It takes its toll on me...this being a doctor....I think as I wait in the Indian restaurant buffet. My son is curled on my lap. Uncharacteristically tired...later he will develop a fever and I will realize why he is so warn out.
It takes it toll on me. I wouldn't say I am a stressed out person but I certainly live with stress. Most of it is self inflicted.
It's just that I can't help feeling responsible. For those few thousand people who have placed their lives in my hands. I know I am not god. I know that Doctors can only do so much. But that doesn't stop me from worrying.
It doesn't stop my mind from racing at night as I pour over the problems of the day. And it doesn't stop the guilt. Every time someone gets sicker then expected. Every time someone dies. And boy do they die. All the time.
I guess that's what happens when you take care of people in their eighties...and nineties...and hundreds. And when you spend a lot of time in nursing homes.
I always ask myself what could I have done different. How could I have been better. Was I enough?
Mostly the answer is yes. Occasionally the answer is no. But I always ask the question.
It takes a toll on me.....the stress. The sadness. And sometimes I wonder what this is doing to my mind. My body. Am I causing in myself that which I spend so much time fighting in others. Will the stress raise my blood pressure. Clog my coronaries. Herald in a major depressive episode....uncontrollable anxiety.
But how can I complain. My life has meaning. I struggle daily with the essence of life. And I get paid a comfortable salary to do so. I get to help people....at least when things are working at their best. I get to reach out to my fellow man.
And I get to do it on my own terms. I work when I want to work....and rest when I want to rest. Sure I spend my share of weekends and nights. But I am usually home by 4pm...no later then 5.
I can count the number of times I have missed dinner with my children on one maybe two hands...ever. I am present. I put them to sleep at night. I see them on the weekends. They know me. They love me.
And maybe that's worth it. The stress...the worry. The physical and emotional burdens of this lifestyle. Maybe its worth it because it has afforded the ability to be there. For my children. For my wife. Such that my son will walk over to me when he is hurting.
He will climb up on my lap. And place his head on my chest. And he will feel safe.
Because I am always here.
Of all the things this profession has allowed....
It allows me to be present.....
In my families life.
Sunday, March 20, 2011
Saturday, March 12, 2011
Why I Feel Shame
Why I feel shame:
1)Because every damn health care article I read somehow finds a way to quote "To ERR Is Human"
2)Because every discussion about torte reform ends up being a soliloquy about those "Bad Doctors".
3)Because every year a new governmental regulation adds a new piece of paper I have to fill out or a new computer screen I have to click through to do my job. Now to discharge a patient I have to fill out three separate forms. Last year it was two. The year before I could give a verbal order (the quality of care has not changed).
4)Because the government gives lip service to improving primary care but just doesn't get it. Now to get home health for my patients I have to fill out even more paperwork....this is not stopping people from using home health inappropriately.....it is just taking up more of my time.
5)Because when I send my patient to have a swallow eval, the speech therapist sends them to a pulmonologist for their cough, and then the pulmonologist sends them to a neurologist for their dizziness. And after thousands of dollars of workup the specialists come to conclusions that I had already told the patient and documented in the chart but no one took the time to ask me because what does a primary care doc know anyway?
6)Because for some reason when patients get sick and die the first question society asks is....Who messed up?
7)Because sometimes I get so involved in using my emr, figuring out eprescribe, or making sure that I have documented correctly for billing purposes that I don't "hear" what my patient is so desperately trying to tell me.
8)Because sometimes, god forbid, I am having a bad day and may not perform to my peak level....somehow that doesn't feel OK anymore.
9)Because I am deathly afraid of my government...breaking down my doors, looking at my records, and asking for money back. Even though certified coders themselves rarely agree with each others findings.
10)Because I used to practice under the assumption that I was being look at under a microscope...now I feel like I am practicing under the gun.
11)Because I secretly worry....that with all the doctor bashing and painting us as knaves in the media...one day a disgruntled patient will walk into my office with a gun and start shooting.
12)Because I went into this profession with such pure and innocent motives...
I wonder how it all became so convoluted!
