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Mean Patients: The Real Reason Why Physicians Are Quitting Medicine?

A "Medical Service Provider"

As I sat in my orthopedist’s exam room, the discussion quickly turned from my chief complaint to his: “I don’t know why I’m doing this anymore,” he said. “Medicine is just not what it used to be, and I don’t enjoy my work anymore. The bureaucracy and regulations are bad enough, but what really gets me is the hostility. My patients are chronically angry and mean. The only comfort I get is from talking to other doctors. Because they all feel the same way.”

Perhaps this sentiment strikes you as the spoiled musings of a physician who is lamenting his demotion from “god” to “man” – reflecting the fundamental change in the public perception of doctors that has occurred over the past ~50 years. Or maybe you wonder if this surgeon’s patients are mean because he is a bad doctor, or isn’t respectful of their time? Maybe he deserves the hostility?

I’ve found this particular surgeon to be humble, thoughtful, and thorough. He is genuinely caring and a proponent of conservative measures, truly eager to avoid surgical procedures when possible. He is exactly what one would hope for in a physician, and yet he is utterly demoralized.  Not because of the hours of daily documentation drudgery required by health insurance and government regulators, but because the very souls he has been fighting to serve have now turned on him.  Their attitudes are captured in social media feeds on every major health outlet:

Doctors? I no longer afford that kind of respect: I call them “medical services providers.” They and their families and the medical cabal created this mess when they got control of med schools so that the wealth of a nation would remain in the hands of a few medical elites and their families. The very notion that doctors are smarter, more productive, more anything than others is ludicrous. They are among the worst sluff-offs of our society, yet the richest at the same time. It is an unreal world they have created themselves and they are now watching the natural outcome of such a false system.

The very best physicians have always been motivated primarily by the satisfaction of making a difference in their patients’ lives. That drive to “help others” is what makes us believe that all the sacrifices are worth it – the years of training, the educational debt, the lack of sleep, the separation from family, the delay (and sometimes denial) of becoming a parent, the daily grind of administrative burden, the unspeakable emotional toll that death and disease take on your heart… All of that is offset by the joy of changing and saving lives. But when that joy is taken from you, what remains is despondency and burn out.

What patients need to realize is that they have been (and still are) the primary motivator of physician job satisfaction. Patients have the power to demoralize us like no one else – and they need to take that power very seriously. Because if negative attitudes prevail, and hostility spreads like a cancer in our broken system, the most caring among us will be the first to withdraw.

And in the end all that will be left is “medical service providers.”

A Physician’s Fantasy World: The Ideal Medical Practice

Medscape has a physician portal and they asked the question: “Where would you like to practice medicine?” The responses from physicians were varied with lots of complaining and joking like “Dubai”, but this reply from a family medicine doctor got my attention. I think he speaks for many physicians.
  • I would like to work in a fantasy world.
  • One where I didn’t have to worry about someones economic status. Read more »

*This blog post was originally published at EverythingHealth*

Physician Burnout Is The Biggest Threat To Healthcare Reform

It was supposed to be delayed gratification.

After all, that’s the American way: work hard, put your nose to the grindstone, get good grades, be obsessively perfectionistic, then you’ll be rewarded if you just stay with it long enough. It’s the myth that perpetuated through medical school, residency and fellowship, and our poor residents, purposefully shielded from the workload they’re about to inherit, march on.

But then they graduate and find that just as the population is aging, chronic and infectious diseases are becoming more challenging, health advances and potential are exploding. Just then, we decide to launch a full scale attack on physicians and their patients with increased documentation requirements, call hours, larger geographic coverage of their specialties, reduced ancillary workforce, and shorter patient vists.

Physicians get it – burn out and dissatisfaction are higher now than ever before. This is probably the greatest real threat to the doctor-patient relationship and health care reform discussions don’t even put it this on the table.

At the same time that we expect our doctors to be devoted, available, enthusiastic, meticulous and at the top of their game with perfect “quality” and “perfect performance,” while simultaneously cutting their pay, increasing documentation reqirements and oversight, limiting independence, questioning their professional judgment, and extending their working hours. We must become more efficient!

Deal?

*This blog post was originally published at Dr. Wes*

The Cause Of Nursing Burn Out

You walk into the unit, put down your backpack, fill your pocket with pen, scissors, and tape, sling the stethoscope over your neck, swipe your namebadge into the infernal timeclock and enter stage right.

It’s showtime!

Get the triage, hook up the monitor, grab the EKG, slam in the saline lock – grab the bloods in the process, hang a liter of normal saline, put up the side rails, hook the call bell to the side rail, throw on a warm blanket, medicate for fever and slam the chart in the “to-be-seen” rack.

Repeat x 30 over the next eight hours.

Feel like burnt toast, look like burnt toast, act like burnt toast.

*****

Where’s the patient?

You know, the person you just triaged, hooked, slammed, hydrated, side-railed, blanketed, medicated and lined up for evaluation?

