I was planning on leaving behind the seriousness of the past few posts and going back to my usual inane writing, but some of the comments have made it too hard for me to keep quiet.  The response has been largely positive, and overall it has been overwhelming.  More people have read or commented on my letter to patients with chronic disease than any in recent history.  I am grateful that it is circulating around the web for others to contemplate, perhaps understanding the intent of what I wrote and improving their relationship with their doctors in the process. The purpose of the letter was to give some helpful insight into the emotion on the other side of the equation.  I can't understand what it is like to have a chronic illness without having the disease, but it is still fruitful for me to try to figure this out.  In the same way, patients with chronic illnesses benefit from a better understanding of the doctors they see so frequently and depend on so greatly.  I can sympathize, but I can't feel the pain.  Still, I do need to listen closely to patients so I can have the best relationship possible.

Some folks felt that I was saying that doctors need their egos stroked and to be treated special, but that is not what I meant to say.  Each person needs to be understood and treated as their situation dictates.  People with chronic illness want to be understood (as witnessed by the incredible response to my letter!) and treated based on that understanding.  Doctors want to be understood as well.  So let me tell you my side of the story.  What is it like to sit in my chair?  I don't say this for sympathy or pats on the back, I say it to be understood.  If I am better understood by my patients (and readers), my relationship with them is better, which is good for both of us.  I think I represent a fair percentage of primary care docs in these ways.

1. I care about my patients - As hard as I try to "just do the job," and not expend the emotion I do during the day, I couldn't live with myself if I let my patients down.  They depend on me for a lot, they pay for my service, and they deserve my best.  I've been told I do this to a pathological degree (along with my llama obsession), but it is there.  I want to help them.  I get frustrated at my powerlessness and am genuinely happy when they do well.

2.  I am tired - Each day demands an emotional price.  Some days the demand is not so high, others suck the life out of me.  Being "needed" cuts two ways; on one side it is nice to truly help people when they need the most help, it's satisfying to see your life making a difference.  On the other side, it is a never-ending river of need, pain, and crises to be handled.  Being patted on the back (or patting myself) is nice, but it doesn't mean anything for the future.  Each day brings new hands to hold, needs to meet, problems to be solved.  Each day is as much a burden as it is an opportunity.  That burden won't leave me until I take down my shingle, yet the opportunities to make a difference will make it hard to take that shingle down.

3.  I also run a business - In terms of priorities, I need to pay my staff, pay the rent, and pay my personal bills to even have the chance to take care of patients.  I get frustrated when patients insinuate that I value money too much.  I get very frustrated by that, actually.  People seem more willing to pay for cable TV, cigarettes, or eating out than to pay me for what I do.  I earn less than most other medical specialists, yet some people resent my income.  The mess of a system we have works against primary care and works against complex patients.  If I spend 30 minutes with a complex patients (I do spend 30 minutes with people regularly), I am paid about 50% more than if I see a 5 minute ear infection visit.  Doing the math says that my mind is not valued and that I should see more ear infections and less chronic patients.  All of this adds to my daily stress.

4.  I am actually a person, not just a doctor - I have four children and a wife, and being a dad and a husband isn't easy when I come from work with the emotional life sucked out of me.  I struggle with my own emotions and I get sick.  I worry a lot about money, and I feel insecure about the fact that despite being a doctor, I am not saving enough.  Hence I also struggle with working too much.  Life's not easy for anyone, and despite my title I am not exempt.

5. I hate bad doctors - Many of the comments to the letter I wrote were lamentations about doctors who suck.  Unfortunately, doctors who take bad care of their patients make my life miserable too.  I have to clean up their messes, I have to re-teach their patients on what medicine should look like.  I have to wean their patients off of addictive drugs that they didn't have the guts to deny. I am personally frustrated when I send a person to a specialist and they don't do anything or upset my patient, and I hate the fact that they almost never communicate with me.  It makes my already hard job even harder.

6. My blog is a refuge and a tool - I am thankful that I have this blog as a means to vent, to use another part of my brain (some may argue that point on some of my posts), and to make a difference.  I actually have a voice in the whole healthcare reform debate.  I actually can reach a large number of people and make their medical experience better (which was the most gratifying thing to hear in the comments to my letter).  I've made practically no money doing this, but I've gotten a whole lot out of it.

That's my story.  Like it or not, it is what it is.  I am just a guy who happens to be a doctor - the same as the rest of the doctors out there.  There will always be angry people and idiots on both sides of the doctor/patient relationship, but no matter what, the doctor-patient encounter is a human thing.  Love is human, war is human, murder is human, and so is childbirth.  You can't put humanity into a bottle, you can't throw a single label on it.  The highest calling is to enter into another's life, to see things from their perspective, and to add good to it.

That goes for all of us, regardless of letters behind our names.

Thanks for listening.

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