Why Your Doctor Thinks You Suck

So I was chatting with a friend of mine (also a doctor) today who has a lot more experience with blogging than I do.  Actually, 97.2% of the free world probably has more experience blogging than I do, so that’s not really saying anything, but I value her opinion tremendously.  She had read my blog, and gave me some great feedback and helpful hints.  Then she hit me with something that was totally unexpected.  She said, “I really like your blog, but your posts aren’t opinionated enough.”  And in many respects, I have to agree with her.  The last thing I want to do as a blogger is simply report what is already public information.  Isn’t the whole point of doing this to get your opinion out there, and then put on your big girl pants and hear what the rest of the world has to say about it?  This blog is for my friend Collette, and I make no excuses for shamelessly pilfering her fabulous title for my post.

One thing that I remember vividly from my days of primary care practice were the patients who made me cringe when I saw their names on my schedule for the day.  Specifically speaking from a pediatric perspective, I’m talking about patient’s parents.  Sometimes it was for obvious reasons – I mean, who likes chronically angry people?  But sometimes the reasons were more subtle, but just as oppressive.  Don’t get me wrong, there are plenty of jerk doctors out there too who think that their patients exist simply to make their lives miserable.  But there are definitely some specific folks who elicit groans of actual pain when their doctors see their names on the patient list.  After thinking long and hard about what it was exactly that made these people so excruciatingly difficult to deal with, I came up with a list of some of my favorites.  You may love it, or hate it, or take the easy route and just assume I’m burned out and bitter.  A few of you may see yourselves in these descriptions.  And if you do, I hope it makes you very uncomfortable, because that means that you care about what I think and perhaps might even consider how you act the next time you visit your doctor.

1. The Entitled Professional:  These folks are a lot of fun.  They virtually always have a terminal degree, and the vast majority of the time, they are lawyers.  They love to come into your office and make veiled threats by throwing important names around, and how they have so-and-so political figure on their speed dial.  Their time is always more important that yours – they throw an absolute fit if they are not accommodated exactly at their scheduled time, but are perfectly content to show up 30 minutes later and still demand to be seen.  They also like to come in with articles they have downloaded off the Internet and wave them in your face.  I remember one mother who came in having printed out an 11 page article on sudden death risk in child athletes, expecting me to read it right there and have an in-depth journal club with her (while of course managing to do well checkups on both her kids in 30 minutes).  I certainly didn’t object to her being a well-informed parent.  In fact, I wish more of my patients had a decent sense of health literacy.  No, what I objected to is that, while she had taken the time to kill three trees to print out the article, she hadn’t actually read it carefully for herself.  Luckily, I already had, and was able to inform her that while the information was important, the study had been conducted entirely in Italy with a set of patients that had very different genetic and ethnic risk factors than American children, and that our standards of care had not changed.

I bet she’s also the same person that would throw the entire article in the trash, instead of recycling it.

2. The “1001 Questions” Patient: These folks come in with a list that is displayed ceremoniously at the beginning of the visit.  It is usually brought out from a pocket or a bag with a flourish, and is often folded about seventy-two times, so there is a grand production of unfolding this piece of paper in preparation for a reading.  Then there is usually some throat clearing or clothing adjustment, followed by a serious look and a proclamation of, “Well, I have quite a few questions for you today.”  To this day, I still don’t know where the VIP entrance to our clinic was in the building, but I knew there had to be one just for these people, because clearly the entered the building and our clinic without once noticing the line of FIFTY @#$%^&* PEOPLE trying to register at the front desk and spilling out of the waiting rooms.  They also don’t realize (really through no fault of their own) that bringing in a list of questions that looks like the Magna Carta  will actually distract their physician from focusing on what is truly important at the moment.  No matter how delicately and professionally I let them know that I would only be able to address their top two or three concerns that day, they inevitably looked completely crushed when they realized that I would have to leave the room in ten minutes to actually go take care of other people too.