Oh.

Did it ever occur to you that the reason you feel like burnt toast is because you are so focused on what you are doing you have lost sight of the “who” you are doing it to?

*****

Well, it occurred to me.

Because that is exactly what had happened.

Oh, my physical care was fine.

But I had stopped looking patients in the eye. I was spitting out standard responses instead of listening to what my patients were saying. I was expending the bare minimum of energy required to complete tasks.

I was doing; I wasn’t caring.

And I was burnt.

*****

But I discovered something.

And this is huge.

I was not focusing on tasks because I had burned out, I burned out because I had started focusing on tasks.

Let’s face it. The ER, while seemingly exciting to those outside the ambulance doors, can actually feel redundant to those of us who deal with the same issues every day. The same complaints. The same symptoms. Over and over and over.

So, what makes each case interesting? What makes each case unique?

The patient behind the story. The person under the symptoms.

Lose sight of the person and you lose sight of the profession. Lose sight of their humanity and you lose sight of your own. Lose sight of your own and you become a burnt shell.

*****

You would think that after three decades of this, I’d have figured this out by now.

I guess you never stop learning.

This time, my teachers were an elderly man with a DVT who talked to me about his time on the LAPD, back in the day.

And the young woman who described, quite vividly, how it felt to go from the pinnacle of health to the devastation of a cancer diagnosis, overnight.

Or the 18-month old who tucked their head under my chin and fell asleep as Mom described  the terror of witnessing a first-time febrile seizure.

*****

Who would have guessed that sometimes patients are the cure for burn out and not the cause of burn out.

The patients didn’t change, they were always willing to talk.

All I had to do was stop and listen.

That simple.

Go figure.

*This blog post was originally published at Emergiblog*

I’m No Superman

essential-qualificationsI love this ad.

I was about this age when I decided to become a nurse.

Maybe a little older.

I was holding a book instead of a teddy bear.

I wouldn’t have been caught dead in that cap, though. Even in those days I knew how to make a totally cool nursing cap out of paper.

That looks like a pillowcase.

Sometimes it’s hard to remember why nursing sounded like a good idea.

********************

You don’t realize it’s happening.

You set a goal and you do what you have to do to get there.

For awhile, you manage to do it all.

Nine semester units.

Working 24 hours a week.

No sweat.

Been there, done that.

Lived through it.

*****

But things start piling up.

Work needs you to pick up some hours.  Coworkers on leave, folks needing time off.

You say yes, because when you need time off, they will make sure you get it.

Only your body isn’t cooperating.

You are in bed for the night at 1600.

And up at 0530.

Then you can’t fall asleep before you go in at 1900.

So you’re up for 28 hours. Straight.

Twice in one week.

That worked when you were eighteen.

It kills you at fifty-one.

*****

So you work, and work is uncharacteristically busy.

You start getting depressed four hours before you go in.

Then you start getting depressed because you have to work the next day.

Your coworkers are getting on your nerves.

You are really getting on their nerves.

You hit the ground and twelve hours later you sit for the first time. In the car. For the ride home.

To sleep for ten hours so you can go back and do it again.

Before your one day off.

That you sleep through.

*****

You fall behind in class; the professors are cool and allow you extra time for the assignments.

Which you need because you are so exhausted you cannot think.

But you won’t give less than an “A” effort so you stress and research and study and fine-tune and finally turn in the missive 48 hours after it is due.

Only to discover your classmates managed the assignment in two paragraphs.

How the hell did they do that?

*****

You start to lose it.

You don’t leave the house on your time off.

You stay in sweats all day and don’t bother to fix your hair.

Your husband thinks you are having a breakdown because he hears you laughing hysterically one minute and bursting into tears the next.

Except it’s not a breakdown, you are just watching “Scrubs”.

(Why the hell did they kill off LaVerne? Idiots.)

You start scanning the ads for a desk job. Part-time. Days. No weekends.

No blood. No pain.

No death.

*****

I’ve been here before.

The demon is back.

I’m in full blown burn-out.

But no major life changes.

Not this time.

I know what to do.

No more extra shifts.

The money is nice. Sanity is nicer.

No more twelve-hour shifts. Kudos to those who can do them.

I can’t.

No summer school.

I’m 12 units away from a BSN.  I can graduate in the Spring of 2010. I gain nothing by sacrificing my mental health to do it by December.

*****

I’m scaling back, I’m taking a break.

For the next few months, it’s all about me.

More visits to Starbucks to read blogs.

More visits to Starbucks to read novels.

More concerts.

More mini-vacations. Son’s graduation. Nascar race in Sonoma. BlogHer in Chicago.

*****

I wish I could do it all and be it all and have it all.

It’s hard to face the fact that I have limitations.

But, I know,

I’m no Superman.

And that is a major bummer.

I’m No Superman

*This blog post was originally published at Emergiblog*

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