100

You expect your doctor to listen.  You expect a sharp mind, a good thought process, a smile, and a solution to your problem.

I walk into those expectations over 100 times each week.  Each patient I see is expecting my best.  That is what they pay me for: a professionally-trained person who can help them get healthy or stay that way.  If I was the patient, I would expect the same of my doctor.  I would assume it.

But it isn\’t always easy.  Last week I had to deal with an incredibly busy schedule, a bad case of child neglect, and an accidental death due to a Tylenol overdose.  My son is starting to interview for college, and there are the usual trials of being a father (with three teenagers) and husband.  I was also fighting a cold, and wasn\’t getting as much sleep as I needed.  Giving 100% when I walked into each exam room was not easy. 

Before I go in to see a patient, I try to clear my mind of distractions and walk into each room fully focused.  The problems I face don\’t always tax my thinking: I may be seeing a healthy baby, an ear infection, or a stable hypertensive patient.  The problem is that I don\’t know when the tough case will show up.  I don\’t know which well-child exam will have the abdominal mass, which ear infected child will be bordering on sepsis, or which hypertensive will have subtle unstable heart disease.  They will be out there, but I don\’t know when and where.

Jerome Groopman, in his book How Doctors Think, describes primary care medicine in the following way:

Imagine watching a train go by.  You are looking for one face in the window.  Car after car passes.  If you become distracted or inattentive, you risk missing the person.  Or, if the train picks up too much speed, the faces begin to blur and you can\’t see the one you are seeking.

Quoting a pediatrician, he goes on:

\”It\’s much harder than the proverbial needle in a haystack, because the haystack is not moving.  Each day there is a steady flow of children before your eyes.  You are doing well-baby checks, examinations for school, making sure each one is up to date on his vaccinations.  It can become rote, and you stop observing closely.  Then you have the endless number of kids who are cranky and have a fever, and it\’s almost always a virus or a strep throat.  They can all blur.  But then there is that one time it\’s meningitis.\”  (from Chapter 4)

The key is to always be on the lookout, always attentive, and as methodical as possible.  I try hard to do everything the same way each time so that I always go through the necessary steps.  Having done this for the past fourteen years, I am pretty good at turning my brain to \”doctor mode.\”

But I have come to recognize that this does take a toll on me – especially during times like last week, when there are many emotional things trying to drag me down, and many interruptions and distractions to my daily routine.  To add to the analogy, it is like looking for that face on the train while in a crowd of shouting people.  It is habit, and I can do it; but it takes its toll.

I am not looking for sympathy.  I am no different from other primary care physicians in this way.  It is important to remember this reality when you hear primary care physicians complaining about the unfair payment system.  We may sound like whiners – and sometimes we are just whining – but it is easy to become jaded. Life for the PCP consists of carrying this burden on a daily basis and then being rewarded with lower pay, more responsibility, increasing scrutiny, and less appreciation for the job we do.

Finally, let me point out that I am the tip of the iceberg.  I am one of the few PCP\’s who is vocalizing this fact.  Most PCP\’s are carrying this burden without a podium on which to complain or an audience to hear it.  I can voice my concerns to the public and at least get some people hearing my complaints, but most PCP\’s just dealing with the stress, taking a deep breath, and walking into the next exam room trying to give 100%.

26 thoughts on “100”

  1. Incredible post. My own medical battles and so much time as a patient has taught me that education is critical to help patients (not “consumers”) understand some of these things to help them take a look at what their “signal to noise ratio” might be so that the burden of seeing that face-in-the-blur isn’t 100% on the clinician. The responsibility doesn’t shift to the patient of course, but they can be partners on the same team.
    Anyway, very touching and insightful, as always.

  2. Incredible post. My own medical battles and so much time as a patient has taught me that education is critical to help patients (not “consumers”) understand some of these things to help them take a look at what their “signal to noise ratio” might be so that the burden of seeing that face-in-the-blur isn’t 100% on the clinician. The responsibility doesn’t shift to the patient of course, but they can be partners on the same team.
    Anyway, very touching and insightful, as always.

  3. Healthcare Today

    100 | Musings of a Distractible Mind…
    Each patient I see is expecting my best. That is what they pay me for: a professionally-trained person who can help them get healthy or stay that way. If I was the patient, I would expect the same of my doctor. I would assume it.

