It happened again. I was talking to a particularly sick patient recently who related another bad experience with a specialist.
Compared with a probability-based sample of 3442 working US adults, physicians were more likely to have symptoms of burnout (37.9% vs 27.8%) and to be dissatisfied with work-life balance (40.2% vs 23.2%) (P < .001 for both).
Analyzing questionnaires sent to more than 7,000 doctors, researchers found that almost half complained of being emotionally exhausted, feeling detached from their patients and work or suffering from a low sense of accomplishment. (From NY Times Health Blog)
Yet my own experience with my own emotions in medicine, as well as my experience with other physicians, suggests that half of the physicians in the survey are probably lying. Being a doctor is certainly a great privilege, but it is also an enormous tax on the emotions. Since I haven't done other jobs I can't compare, but there are many days I find myself wishing I had a job I could just do and then just leave at the office. The changes in health care over the 18 years I've practiced have increased that frustration and fatigue, causing me to catch myself pining for the "good old days." Ugh.
1. The pressure to see a high volume of patients - because I am paid by volume, I am constantly pressured to spend less time with my patients. This makes me feel like I'm not doing a good job on anyone.2. The fact that good work is penalized - When I do explain things, call people, or just act friendly toward my patients I am rewarded with a lower salary. I constantly have to choose between doing good and getting paid, and that's really lousy.3. The piles of paperwork - This has grown steadily over time, and is barely reimbursed at all. The time I spend doing paperwork either takes away from my productive time with patients, time with my family, or my own personal time to take care of Rob.4. The ridiculous rules - Complying with coding requirements for documentation, with "meaningful use rules," and with increasingly invasive rules around prescribing controlled drugs makes me nauseated. Not only are these rules complicated and confusing, but noncompliance (intentional or not) to them could make me lose my license or worse.5. Dr. Oz and his cronies - I single out Oz only because of his overall influence (and to get back at Oprah for her vendetta against me), but the increasing invasion of medical information with self-serving balderdash is both annoying and destructive. I don't want to explain why all fatigue is not thyroid, or why gluten is not a toxin, yet I must do so to be able to care for my patients.6. The Evening News - The love affair the networks (CNN and company included) have with the "latest study" is enough to make me consider experimentation in television/baseball bat mating. Every day there is a study showing that what was helpful last month will now kill you. It's all headling grabbing for money, and I spend an increasing amount of my time dealing with it.7. Drug seekers - Fueled by codependent doctors who can't say no to requests for controlled substances, far too much of my day is spent explaining why Percocet is not a good choice for chronic pain, and daily Xanax will just make things worse. A huge percentage of my phone messages are about these medications and I would gladly stop prescribing them altogether if they didn't help some of my patients as much as they do.8. Politics and medicine - I've already said enough on this issue. Unfortunately, the politicians are supposed to fix this mess, and that's a pretty depressing reality.9. The constant weight of responsibility - Over the past 18 years I have never had time away from the reality of this. It isn't gone when I go home, and it doesn't disappear when I go on vacation. I can do 18 years of good work, but I can never coast. The next exam room may be that child with subtle meningitis, or the person seriously considering suicide. It's in the fine print of the job, and I accept that, but it gets pretty heavy over time.10. Knowing that it can all crash any moment - If I miss one case of meningitis, don't address the depression properly, or simply have a bad day, I can see my reputation ruined. Any day could be "that day" when my life can become 100 times harder. Despite a career of doing good, one bad day can put me in the spotlight as a "bad doctor."
So do I want you to feel sorry for me? Please no. But I do want people, especially those who regularly put doctors in their crosshairs, to remember that this is a really, really tough job. Yes, it's a privilege, but sometimes the pressures can turn the nicest doc into a jerk, the most careful clinician into a quack, and the most caring person cold.