Tuesday, February 4, 2014

What Doctors Feel

--- is the book title of Dr. Danielle Ofri's latest book, which in my opinion is a must-read for anyone struggling with the demands of the medical field.



I really needed to read this book this past weekend. There are days when I really don't think I am cut out for medicine... days when interruptions every 10 minutes that disrupt efficiency and productivity really drive me nuts (a NYT article I read last year commented that interruptions and multitasking really make you more stupid), days when I forget to or don't have time to eat because I'm so caught up in others' needs or have procedures scheduled over the noon hour, and days when, when I [finally] get home, I (very much an introvert) have no physical or emotional energy left for myself or my spouse (or for anyone else, for that matter).

"Compassion fatigue" which you can read about here is a very real phenomenon among health care providers, and, also, in my opinion the inevitable "natural outcome of putting smart, competitive, perfectionist people in a high-stress system with myriads of ever-changing tasks for which they feel professional responsibility, coupled with sleep deprivation and the granite-hard fact of only twenty-four hours in the day..."  as Dr. Ofri writes on page 34 of her book.

The book, which includes numerous anecdotes from her own "trainee" days as a student, intern, and resident and eloquently discusses challenges of being an attending physician, touches on how doctors' emotions-- including fear, shame, guilt, anxiety, frustration, anger, empathy, and more, affect patient care (in both good and bad ways).

When you (you as a patient) are annoyed when you are stuck in the waiting room of your doctor's office, remember that your doctor (at least this one) hates to run late and feels a whole lot of guilt for seemingly wasting your time (and always apologizes). I am running late likely because there was a late patient before you who we felt still needed/deserved to be seen, or someone who needed some extra care, or an emergency or unanticipated delay at the hospital.

Your doctor (at least this one) hates 15-minute appointments, because they generally are not long enough to really address more than 1-2 of your concerns and delve into how you really feel (or discover what else is going on in your life), and they breed fear of not making the right diagnosis or making a mistake in such limited time.  Lack of time with patients is a top reason why many doctors are dissatisfied (but we are largely powerless due to enormous pressure, stress, and demands of documentation, paperwork, and the goal of "productivity," which is measured by the number of patients seen, and not the quality of care provided).

Most of us doctors (at least this one) are working long before clinic starts, during lunchtime when the office is "closed," and charting after work. We are often working finishing notes or refills at night or on our days off remotely from home, because we have families (and lives), too and like to be home at semi-reasonable hours; however, we worry about you after-hours because being a doctor isn't really a 9-to-5 job. We gave up our twenties (or another decade) to work 80-hour weeks (on average) and learn to competently take care of you while missing birthdays, weddings, and other important events of our loved ones. We still miss many of these things, due to on-call responsibilities, even though residency is over... We work nights, weekends, holidays, the days after working nights or weekends on very little to no sleep, while sick, and often on very little reserve in the tank because we don't want to inconvenience you and we want to make you better, although we may not be doing so well ourselves.

We share your joy at the birth of your child when we are lacking our own, and share in your accomplishment when you successfully quit smoking, lose weight, or get your hemoglobin A1C under 7.0%! We grieve, sometimes cry, and feel entirely responsible when there is a surgical complication, missed diagnosis, bad outcome, or a death, and wonder, "could I have done something differently to prevent this?" We are hard on ourselves. We feel shame.

Many of us often think about what it would be like to change careers and have "normal" hours, less stress, and to not have so many people depending on us all the time and expecting us to be virtual superheroes who can "do it all" and do it all well.  But we also know that this field, with its relationships, can be very rewarding.

So if you are a patient, a provider yourself (particularly a primary care doctor), or someone who lives with or loves a doctor, please read this book (and thank a doctor today). Remember and embrace that doctors are not perfect but we are living, thinking, breathing, and feeling human beings who want the best for you and are doing the absolute best we can.

1 comment:

Lisa Cronk said...

Beautifully said Tara! I look forward to reading this book. Thanks for the recommendation.