some: I’m a doctor, and I refuse to be imprisoned by my profession. For the first half of my career, work bled over into my home life. I had notes on my mind, messages to check, and, quite honestly, work stressors followed me home.

Self-advocacy looked like identifying this as something that didn’t work for me. And that I wanted to change it. I started with charting, not writing the next novel, and niceties about the patient’s dog in the note. Templates and judicious copy-forwarding were implemented. And I declared that when each patient left the room, their note was completed.

The act of focusing on what I needed: a functioning computer in each exam room, to type during the visit, and to close out each chart from my brain was a tremendous step in self-advocacy. My bandwidth was focused on this patient, right now, in the office. And when they departed, so did all my focus upon them. I could not focus on the next task, or the next patient, or even better yet: leaving the building.

Self-advocacy looks a lot like actually admitting that physicians have needs, that we can prioritize our needs, and take care of them. Taking care of our needs does not compete with taking care of patient or institutional needs.

In fact, taking care of our needs and advocating for how we can individually work at our best helps everyone.

Here’s the thing: the professional organizations don’t know what I need in my day-to-day clinic. I’m not waiting for the system and the culture to change from the outside. I get to identify where I can self-advocate for my own needs (like seriously needing 9 hours of sleep every night). That’s my job. ☤

Wendy Schofer, MD, is a pediatrician and physician life coach. www.wendyschofermd.com