Deflating

I logged on to our EMR from home last night.  That is one of the “benefits” of EMR – access to information from home and the ability to finish your charts when at home instead of hanging around the office to do it.  It really is a benefit; it’s also an anvil.  Seeing the long list that had accumulated over the weekend and my Monday day off, it was deflating.

Yes, get out the violins and play a sad song.  Dr. Rob has a very hard life being a doctor!  Poor doctor who gets every Monday off!  All hearts should bleed for his terrible plight, right?  No, I am not trying to pluck heartstrings or pretend there are not incredibly great things about being a doctor.  I don’t blame people who get impatient when they hear doctors trying to paint themselves as martyrs.

I am no martyr; but I do sometimes feel the weight of my job full force.  Normally, I am enjoying the day to day interaction with patients, the joy of helping people, and the intellectual challenge enough that the burden is offset.  There are other times when that burden threatens to drag me down, pull me under, burn me out.

If I ever quit being a doctor, it won\’t be because I don’t like taking care of people.  It won’t be because of paperwork or dissatisfied patients.  I won’t quit because they don’t pay primary care doctors enough or because specialists don’t send me their consult notes.  It\’s not facing suffering, pain, and death that saps my strength.  All of these things are trouble, but not trouble enough to turn me away from a job.  The real threat is the slow and steady drain that I felt when I logged on last night.

If I quit, it will be because I love what I do and care about my patients.

What saps the drive is not the weight of the burden, it is the fact that it can never be put down.  When I have been away on vacation I come back to a long list of things that couldn’t be handled in my absence.  I know these people, I ordered the tests or started the medications; they are my patients.  Yet the burden is not even the work, it’s the emotion invested.  I do care about my patients and want to do them good.  The wonderful fact that I am meeting patients’ needs is followed by the shadow of patients needing me.  I am never let go by that need; or rather, I don’t let go of it.  I think both are true.

Parents of young children know the feeling; you can’t ever really get away.  Teachers know the feeling as well.  I have spoken with some very good teachers who, at the start of the school year, wonder how many more times they will be able to pick up the burden of that emotional investment they make in their students.  The best teachers don’t see what they do as a job, they care about their students.  The best parents are the ones who take the responsibility seriously and invest themselves in the child.  The best doctors are the ones who are doing it for more than money, prestige, and pats on the back; they do it because they care.

Sometimes I wish I didn’t care so much.  I wish I could go into work and punch the clock.  I wish I could help people without becoming emotionally invested.  I fantasize about really getting away from this burden.  But I know that I cannot step into my office without taking the next step.  I can’t not care.

So as I look at the labs, phone notes, consults, and hospital notes on my desktop I sigh deeply.  I wish they would just stop needing me.  But they aren’t just labs, phone notes, consults, and hospital notes; they are all people.  They are people who need me – people I care about.  It’s what I asked for, and it’s what I keep encouraging when I set foot in my office.  Would I really want to be without this burden?

No way.  I just wouldn’t mind a break every once in a while.

29 thoughts on “Deflating”

  1. You’re obviously not my doctor, but you remind me of him. That is a good thing, by the way! About a year ago, he switched from a large group practice to sharing an office with a colleague, having cast his lot with MDVIP. He is meticulous, he is talented, and he cares.
    Friday, I woke up pretty ill with a fever and coughing up blood. He was out of town attending a medical conference, and yet, even from that long distance, he orchestrated my care, and did it better than anyone else could have. (As the joke goes, “I’m feeling much better now…”)

    I want you to know that we don’t take people/doctors like you for granted. I wish that our profound gratitude were enough to tide you over those moments/days when you want a break from caring.

  2. You’re obviously not my doctor, but you remind me of him. That is a good thing, by the way! About a year ago, he switched from a large group practice to sharing an office with a colleague, having cast his lot with MDVIP. He is meticulous, he is talented, and he cares.
    Friday, I woke up pretty ill with a fever and coughing up blood. He was out of town attending a medical conference, and yet, even from that long distance, he orchestrated my care, and did it better than anyone else could have. (As the joke goes, “I’m feeling much better now…”)

    I want you to know that we don’t take people/doctors like you for granted. I wish that our profound gratitude were enough to tide you over those moments/days when you want a break from caring.

  3. @doc_rob,You are always able to put your finger directly on the pulse of America from a dedicated physician’s viewpoint. Thank you for sharing amusing and heartfelt comments that are clearly making a difference.

    @mkmackey on Twitter

  4. @doc_rob,You are always able to put your finger directly on the pulse of America from a dedicated physician’s viewpoint. Thank you for sharing amusing and heartfelt comments that are clearly making a difference.

    @mkmackey on Twitter

  5. So incredibly true. Sometimes I long for my first year of residency, when names on a chart were just names, I didn’t know their stories, and a low Lithium level was just a low Lithium level. I love your posts.

  6. So incredibly true. Sometimes I long for my first year of residency, when names on a chart were just names, I didn’t know their stories, and a low Lithium level was just a low Lithium level. I love your posts.