1)Because every damn health care article I read somehow finds a way to quote "To ERR Is Human"
2)Because every discussion about torte reform ends up being a soliloquy about those "Bad Doctors".
3)Because every year a new governmental regulation adds a new piece of paper I have to fill out or a new computer screen I have to click through to do my job. Now to discharge a patient I have to fill out three separate forms. Last year it was two. The year before I could give a verbal order (the quality of care has not changed).
4)Because the government gives lip service to improving primary care but just doesn't get it. Now to get home health for my patients I have to fill out even more paperwork....this is not stopping people from using home health inappropriately.....it is just taking up more of my time.
5)Because when I send my patient to have a swallow eval, the speech therapist sends them to a pulmonologist for their cough, and then the pulmonologist sends them to a neurologist for their dizziness. And after thousands of dollars of workup the specialists come to conclusions that I had already told the patient and documented in the chart but no one took the time to ask me because what does a primary care doc know anyway?
6)Because for some reason when patients get sick and die the first question society asks is....Who messed up?
7)Because sometimes I get so involved in using my emr, figuring out eprescribe, or making sure that I have documented correctly for billing purposes that I don't "hear" what my patient is so desperately trying to tell me.
8)Because sometimes, god forbid, I am having a bad day and may not perform to my peak level....somehow that doesn't feel OK anymore.
9)Because I am deathly afraid of my government...breaking down my doors, looking at my records, and asking for money back. Even though certified coders themselves rarely agree with each others findings.
10)Because I used to practice under the assumption that I was being look at under a microscope...now I feel like I am practicing under the gun.
11)Because I secretly worry....that with all the doctor bashing and painting us as knaves in the media...one day a disgruntled patient will walk into my office with a gun and start shooting.
12)Because I went into this profession with such pure and innocent motives...
I wonder how it all became so convoluted!
Sunday, March 6, 2011
Tuesday, January 25, 2011
Touch:The Journal Of Healing
Check out the January 2011 edition of the Touch: The Journal of Healing. Two of my poems were selected.
Sunday, January 9, 2011
Why I Feel Shame
In response to commenters on my last post. Why I feel shame (from KevinMD):
Are physicians motivated by virtue or are they passive victims?: "Often the individual likes their physicians and thinks of him or her as a “knight.” This is the belief that the physician has the patient’s best interests in mind at all times and takes the needed steps to be sure that the patient is always placed first. But society overall does not think this way of physicians. To most, physicians have long ago lost their “Marcus Welby” status and instead are driven by the desire for a high income, reduced work load and less attention to the patient and the patient’s needs. With this sort of attitude, society through its elected officials and through the insurance apparatus erects many polices and procedures to guard against the “knave” doing harm, reaping too much income, etc"
Are physicians motivated by virtue or are they passive victims?: "Often the individual likes their physicians and thinks of him or her as a “knight.” This is the belief that the physician has the patient’s best interests in mind at all times and takes the needed steps to be sure that the patient is always placed first. But society overall does not think this way of physicians. To most, physicians have long ago lost their “Marcus Welby” status and instead are driven by the desire for a high income, reduced work load and less attention to the patient and the patient’s needs. With this sort of attitude, society through its elected officials and through the insurance apparatus erects many polices and procedures to guard against the “knave” doing harm, reaping too much income, etc"
Wednesday, January 5, 2011
On Being A Doctor
Dr Wes said a few words and then we settled in for the movie. A documentary. the crowd was about one third physicians. The others undoubtedly physician supporters. Family, friends, nurses, hospital staff.
Of course it was preaching to the crowd. A story of a physician who found doctoring much less then expected. Stressful, time consuming, frustrating. So rarely did he feel like he was doing what he went to medical school to do...helping his fellow man.
Some in the crowd shook their head in agreement. Others nodded vigorously in disapproval.
And the lights came up. Dr Wes said a few more words. Then Nancy Pando asked the physicians in the room to stand. Reluctantly men and woman arose and looked around. Then something unexpected happened. The crowd started to applause. Loudly and with exuberance.
And briefly I felt profound pride in myself and my profession.
Sadly this gratifying moment was quickly overshadowed by a sobering realization.