    But it isn’t alwa…

  4. I remember when my son at age 6 was hospitalized with a horrible sinus infection that they were trying hard to keep from becoming meningitis. I didn’t even know such things could cause meningitis. His Doctor was at that hospital multiple times each day while he was in ICU. It was 6 days before we felt confident that the infection was under control enough we could take a breath. It was in the sinus passage that drains right beside the brain and this was what was so troubling. I remember thinking that I was going to die when his Dr. told me that if the infection goes to his brain, there is a 70% chance he will not live. I never seen any Dr. more concerned than what he was. The nurses told me he also called several times a day from his office and sometimes even during the night.
    I hope every now and then at least one of your patients send you a thank you card. You are tops and they are very lucky. Also, can you tell me if 70% of meningitis in kids is still fatal? That has been 29 years ago we went through that.

  5. I remember when my son at age 6 was hospitalized with a horrible sinus infection that they were trying hard to keep from becoming meningitis. I didn’t even know such things could cause meningitis. His Doctor was at that hospital multiple times each day while he was in ICU. It was 6 days before we felt confident that the infection was under control enough we could take a breath. It was in the sinus passage that drains right beside the brain and this was what was so troubling. I remember thinking that I was going to die when his Dr. told me that if the infection goes to his brain, there is a 70% chance he will not live. I never seen any Dr. more concerned than what he was. The nurses told me he also called several times a day from his office and sometimes even during the night.
    I hope every now and then at least one of your patients send you a thank you card. You are tops and they are very lucky. Also, can you tell me if 70% of meningitis in kids is still fatal? That has been 29 years ago we went through that.

  6. I don’t know where the 70% comes from. It really depends on the type of meningitis – some are nearly that lethal, while others are not so bad. Fortunately, we don’t see nearly as many cases of meningitis due to some of the more recent immunizations added to our arsenal.

  7. I don’t know where the 70% comes from. It really depends on the type of meningitis – some are nearly that lethal, while others are not so bad. Fortunately, we don’t see nearly as many cases of meningitis due to some of the more recent immunizations added to our arsenal.

  8. Very nice post Dr. Rob– it’s uncanny that you mention ‘whining’. Hanging on the exam door(s) @ my PCP’s office is a ‘traveling’ sign–the nurses keep moving it from door to door– that says ‘No Whining!’ He’s a great guy and I’d bet $100 he feels the same way you do. Every time I see him I tell him I don’t know he does it, just being a physician, let alone being a husband & father as well.

  9. Very nice post Dr. Rob– it’s uncanny that you mention ‘whining’. Hanging on the exam door(s) @ my PCP’s office is a ‘traveling’ sign–the nurses keep moving it from door to door– that says ‘No Whining!’ He’s a great guy and I’d bet $100 he feels the same way you do. Every time I see him I tell him I don’t know he does it, just being a physician, let alone being a husband & father as well.

  10. Great post Rob. I agree with MottsA-I don’t know how y’all do it either.
    You know that saying… A man’s job is from son to son-and a woman’s job is from sun to sun. Sounds like you Doc’s give the women some competition in that area.

    If you were my doc..I’d bring you and staff some food… every so often. πŸ™‚

  11. Great post Rob. I agree with MottsA-I don’t know how y’all do it either.
    You know that saying… A man’s job is from son to son-and a woman’s job is from sun to sun. Sounds like you Doc’s give the women some competition in that area.

    If you were my doc..I’d bring you and staff some food… every so often. πŸ™‚

  12. Hear, hear, Dr. Rob. It’s been a few days of poor sleep and too many charts for myself as well. It’s very hard to make myself slow down, double check my work, and make sure I’m not missing stuff. A good support staff makes a huge difference, but ultimately it comes down to me (and you). Whining helps, as long as it’s the exception, not the rule.
    Early to bed for me tonight. Hopefully tomorrow will be a better day.

    Smak

  13. Hear, hear, Dr. Rob. It’s been a few days of poor sleep and too many charts for myself as well. It’s very hard to make myself slow down, double check my work, and make sure I’m not missing stuff. A good support staff makes a huge difference, but ultimately it comes down to me (and you). Whining helps, as long as it’s the exception, not the rule.
    Early to bed for me tonight. Hopefully tomorrow will be a better day.

    Smak

  14. Wow. Your frustration is understandable. πŸ™
    This may seem like an incredibly naive question, but can you hire a PA or NP to take some of the more routine cases? Or does this increase costs too much?

