Making Valentine’s Day matter, without spending a cent

For many years, I rallied against Valentine’s Day.  I saw it as crass commercialism of love.

If I’m honest, I think that underlying my objection were memories of teenage angst.   Unlike all of the “popular” girls at school, I didn’t receive a single Valentine’s Day card or gift.    In the typical heightened emotional mindset of an adolescent, I saw Valentine’s Day as an annual reminder of how unloved and unlovable I was.

I learned the truth at seventeenJe ne regrette rien
That love was meant for beauty queens
And high school girls with clear skinned smiles
Who married young and then retired
The valentines I never knew
The Friday night charades of youth
Were spent on one more beautiful
At seventeen I learned the truth

Janis Ian “At Seventeen”

Fast forward a couple of decades and I found myself with a man who loved Valentine’s Day.  Growing up in America, for him it was a much hyped event.  According to Wikipedia, “in the United States, about 190 million Valentine’s Day cards are sent each year, not including the hundreds of millions of cards school children exchange”,  and “the average Valentine’s spending has increased every year, from $108 a person in 2010 to $131 in 2013”.

For my partner and his family however, Valentine’s Day was not about sending cards or gifts, it was about showing friends and family how much you appreciated them.

In some Latin American countries, Valentine’s Day is known as “Día del Amor y la Amistad” (Day of Love and Friendship). Part of this is about performing “acts of appreciation” for friends and colleagues: acts like a kind word, helping someone out with a chore, expressing gratitude, and telling colleagues, friends and family how much they mean to you.

You could argue that we should be doing this every day of the year, and you would be absolutely right, but it can help to have a day to remind us to focus our efforts on nurturing our various relationships, personal and professional.

Extending this further, it may be a timely reminder to check in on the most important person in our lives: ourselves.  How are you travelling? Are you nurturing your body and mind? Showing yourself a little self love? As we are all aware, we need to look after ourselves properly in order to help others.

My Valentine’s Day-loving partner is no longer with us, may he rest in peace.  However, I would love his non-commercial passion for Valentine’s Day to live on and be shared with others.  So I’m asking you all to consider reaching out to those in your life this Valentine’s Day, and bestowing upon them “acts of appreciation”. And, if you feel so inclined, put aside five minutes to take stock of your own state of happiness and well-being, hopefully showing yourself a little bit of self-compassion and kindness as you do so.

Physician Don’t Heal Thyself

One reason why I chose to do medicine was that I didn’t always trust doctors – another image stethoscopebeing access to an endless supply of jelly beans.  My mistrust stemmed from my family’s unfortunate collection of medical misadventures: Grandpa’s misdiagnosed and ultimately fatal cryptococcal meningitis, my brother’s missed L4/L5 fracture,  Dad’s iatrogenic brachial plexus injury and the stuffing-up of my radius and ulna fractures, to name a few.

I had this naïve idea that my becoming a doctor would allow me to be more in charge of the health of myself and my family. When I discovered that doctors were actively discouraged from treating themselves, their loved ones and their mothers-in-law, and that a medical degree did not come with a lifetime supply of free jelly beans, I felt cheated.   I got over the jelly bean disappointment quickly – after all, the allure of artificially coloured and flavoured gelatinous sugar lumps was far less strong at age 25 than it was at age 5 – but the Medical Board’s position regarding self-treatment took a lot longer to swallow.

Over the years I’ve come to understand why guidelines exist regarding treating oneself and one’s family, as well as close colleagues, staff and friends.  Lack of objectivity is not the only problem. Often these types of consults occur in informal settings and do not involve adequate history taking, examination or note-making.  They can start innocently enough but have the potential to run into serious ethical and legal minefields.  I’ve come to realise that, like having an affair with your boss or lending your unreliable friend thousands of dollars to buy a car, treating family, friends and staff is a pitfall best avoided.

Although we’ve all heard that “A physician who treats himself has an idiot for a doctor and a fool for a patient”, large numbers of us still self-treat.  I recently conducted a self-care session with about thirty very experienced GP supervisors whose average age was around fifty. When asked for a show of hands as to how many had his/her own doctor, about half the group confidently raised their hands. I then asked these to lower their hands if their nominated doctor was a spouse, parent, practice partner or themselves. At least half the hands went down. When asked if they’d seek medical attention if they were significantly unwell, several of the remainder said, “I don’t get sick,” and one said, “Of course I’d see a doctor – I’d look in the mirror.”

Us girls are a bit more likely to seek medical assistance than the blokes (after all, it is pretty difficult to do your own PAP smear – believe me, I’ve tried), but neither gender group can be held up as a shining example of responsible, compliant patients. It seems very much a case of “Do as I say, not do as I do”.   I wonder how much of this is due to the rigorous “breed ’em tough” campaigns we’ve been endured from the earliest days of our medical careers.  I recall when one of my fellow interns asked to finish her DEM shift twenty minutes early so that she could go to the doctor. Her supervising senior registrar refused her request and told her, “Routine appointments need to be made outside shift hours.  If you are sick enough to be off work, you should be here as a patient.”  My friend explained that this was neither routine, nor a life-threatening emergency, but that she thought she had a urinary tract infection.  She was instructed to cancel her appointment, dipstick her own urine, take some antibiotics out of the DEM supply cupboard and get back to work.  “You’re a doctor now; get your priorities right and start acting like one” was the parting message.

Through my medico-legal and medical educator work, I’ve had the opportunity to talk to several groups of junior doctors about self-care issues and the reasons for imposing boundaries on whom they treat, hopefully encouraging to them to establish good habits while they are young and impressionable.  I try to practise what I preach: I see my doctor semi-regularly and have a I’d-like-to-help-you-but-I’m-not-in-a-position-to-do-so mantra down pat.  I’ve used this speech many times to my advantage, such as when I’ve been asked to look at great-aunt Betty’s ulcerated toe at the family Christmas get-together, and to write a medical certificate and antibiotic script for a whingey boyfriend with a man-cold.

The message is usually understood but the reasons behind it aren’t always so.  My niece once announced knowledgably, “Doctors don’t treat family because it’s too hard to make them pay the proper fee.”  This young lady wants to be a doctor when she grows up, but must have different reasons than I did at her age. She doesn’t even like jelly beans! 

Adapted from an article first published in MIPS Review Autumn Edition, 2012 

Published on Meducation.net  December 2013 “Physician don’t heal thyself“,