Not all doctors are resigned to fading away amid the complexities of modern healthcare. Robert Rufsvold was a small-town doctor in a solo practice for years and found the thing he loved best about his job, connecting with patients, was often lost in the shuffle of administrative and other stresses. "It's so easy to lose sight of that connection every time I had to fill out a Medicare form," he says. A decade ago, he came to California for a workshop that led to the Finding Meaning in Medicine program, developed by Rachel Naomi Remen, a family and community medicine professor at the University of California-San Francisco. The program focuses on physicians who feel they're missing something in their careers. "They aren't practicing with the same joy or passion they once felt," says Rufsvold. In what are essentially support groups, doctors meet regularly to talk about things they don't usually share with one another, structured around themes like trust, fear, service, and compassion. (Those are deliberately vague, allowing doctors to discuss cases and patients who have particularly affected them.) Rufsvold did end up quitting his job in 2001--to work with Remen full time, giving more workshops.
Remen has also developed the Healer's Art, a course for med students that will be taught at 33 schools this year. Remen is concerned about the cynicism and loss of commitment she sees in both midcareer docs and those who haven't even begun to practice. "In the process of training, they somehow become depressed, cynical, alienated, and angry," she says. The course focuses on themes such as loss and recovering a personal sense of the Hippocratic oath. The students might discuss what it's like, for example, to treat someone with a problem they cannot fix. "Med school can be isolating, and it's easy to lose sight of why you're there," says Julie Connelly, who with colleagues teaches the Healer's Art at the University of Virginia School of Medicine. "They need skills in being good doctors, and they need to learn to take care of themselves." -Katherine Hobson