3. The “I Can’t Be Bothered To Learn How This Place Works” Patient:  These patients are especially choice.  Despite the fact that they have been coming to your clinic for years, they can’t be bothered to learn anything about how the place runs. Consequently, they are always angry about something each time they come in for a visit. Often, it’s the exact same thing as last time, and even more often, it’s something I have zero control over fixing.  Yes, our parking garage is run by Satan.  Yes, it constantly takes at least an extra 20 minutes to find a spot or get the valets to park your car.  I too have the joy of parking in this garage, but somehow I manage to allot the extra time I know it will take to park my car, so I am not late as you were today and every other day you have come in bitching about the parking garage.   

My favorite was one father in particular who, every single visit, would throw a Grade A tantrum about being seen by a medical student or resident.  I worked in a teaching hospital, which means we were affiliated with a School of Medicine.  That we were an institution of learning was no mystery: the name of the hospital has the word “University” in the title, and was actually physically on the campus of the University.  This meant that students and residents in training would be part of the medical care team (this is how we turn students into the adult doctors who will be taking care of you when you are old!)  Yet every time this guy would come in he would rip the poor student or resident a new anal orifice, and demand to see the attending physician immediately.  Apparently, he had gained quite a reputation for this among the staff and even my colleagues.  When he invariably landed in the resident clinic I was supervising and started screaming in the hallway, I marched out of the attending room, walked up to him, and very publicly explained to him how a teaching hospital worked.  I also invited him to explore private practices in the area to see if those might be a better fit for his needs, as they would not have students and residents working in them.

One might think that my efforts to find this gentlemen the best fit for his needs might not go over so well with my administration, given that I was encouraging him to get with the program or get out.  However, the incredibly “progressive” thinking in my institution meant that they had crunched the numbers, and come to the realization that a new patient was worth far more money than a returning one.  A new patient history and exam are much more detailed (and therefore billed at a higher level) than the visit for someone already known to the system.  So as far as they were concerned, this guy could go suck it – there would be a brand new shiny patient to take his place who was worth a lot more.  Isn’t managed care medicine great!?!?

4. The Staff Abuser:  This is fairly self-explanatory.  These are the people who come in an scream bloody murder at each and every staff person they encounter.  Check-in staff, annihilated.  Screening nurse, bawled out.  Managed care coordinator, decimated.  But then somehow by the time I see them, they have miraculously transformed into the sweetest, kindest, brown-nosiest person I have ever seen.  As if I somehow managed to completely miss the Armageddon they just laid down in my waiting room, and I think they must be the kindest people I have ever met in the whole world.  Something about these folks in particular sickens me – the fact that you kiss up to me because I have an M.D. after my name makes me like you less, not more.

5. The “Why Do You Even Come Here” Patients:   I think these folks may be the winners as far as I’m concerned.  For the life of me, I never understood why they even came to the clinic at all.  They already had decided what they were going to do, they had no interest in any medical advice I had to offer, they never followed any instructions that were given, and then were stupefied when their kids would run into problems.  One family I worked with were staunchly against vaccinating their children.  This wasn’t new to me – there were plenty of families in the community I worked in who chose not to vaccinate their children for a variety of reasons.  (Whether I think this is a reasonable choice or not is another blog entirely….)

This family in particular made a huge stink every visit about not doing things that weren’t “natural”, which for them included not vaccinating their kids.  Every time I patiently reviewed the potential risks of not vaccinating with them, and had them sign a form stating we had discussed just that.  This went on for years, until the day one of the kids caught Pertussis (Whooping Cough), which he proceeded to spread to his entire unvaccinated family.  Pertussis is one of those illnesses that, while incredibly annoying in older children and adults, is actually often fatal in infancy, which is why we vaccinate against it and outbreaks are closely monitored.  The mother called me, horrified, to complain that the Department of Health had come to her home to investigate the mini-outbreak that had occurred there.  Well what on earth did you think was going to happen?

