I recently read the blogpost on KevinMD, “I’m sorry: Why I lost my love for medicine.” I wrote this in response.
Dear Anonymous Physician,
I read your article: “I’m sorry: Why I lost my love for medicine” with great sadness. My heart goes out to you and many of your concerns echo deeply within me. I am sorry that we as colleagues in health care have not done enough to help you, and that our system so frequently failed you (and everyone else).
You are right: Healthcare as a System, in the United States, is broken. It is sad, terrible, and infuriating. Let me respond with a consideration for all physicians out there, especially those “on the cusp” of giving up. What if we could separate the “business” / “admin” / non-doctoring part of our job, from the Doctoring part? What if we emphatically separate out the noise?
A long time ago in a HIPAA compliant response-article far away, I was getting ready to leave for the day and was walking to my office, near the imaging suite. The Code Chimes went off. I was thirty feet away, so I ran and took over. The patient had no IV access, no pulse and was not even on a hospital bed. They were in street clothes.
We managed to get access to deliver medications after spraying epinephrine down an LMA that we put in rapidly, without trying to intubate so we could at least get some medicine in, somehow, without any delay. We later intubated the patient and all-in-all, provided round after round of CPR, and shock after shock for unusual rhythms. We were there for well over an hour. Every patch of stability was lost with malignant dysrhythmias and lost pulses. Our workup was fairly benign – just bad rhythm after bad rhythm. But the repeated compressions were getting longer and longer and in truth, I didn’t think the patient would make it.
To my surprise, however, my patient stabilized, I transported them to the intensive care unit and transferred their care to a brilliant ICU team.
I went home. My kids were getting set for bed, my wife was frustrated at how late I was, and I was hungry and exhausted. And I was needed by my kids and family – I am not the doctor of yore who may have gone home and given little thought to their in-depth contributions to family and children, maybe smoking a cigar in a backroom. I am an active, highly involved parent, just like many of my colleagues. So I stayed hungry, grabbed a granola bar and tried my best to play actively, give attention and love on my kids before they went to bed. And I ate while doing the dishes and cleaning our house up. After everything was taken care of, I still had to prepare for my next day – reviewing charts and teaching and planning with a resident on how to provide anesthesia for our next set of patients.
Yes this was exhausting. No, in actual truth no administrator cared that I was there. I probably couldn’t bill time for my department or hospital (or at least I didn’t document enough information to even attempt to “bill” time), and even in showing up I exposed myself to high risk of a malpractice suit – when people are at risk of dying, it’s a high-risk spot for things not going right, or going right and still having someone experience loss or injury. I doubt more than one or two of my colleagues ever realized I was even there, and certainly, no one ever gave more than a few minutes thought about it or would ever thank me for it.
But, I signed up for this. I signed up to be on call and to sacrifice my time (some of my time, anyway, I can hardly say I’m abused in my current practice which has great flexibility). I signed up hoping that someday I could be the person that ran into a room and knew what to do and how to direct a team of 20+ people and – hopefully – save someone’s life.
I stopped by the patient’s room the next day, nervously expecting that they would be comatose and sick and the family would be agonizing over what to do next. But in the room I found a smiling patient, with no breathing tube and with no cardiovascular support on. They smiled at me, and said “So you’re the one?” They grasped my hands and said thanks. I teared up then and still tear up now writing about it. They went home the next day. I later got a letter from the family some weeks later, thanking me for saving their loved ones’ life and giving them precious time. The letter sits at my desk, front and center in front of me.
As someone who tends to run towards the dumpster fires, I would be lying to pretend it always goes like this. Most people who arrest are unable to be saved, or are saved and have new health compromise on top of already poor health. I sometimes do everything right, yet the patient can’t make it. I sometimes don’t feel I was “on-point,” and am late to check a glucose, or frustrated at poor compressions and can’t seem to rotate people in and out smoothly. Or I don’t think of something clever, or something doesn’t go well. And sometimes those people die, and I have to wonder if – despite my expertise and skill – I could have done it differently. I try to remind myself that it is like shooting a last-second buzzer beater – no matter how good you are, sometimes the shots don’t go in (even if you’re Michael Jordan). But it still absolutely sucks in a way that no one outside of our world can ever understand. Even within our world, there are few who take it all to heart and who truly live with their outcomes.
I worry that sometimes we focus endlessly on things beyond our control. Press Ganey scores come to mind, as do the myriad of billing notices I get in order to change my charting to be “compliant.” Or just “compliance” to the inane volume of online quizzes I have to take to ensure I understand HIPAA and inappropriate gifts, and resident supervision, and fire safety, and on and on and on. Other more severe and serious things come to mind – the rise of non-physician providers that pose a risk to defining physician expertise, or who may compete for our job market, or who in advertisements insult our compassion. “Heart of a nurse, brain of a doctor” was quite simply one of the most insulting and personally hurtful ads I’ve ever seen, and it impacted me deeply. Administrative pay increases while cutting the front-line workforce and decreasing nurse and doctor pay and benefits is equally important and infuriating.
All these things need to be fixed. All of them warrant our attention and all are critically important.
But, a long time ago I was able to come back from burnout. I first took a lot of “back-off” time, talking to family and colleagues and friends, of course. But then, I started by reading my personal statement and thinking – “Why did I do this?” Next, I tried to go through memories and hold onto the people I helped, the cool diagnoses I made and the unique procedures I’ve been able to do. I realize I only could do those things by sacrificing time and energy and by putting up with stress and fatigue. But in the end, I found it crucial to remember that – whatever anyone else things or says – what I do, and what we all do, is very, very special. I can get bad reviews, make mistakes, have someone insult my abilities, have angry patients, miss easy diagnoses – all sorts of bad things – and if I focus on those things, I become lost and burnt out. I also get burnt out if I only read about the struggles of healthcare and – oddly – when I’m reading anything about physician burnout. But, if I hold onto those truly special patients and situations like a sigil burnt into my soul, I can sometimes ignore the BS long enough to feel that my job and my career as a physician has a deep meaning and purpose.
I’m sorry you lost your way, and it’s a tragedy that so many of us struggle, and of course your article is touching and sad because it is simply so true. I am not pretending healthcare is perfect, and I would definitely hesitate to encourage my children to become doctors. But I am hopeful that someone can read this and re-grasp the idea that sometimes – just sometimes – we can be the doctors we wrote about in our personal statements all those years ago.