I look earnestly at the person across from me. Anger, frustration, desperation. I am intensely aware of all these tensions directed at me, at the clinic, at the medical system in general. I am also aware of the time. We have 15 minutes scheduled for this encounter. This patient is new to me, but the tension is all too familiar. This patient may be frustrated about one of any number of things. It could be that the provider they saw last week ordered a test for them but it was not covered by their insurance. It could be that they just want a referral to someone else, but their insurance required them to be seen here first - I am the gatekeeper. It could be that they have seen 3 different providers for the same concern and no one seems to be taking them seriously. Each time I find myself across from someone in this state, I feel their frustration, and each time I strategize how best to use my time with them such that their goals can be met. Each time I hope to win them over and do right by them. “I’m on your side”, I declare with a smile. The tension eases. Their muscles relax a little, their voice becomes calmer. I am not the enemy. I also have just 15 minutes to somehow navigate this and figure out a solution.
I belong to a facebook group composed of 70,000+ other physician moms. This group was born out of frustrations inherent to doctoring (and parenting) in the current medical/social climate. The posts are a strange amalgam of peer inquiries for input on difficult medical cases, questions about how to get a baby to sleep through the night, and various rants and vents about difficulties in medicine ranging from chauvinism in the work place, to difficult patient interactions, to frustrations with the insurance company or pharmacy benefit system. Hard working doctor moms come here for support and to be supportive. It is not uncommon for women to post utter frustrations and cries for help as they try to figure out how to find balance in life. The phrase coined by outside entities to capture this frustration and fatigue is “burnout”. Physicians are burned out. Or are they? When a system beats you down to the point that you just cannot take it anymore, is that burn out, or is that just a human reaching a breaking point?
“I am on your side”.
When patients are frustrated with us as medical providers, they are frustrated with the providers we have been made into by an impossible system.
Here is the voice of one “burned out” physician (unedited, typos are directly from the poster who is ESL):
“I did the mistake of glancing at my schedule for tomorrow . I’m scheduled to see 28 pts in a regular day . 28 ! Double booked 3 times - 2 for pre admission clearance and once for an AWV . This means I won’t get any lunch . This also means I will run behind . This also mean I won’t get home 2 or more hours till after day ends . In the meantime all these patients will get press ganey surveys asking if I spent enough time with them . In one month we will have a quality meeting discussing if all my pts are up to date on preventive studies. Shud I invent a time machine during the night so I can spend enough time with each ? Or travel to another dimension with each patient where time moves slower ? I’m thinking about writing an angry email to the cmo and coo and give them a piece of my angry upset mind which I am sure I will regret tomorrow. Rant over 😭😭😭”
“just need to vent. had to walk out of patient room and make it outside before i had a total panic attack this afternoon. i am buried in work, have 25 patients today in 7 hours (none of which are actually easy), am trying to move this weekend and the movers FINALLY sent me a quote for $1500 to move literally 8 pieces of furniture one hour away. my desk is littered with paperwork to fill out. i am SO tired of staying till 6 or 7 every night to try to catch up, only to be literally buried again the next day. :( thankfully, my last day in primary care in next friday. i have no idea how i’ve made it this long, but i’m not sure how i’m going to make it until then. thanks for “listening.” i cried hysterically outside for about 15 minutes and i really hope my 1:00 patient couldn’t see the tear stains. thank god for masks and goggles that are now both required.”
It was not hard to find these posts. I found three just like this that were all posted within the last few days. Just a few flicks of the thumb scroll.
We all know the US healthcare system is broken, but do we all recognize that the very foundation - our primary care providers - are crumbling under the pressure?
At my previous clinic I often heard complaints from patients that they never saw the same provider twice, or they were frustrated that their doctors kept leaving. Clinics all over the U.S. are struggling to keep primary care providers. One big reason for this is that primary care docs are checking out. Some are taking administrative roles, some do consulting, some are finding ways to work part time or job share, some are switching careers entirely. I have many friends who are saving as much as they can so they can retire early and get out. Most physicians when polled say they no longer recommend medicine to their children as a career. How did what was once such a noble, lifelong profession go so wrong?
“I am on your side”
We physicians are suffering along with you. The frustrations you feel when dealing with your insurance company, the front office staff or the pharmacy are frustrations we are mired in daily. We feel your pain. We suffer with you and for you.
Just a few years ago I told my husband I didn’t know if I would ever retire. I felt I could do my job forever. I was a small town physician in Nebraska. I had a wide breadth of skills, and I used them regularly. I knew my patients well, and I took excellent care of them “from cradle to grave”. I had well trained nurses at my side during rounds or taking phone orders - taking much of the task burden off of my shoulders. When I saw patients in the clinic for their follow-up appointment from their ER visit, I knew exactly what had transpired there, because I was also their ER doc and their hospital attending. Most patients were gracious. Most were kind. Few seemed entitled. Perhaps most critically I knew all of my patients very well, and they knew me. There is great value in those relationships.
Practicing rural medicine is like a throwback to the way I imagine things were in medicine 30 years ago. Leaving that little town and my beloved community and role there was difficult. Going back, for us, is not an option. It was not a great fit for my husband, and here we are closer to family. We will raise our kids here amongst a diverse and forward thinking community. Turning back the clock and bringing back our paternalistic medical system is not an option either, nor would I want it to be. So what is a doc who still loves medicine to do when the system and people around her do not value her?
I want what everyone wants. I want to have gifts that I can give to others. I want to feel good about what I do. I want positive relationships with others. You cannot do the deep work that I want to do in 15 minutes, nor can you build relationships when the system sets up barriers to patients actually seeing you and spending time with you. I don’t want to churn through 20+ patients a day, referring many simply because I am out of time, while squirreling away my dollars for an early retirement. I want to do exactly what I was trained to do. I want the hard work, and I want the reward of a job well done. I want the ongoing privilege of knowing people on the deepest possible level and seeing them through the good and the bad of their lives. I want the satisfaction of sharing my gifts with them. I want people leaving my clinic feeling they were well served. After all, we are on the same side.