Not wanting to end on a completely negative note, I think it’s worth mentioning that for every type of patient I mentioned above, there was an equally lovely and appreciative person for whom providing medical care was a joy.  Too bad we can’t bottle those and save them for a rainy day.

~Lumi

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On Leaving Medicine: Intro

DISCLAIMER: The following blog addresses some very real issues regarding providing medical care in this day and age in the U.S.  Despite my struggles to reconcile my own feelings about practicing primary care, I still do and always will love medicine.  I cannot emphasize it enough.  I trained to become a knowledgable, compassionate, and competent doctor, and my love for that will never change.  It’s all the other bull***t that keeps getting in the way and messing things up.

It only makes sense that my first real post would address the huge dead elephant in the room.  At the age of 37, I took a big breath and completely walked away from my career in clinical medicine.  Obviously, I didn’t just wake up one day and decide to quit being a practicing doctor.  This was a heart-wrenching resignation that was made over many years and many countless attempts to fall back in love with being a practicing physician.  I also think it’s important to mention that I am not one of those folks who came out of the womb knowing I absolutely had to be a doctor.  There have always been other interests and talents in my life that have pulled at me in other directions, and I have never worried that the sun would somehow fail to rise in the morning if I decided to do something else.  I have shifted my horses in midstream, become my own boss, and am doing a combination of medical consulting and foreign language interpreting, and quite honestly cannot remember a time when I have been happier in my work (more on that later….)

Still, what was it exactly that lead me to basically (and with much relief) walk away from what appeared to be a thriving clinical career and throw all my colleagues into an apoplectic fit?  The answers do not only belong to me, but to a startling number of my fellow physicians who are struggling daily with the urge to simply give up.

According to a 2011 JAMA article by Dyrbye and Shanafelt, an estimated 30 to 40% of physicians are experiencing burnout.  It’s not just a few disgruntled docs who have been at it too long and need to spend more time finding their inner zen.  Burnout among our nation’s physicians is nothing short of an epidemic right now, and one we cannot afford given that we have some of the poorest medical outcomes among industrialized nations.  Yes, we all love to think that America is the mecca of medical care, but compared with other economically-industrialized countries, our statistics are some of the least desirable in areas like infant mortality and life expectancy (OCED health data 2011).

So what’s at the heart of this tsunami of doctor burnout?  There are lots of articles and research efforts being devoted to this very question.  Right now there is an interesting article posted on kevinmd.com regarding gender differences in physician burnout.  For me, I did a lot of introspective thinking in the six months I took off after my resignation.  I don’t claim that every other physician experiences these issues the same way I did.  But for me, they were very real and ultimately forced me to walk away from clinical practice in order to salvage my love for it.

After much thought and soul-searching, here are the things that drove me to leave clinical medicine (in no apparent order):

  1. Managed Care Impositions
  2. Administration Without Vision (aka “Looking for Icebergs Instead of Bailing Water”)
  3. Grossly Negligent Support Staff
  4. Passive Parents
  5. A Voiceless Faculty
  6. A Startling Self-Realization

My blog posts over time will address each of these, and will probably require a decent amount of red wine to get everything put down honestly and accurately.  I hope for some of my colleagues, this may serve as some comfort knowing you are not the only one feeling this way.  And for others not in the field, I hope you will find this helpful in taking away a little empathy for what your doctors deal with in their work day.  Cheers….

~Lumi

New Blogger Alert

Forgive my stumbling around my new blogsite as I try to catch up with the rest of the 21st century.  I’ll be posting something of actual reading value soon, and I hope you will come back often to see what’s new.  I look forward to exploring some uncharted territory when it comes to recovering from burnout, and not just posting a bunch of bitter comments.  Ok, well some of the comments will be snarky and bitter I’m sure.  But I’m hoping there will be plenty of lovely moments peeking out like weeds between the cracks in the sidewalk.

~Lumi