First day back in this Primary Care clinic. Get ready for some posts reflecting on the experience of seeing patients in this kind of a setting. It’s not that it’s a bad experience, it’s just very surreal.
I know I care about people, I care about the patients who walk in, and I want to use my skills to make them better. And yet everything about the patient interaction seem rigged.
Most visits leave me feeling as though I didn’t accomplish anything meaningful for my patients. And maybe that’s exactly how medicine is supposed to be.
Nevertheless, this feeling of being so ineffective isn’t something I can shake. It’s not something that I can just get over and come to work pretending as though it’s not happening.
To be honest, I don’t even know what my exact purpose is here in a Primary Care clinic. What am I supposed to be doing to help the patient? Ease their suffering? Improve their lab values? Make them healthier? Cure diseases?
Seriously people, I’ve been doing this shit since 2006, 14 years later and I don’t know what my exact purpose is here.
I listen to complaints about the how it’s hard for them to get an appointment to the clinic. They tell me that they couldn’t get their meds at the pharmacy. That they couldn’t afford the last cream I prescribed.
Look, if I was jaded then I wouldn’t give a shit. I’d walk into the room, drop my spiel on the patient and walk out, not caring if they followed my advice or not. But I do care … just that I can’t control the outcome.
Is that jaded?
A jaded doctor would nag and complain about every single patient. They would butt heads with patients and assume all patients are doomed. Or maybe that’s a bitter doctor…
I don’t think jadedness is the problem here. I’m not worn out, I’m not cynical. I simply feel like I’m a waste of a medical degree, standing before the patient not being able to do anything for them other than titrate medications.
Caring About Patients
Caring about a patient means putting in the effort needed to help that person get through whatever health problem they have. Listen to them, help them overcome their barriers, educate them, and rinse and repeat.
Apparently caring is also demonstrating empathy. But to me that’s always been too narrow of a definition.
The essence of caring isn’t to hug my patient and put my hand on their shoulder and shit. It’s caring about their ultimate health – it’s doing the best I can as the expert before them. I got to be the best damn doctor for them.
I don’t have to be their financial confidant. I don’t have to be their punching bag because they have marriage problems. And I can’t do anything about the traffic they faced getting to the clinic.
Instead, caring is going above and beyond. Spending an hour in the exam room, if necessary, and talking about the difficult things with the patient. Tough love, for example.
If I care then I’m gonna be honest with the patient. I’m not going to sugar coat things. I’m going to set realistic expectations while offering them hope and my support.
The Patient-Doctor Relationship
There are those patients who doctor shop. They jump from one doctor to another and they complain and are a drain on everyone’s time.
It’s not like I can be blunt with that patient. I can’t call them out on their bullshit. I can’t interrupt them mid-speak and tell them that I’m not here to play their manipulation games.
But these medical visits are forced. Patients feel as though they have to come to see me because they’ve exhausted their other doctors. They want to be better and all they can think of is to make yet another appointment.
Despite this, they don’t feel that they should be honest with me. They all eat salads for lunch, have fasting blood sugars of 120, and they all take their medications every day.
It’s not fully their fault and it’s not the fault of the doctor. But I have to place some fault with the medical system. After all, they are the ones who butt into this patient-doctor relationship. In fact, it’s a legal definition which the medical industry has constructed.
It’s Easier to Not Care
It’s easier to not care. It’s easier to walk into the exam room smiling, oblivious to the reality of the situation.
The patient will feed me their usual bullshit about how the pharmacy didn’t give them their insulin. And that their glucometer was broke. That the referral coordinator was rude so they didn’t go for their follow-up. I simply nod, tilt my head, and flex my chin.
I want to care about my patients and genuinely do everything it takes to improve their health. But I feel as though the system is designed for me to not give a shit. To just clock in, type a bunch of stuff into the EHR, click on order sets, order meds, and book the next useless appointment.
The Penny Dropped
Maybe I had an epiphany today, maybe the penny dropped. Yesterday was my first day back in clinic after being off for 3 months. Today, on my 2nd day, I’m approaching things 180 degrees differently.
I’ll care as much the clinic cares. I’ll care as much as the medical system cares. And I’ll care as much as the patient cares.
I remember a couple of years ago I wrote another post along this same line. It had to do with antibiotics stewardship and I feel that I’ve not made much progress since that time. So, it’s good that I’m revisiting this topic of “caring” again today.
The problem with burnout in medicine is that it can happen from either direction. You can either be too vested and you’ll burn out or you can burn out from having too little emotional connection with the work.
I haven’t ever recovered from my burnout back in 2016. It left a bad taste in my mouth. Add to that my medical board investigation in 2017 and it’s been a lot to deal with.
But I don’t think anything I covered here today will serve as an antidote to burnout. Instead, this is such a coping mechanism for the work. A way to feel balanced so that you don’t feel taken advantage of but also don’t feel that you’re robbing someone else of their rights.