  7. I hear you! You are not alone. I only work part-time, not even half-time really, but I have my own patient load, and sometimes find myself losing sleep because I can’t stop thinking about how a particular patient is doing on a given night. I become irritable and snap at my children because I’m trying to think about whether there is a treatment I haven’t considered for a complicated case, that maybe I should try, and the kids want me to focus on more mundane tasks, like dinner. It’s very difficult to balance every day life with patient care. At least, it is for me.

  8. I hear you! You are not alone. I only work part-time, not even half-time really, but I have my own patient load, and sometimes find myself losing sleep because I can’t stop thinking about how a particular patient is doing on a given night. I become irritable and snap at my children because I’m trying to think about whether there is a treatment I haven’t considered for a complicated case, that maybe I should try, and the kids want me to focus on more mundane tasks, like dinner. It’s very difficult to balance every day life with patient care. At least, it is for me.

  9. This is true of many of the healing professions. You were able to say what many can’t put into words.Thank you.

  10. This is true of many of the healing professions. You were able to say what many can’t put into words.Thank you.

  11. I would have already quit if I had to work 5 days/wk. The volume I see in the 4 makes up for having the day off. It’s all about staying sane.

  12. I would have already quit if I had to work 5 days/wk. The volume I see in the 4 makes up for having the day off. It’s all about staying sane.

  13. The first post I read on your website was “Top 10 Ways Doctors can Annoy Patients”. I don’t know how my search brought me to that article but it did. It really make me wonder exactly what type of doctor you are. I was wrong after reading this…your heart is in the right place. Keep that funny sense of humor…it is serving you well. No violins needed here!

  14. The first post I read on your website was “Top 10 Ways Doctors can Annoy Patients”. I don’t know how my search brought me to that article but it did. It really make me wonder exactly what type of doctor you are. I was wrong after reading this…your heart is in the right place. Keep that funny sense of humor…it is serving you well. No violins needed here!

  15. Thanks. I can see how that post would give you the wrong idea. It was certainly meant in jest. I appreciate the link to Dr. Makous’ book. I’ll look into it. The premise is something I have written a lot about.

  16. Thanks. I can see how that post would give you the wrong idea. It was certainly meant in jest. I appreciate the link to Dr. Makous’ book. I’ll look into it. The premise is something I have written a lot about.

  17. Rob, Well said! I love your humor but I also love your dedication and caring about people. It really really shows. As a nurse working mainly critical care and lots of suffering and death as well as near miracles of recovery, I had beaucoup times when I went home but couldn’t stop thinking about particular patients. Often this led to calling back to the unit on days off to check on one who was on a slippery slope. I understand exactly what you’re talking about here and totally agree. Often, despite the dedication, you just need a genuine break from the worries about the ones in your care. Keep it up, you’re one of the good guys.

  18. Rob, Well said! I love your humor but I also love your dedication and caring about people. It really really shows. As a nurse working mainly critical care and lots of suffering and death as well as near miracles of recovery, I had beaucoup times when I went home but couldn’t stop thinking about particular patients. Often this led to calling back to the unit on days off to check on one who was on a slippery slope. I understand exactly what you’re talking about here and totally agree. Often, despite the dedication, you just need a genuine break from the worries about the ones in your care. Keep it up, you’re one of the good guys.

  19. Care factor | newcastleonhunter.com

    […] reads a blog by a “moderately strange primary health care physician” called Dr. Rob entitled “Musings of a Distractible Mind.”  Dr. Rob just explained why he doesn’t walk away from an impossibly exhausting job. […]

  20. Hmm, I don’t take charts home, EMR or not… and what if one of your patients dies before you finishing charting?? Hasn’t happened?………………..Not Yet anyway, and I thought EMRs made charting simpler, just point and click to your hearts content…And don’t feel guilty about that 4 day work week, wait a minute…who’s seein your treasured patients the other 72 hours of the week??? Oh yeah, they can just check the EMR to find out whats goin on with Mrs. Whatever-her-Name-Is…
    DOH!!!!!
    Seriously, dont go to next patient till done with last patient, OK, I do ER, so I know its unrealistic, Patient’s not done till Charts done…
    “If its not in the Chart it didn’t happen”

    Hmm sometimes that can be a GOOD thing…

    I think you’r onto something Dr. Robb
    Now if I could just see patients from Home…

    Frank

  21. Hmm, I don’t take charts home, EMR or not… and what if one of your patients dies before you finishing charting?? Hasn’t happened?………………..Not Yet anyway, and I thought EMRs made charting simpler, just point and click to your hearts content…And don’t feel guilty about that 4 day work week, wait a minute…who’s seein your treasured patients the other 72 hours of the week??? Oh yeah, they can just check the EMR to find out whats goin on with Mrs. Whatever-her-Name-Is…
    DOH!!!!!
    Seriously, dont go to next patient till done with last patient, OK, I do ER, so I know its unrealistic, Patient’s not done till Charts done…
    “If its not in the Chart it didn’t happen”

    Hmm sometimes that can be a GOOD thing…

    I think you’r onto something Dr. Robb
    Now if I could just see patients from Home…

    Frank

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