    Anyway, if you were my doctor, I’d bring you a homemade cheesecake and a big thank you card today. Hope tomorrow is better.

  15. Wow. Your frustration is understandable. πŸ™
    This may seem like an incredibly naive question, but can you hire a PA or NP to take some of the more routine cases? Or does this increase costs too much?

    Anyway, if you were my doctor, I’d bring you a homemade cheesecake and a big thank you card today. Hope tomorrow is better.

  16. I have a PA. She takes the “easy” stuff. That means I get to see the elderly with 15 meds my whole day. Plus I am still legally responsible for what my PA saw and performed, plus all her paperwork, plus all the complaints about “I never get to see you anymore”.
    She works hard enough to make her income and help pay for the electricity, rent, etc. but that is about it. And no pay raise for the last 3 years. She is a saint for staying with me.

  17. I have a PA. She takes the “easy” stuff. That means I get to see the elderly with 15 meds my whole day. Plus I am still legally responsible for what my PA saw and performed, plus all her paperwork, plus all the complaints about “I never get to see you anymore”.
    She works hard enough to make her income and help pay for the electricity, rent, etc. but that is about it. And no pay raise for the last 3 years. She is a saint for staying with me.

  18. We actually have 2 PA’s. They do help, but when you run the business, anxiety will always be there.

  19. We actually have 2 PA’s. They do help, but when you run the business, anxiety will always be there.

  20. I enjoyed your article enormously.
    Daniel Village Barber Shop proudly serves the Augusta Medical Community.

    I hope you don’t mind that I posted the article on my site.

    Thanks

    Billy Reeves

  21. I enjoyed your article enormously.
    Daniel Village Barber Shop proudly serves the Augusta Medical Community.

    I hope you don’t mind that I posted the article on my site.

    Thanks

    Billy Reeves

  22. Keep writing, Rob! People need to understand what it is to do a job that drains so much from one human being. They don’t understand the long hours, not really. They don’t realize all the work that is on your desk long after the office has closed. They can’t know the emotional, mental, and physical drains that are placed on the physician.
    Here is one human in a sea of thousands of patients, then family – they want to be with you, they want you near, they want to share their life with you, and the list goes on of all the thousands of people that want a piece of you. It seems there is no one there to rescue the physician when he becomes ill, and drags him or her self into the job day after day. They can’t just pick up the phone and call in for the day. I don’t see it as whining at all! It’s real and it’s human. Your writing it out is educating others.

    I had one woman the other day so angry at the Dr. for making her wait. So upset that the place was so busy. I stopped and took the time to look into her eyes, and I explained we had some serious emergencies come in. He was with one of them now, and that we were sorry and understood her frustration, but this patient was seriously injured and her doctor was only one man, and so many were in need of help. She softened and really looked me over and seemed to think on it, and she said something quietly I couldn’t understand, but I knew it was said a little sheepishly, and she quietly had a seat and waited until we could get to her. They just don’t understand. So keep writing and telling your side from time to time. (sorry so long, I hope you are feeling better.)

  23. Keep writing, Rob! People need to understand what it is to do a job that drains so much from one human being. They don’t understand the long hours, not really. They don’t realize all the work that is on your desk long after the office has closed. They can’t know the emotional, mental, and physical drains that are placed on the physician.
    Here is one human in a sea of thousands of patients, then family – they want to be with you, they want you near, they want to share their life with you, and the list goes on of all the thousands of people that want a piece of you. It seems there is no one there to rescue the physician when he becomes ill, and drags him or her self into the job day after day. They can’t just pick up the phone and call in for the day. I don’t see it as whining at all! It’s real and it’s human. Your writing it out is educating others.

    I had one woman the other day so angry at the Dr. for making her wait. So upset that the place was so busy. I stopped and took the time to look into her eyes, and I explained we had some serious emergencies come in. He was with one of them now, and that we were sorry and understood her frustration, but this patient was seriously injured and her doctor was only one man, and so many were in need of help. She softened and really looked me over and seemed to think on it, and she said something quietly I couldn’t understand, but I knew it was said a little sheepishly, and she quietly had a seat and waited until we could get to her. They just don’t understand. So keep writing and telling your side from time to time. (sorry so long, I hope you are feeling better.)

Comments are closed.

%d