Although I cant explain why......lately I feel something completely different in relation to being a physician...
overwhelming shame.
Of course it was preaching to the crowd. A story of a physician who found doctoring much less then expected. Stressful, time consuming, frustrating. So rarely did he feel like he was doing what he went to medical school to do...helping his fellow man.
Some in the crowd shook their head in agreement. Others nodded vigorously in disapproval.
And the lights came up. Dr Wes said a few more words. Then Nancy Pando asked the physicians in the room to stand. Reluctantly men and woman arose and looked around. Then something unexpected happened. The crowd started to applause. Loudly and with exuberance.
And briefly I felt profound pride in myself and my profession.
Sadly this gratifying moment was quickly overshadowed by a sobering realization.
Although I cant explain why......lately I feel something completely different in relation to being a physician...
overwhelming shame.
Saturday, December 18, 2010
Time Waits For No One
We sold it. Katie and I. Leila's Crib.
It had been sitting. Stuffed in the corner. For the last year. After Leila got her "big girl bed" and learned how to awake in the middle of the night and wreak havoc on the household.
At first it was just laziness. We kept planning to sell but never got around to it. Then finally the add was placed on Craigslist. And the days passed and no interest. It was a beautiful crib. Pristine condition. Stylish.
So eventually we dropped the price and re listed a few times. Nothing for days....and then an email. They wanted to see it. They would be right over.
A young couple. First child. Last few months of pregnancy. They eyed the crib up and down as Leila tried to initiate conversation and Cameron ran to get his pottery. But it only took a minute to decide. They would take it.
Quickly I got the tools and started to disassemble. Leila's home. For the first two years of life. There was a flurry of activity. Unscrewing....lifting...carrying. Money was exchanged and we wished the couple well.
As they amble slowly through our front door carrying various pieces of furniture it hits me. We sold Leila's crib! My mind flashes forward to a much later time. Nursing home bound my addled brain struggling through dementia's cobwebs. I become agitated from time to time and the nursing staff hands me a baby doll. The studies show that it calms demented people to care for a pretend child.
I will hold the doll thinking that it is Leila and wander aimlessly through the nursing home. Searching for a crib to lay her down for her afternoon nap. Except that I won't find it....because I sold it. On Craigslist.
And as I stare out the window at the young pregnant women carefully placing the deconstructed crib in the back of her truck I feel great regret.
Because even now before my brain ages and becomes entombed in the plaques and tangles of senility I can't escape the basic fact:
No matter how bad I want it to....
time waits for no one.
It had been sitting. Stuffed in the corner. For the last year. After Leila got her "big girl bed" and learned how to awake in the middle of the night and wreak havoc on the household.
At first it was just laziness. We kept planning to sell but never got around to it. Then finally the add was placed on Craigslist. And the days passed and no interest. It was a beautiful crib. Pristine condition. Stylish.
So eventually we dropped the price and re listed a few times. Nothing for days....and then an email. They wanted to see it. They would be right over.
A young couple. First child. Last few months of pregnancy. They eyed the crib up and down as Leila tried to initiate conversation and Cameron ran to get his pottery. But it only took a minute to decide. They would take it.
Quickly I got the tools and started to disassemble. Leila's home. For the first two years of life. There was a flurry of activity. Unscrewing....lifting...carrying. Money was exchanged and we wished the couple well.
As they amble slowly through our front door carrying various pieces of furniture it hits me. We sold Leila's crib! My mind flashes forward to a much later time. Nursing home bound my addled brain struggling through dementia's cobwebs. I become agitated from time to time and the nursing staff hands me a baby doll. The studies show that it calms demented people to care for a pretend child.
I will hold the doll thinking that it is Leila and wander aimlessly through the nursing home. Searching for a crib to lay her down for her afternoon nap. Except that I won't find it....because I sold it. On Craigslist.
And as I stare out the window at the young pregnant women carefully placing the deconstructed crib in the back of her truck I feel great regret.
Because even now before my brain ages and becomes entombed in the plaques and tangles of senility I can't escape the basic fact:
No matter how bad I want it to....
time waits for no one.
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