This is the third in a series of workplace analysis pieces. The first is here
If you haven't guessed, I am a physical therapist working in orthopedics.
Like I've mentioned, lots of things that I do, post-op total knee replacement management, management of chronic pain, management of dizziness and concussion are what you'd expect. It's a mix of rehabilitation science, some tactics borrowed from the mental health field, and a generous dash of just being a decent, empathetic person. What's funny over the years has been watching wellness culture (an extension of the woo-turn of the counterculture) bleed into a practice that I took on as a quest to build a skillset that I could use to heal people without needing to be tied to equipment or resources (i.e. capital).
In a quest to escape the awful work-life balance of, say, a large chain practice (think billable unit quotas, upwards of 20 clients per day, mountains of documentation, extremely brief appointments) lots of small practices have evolved into this model where, they treat patients, but are also something else -- life coaches, or a crossfit gym, or a yoga studio. In essence, they hook you with PT care, then roll you into a weekly massage session with reiki, or guided workouts, or personalized pilates sessions. Add a splashy web page about "our strong community" or "come join our tribe of passionate movers," and they're pulling a funny trick, healthcare as a lifestyle, as pursuit of perfection, as fulfillment. These are often cash pay, to avoid the hell that is billing insurance or medicare/medicaid, and serve middle-upper class folks nearly exclusively.
I'm not against the idea of just plain having a place to work out, or some therapeutic support or athletic coaching, or a group of friends who like what you like. In ideal communism, shouldn't we all have our physical/mental/emotional selves cared for?
What I hate about this is model is that it sells dependence. Without my expertise, you won't be living optimally. Without my community based on optimal living, you won't feel understood. It doesn't foster self efficacy with regards to taking care of yourself. I work hard to support my patients, but also to help them feel that they can understand their injuries and take action to make it better, and have a good heuristic to estimate how they're doing when they need outside help. Without that it destroys self-efficacy. It's just coming to see the guru.
Furthermore, I think this approach is profoundly disabling to political action both on the part of the patient, who gets on a never-ending hamster wheel of pursuing performance and self actualization, and on the clinician, who never sees a member of the working class and never gets exposed to the grinding brutality of physical work. It immunizes you against radicalization. If you're too busy working on yourself, or treating only rich people, you're insulated from the material lived realities of the oppressed and exploited. Like any post-60's self improvement-cum-religion, it kills the possibility for connection, action, empathy and solidarity.
That said, I haven't done pro-bono clinic service since starting my new job. 50-hour weeks tend to do that to you. This is in contrast to my student days where I fit in a lot of pro-bono clinic time, as well as outside activism. So fuck me, right?
Our current system makes self-aware individuals feel immensely guilty for their forced participation in it.
You as an individual can't do anything to fix these large institutional problems. We can't fix the healthcare system that prioritizes profits over people-- the system that actively tries to keep people sick enough for a lifetime of treatment. And by proxy, you might feel complicit in the scheme because of your elective participation.
So we become riddled with guilt, because you see what's happening and want to stop it, but you can't. You can only watch. There are no viable solutions.
You could quit that practice, but you'll probably just land at another one molded by the features of capitalism. You could volunteer more, but you are already burned out at your job, so you don't wanna do much of anything at all over the weekend so you can physically and emotionally recover, then you feel guilty because you were too tired to participate in volunteering. Or too tired to pursue a hobby you enjoy. More guilt.
We all tend to be so hard on ourselves because that's what capitalism taught us. Its always the fault of the individual. I feel guilty for putting gas in my car or a piece of meat in my shopping cart, because I think about how much cruelty it took to produce those things most people never think twice about.
So now I feel just a little bit responsible (and guilty) for oil war occupations in the middle east or horrible working conditions of animals and immigrants in meat packing plants. But what can you or I hope do realistically do against the oil and meat industry??
I think all you can do is opt-out from as much as you can, when you have the privilege to do so. I would never chastise a person living paycheck to paycheck that they shouldn't eat meat or drive a car, because they aren't in a position to do so. They aren't stabilized high enough on Mazlows hierarchy for that to be a viable option.
So change the things you can control. It doesn't have to be profound or revolutionary. It might be as simple as not using Amazon or Facebook. And when you participate in this kind of opting out, think about how it makes you feel. Was Amazon really that helpful since you could order kitchen towels with a 2 hour delivery window? Or do you notice how many it actually prevents you from buying a lot of junk you don't need because now it's extra work to physically go to a store??
Then over time, you can share some of these opt out stories with your patients; there's probably a lot you can share about your own experiences that will be concurrent with those you are helping.
My Two cents: Control the things you can and you'll reduce the burden of guilt for things you can't change at the moment.
Ah dang dude you brought a tear to my eye. Tough racket living under capitalism where you have some money and stability, but all you want is free time.
I'm trying hard to get back to a better system to work within. I'm actually talking with a cash-pay practice where I'd be able to get benefits, if a low salary, working 25-30 per week. Despite mostly working for wealthy clients, that'd give me the time to go do pro bono care and other things. We'll see where the year takes me.
I hear you with the opting out. I try that here as much as I can. Shop at the local place not the big chain grocer. Make gifts don't buy them etc etc.