Thursday, August 27, 2015

Sharper than a serpent's tooth


Once upon a time, I had a lot of it. I guess I still do, or I wouldn't be at this desk.

I think most medical students start out that way. We want to help the sick, heal the wounded, decrease suffering. All that stuff we once wrote in the "personal statement" section of the universal med school application. And believed.

A friend of mine, an OB/GYN, and I were chatting about how this job can suck the compassion out of you. There are some people you just can't help. She recently had to do emergency surgery on a 15 year-old girl for an ectopic pregnancy. The girl had had upwards of 20 sexual partners already, and was, of course, angry at the doctor for having emergently done something that might prevent her from having kids, even if the goal was to save her life.

We all have stories like that, little knives that cut away part of our compassion. They add up over time. And, for most of us, we remember when it started.

Mine began over 25 years ago. I was a 3rd year med student, working at the school's clinic. That day the resident and I were doing a routine pregnancy visit on a 19 year old who already had 3 children. Her other kids were there, undisciplined and destroying the exam room as we tried to work. None had the same father. Of course, they were on welfare and food stamps, and the unemployed mother had brought paperwork to get her amounts increased.

It hits you hard that first time, when you realize where some of your tax dollars are going, and that I was supporting her. Walking home that night, at the end of 17 hours at the hospital, I realized that, if her welfare money were cut off and she and her kids died of starvation and exposure in the street... I probably wouldn't lose any sleep over it. None. Zip. Nada.

Terrible thing to feel that way, huh? It's not like the kids had asked to be in this situation. And then I was angry at myself for even having such an awful thought. But I've never forgotten that moment, when I first realized that, at some point, even my concern for others ran out.

That was the first, and they add up over time. The patient who's in for yet another drug overdose,  knowing that, after me and the ICU team patches them together, they'll go out and do it again. Often they're on welfare, but even if they're not, the bottom line is that we're all paying for them one way or another, either through our taxes or insurance premiums.

The epilepsy patient who doesn't take her meds, and several times a year I have to go in at 2:00 a.m. to pull her out of the fire. She might be pregnant, too, and the repeated effects of uncontrolled seizures will damage the next generation.

The anxious guy who thinks he's dying of something, who you agree to "squeeze in" and give up your 15 minute lunch break for... and then never shows up. He calls later to say he'd forgotten, or been busy, or had to wash his hair,  then screams and threatens legal action when Mary refuses to work him in the next day.

The obviously bogus disability claim, who wants lifetime payments for exaggerated or fraudulent problems, and is bringing you the paperwork demanding it be filled out in his favor.

The guy you went the whole 9 yards for, filling out forms and writing appeals, to get his $800 per month medication covered. Then sends you a nasty hate-filled letter because your staff charged him the $15 co-pay his insurance requires you to.

The lady whose neurological issues you finally get controlled after 2 years of frequent appointments, medication changes, pharmacy coverage appeals, and late night emergency phone calls... who ends up in ER after stopping treatment because she took some TV charlatan's advice over yours.

Don't go thinking all patients are like this. Most aren't. They're decent people who want your help, and are grateful for it. The problem is that the one crappy person in a day of 10 good ones can dwarf the nice people to nothingness and make you forget about them.

It becomes a political issue. The conservatives would have you believe that all people on welfare are like this, and deserve to starve and die. The liberals claim that as a society we have to support all our members, regardless of cost or lifestyle decisions. The real truth varies from case-to-case, and is always somewhere in between. There are plenty of other sites where you can argue those points, and this ain't one of them. So I'll leave that there. You want to post a political tirade about this? Go troll elsewhere. That not the point of this post. This is:

What does it do to your doctors? And nurses? And all the others in healthcare who have to deal with these cases?

It sucks the compassion out of you. You came here believing that somewhere, somehow, you'd be able to help people. To make a difference in the lives of others. To care.

And, for the most part, we do. But the thing that slaps you hardest is learning that you can't help everyone. There are always going to be the ones who don't want to be helped, or don't believe you can help them, or are only there to game the system. A million reasons with the same end result. You watch your best efforts, midnight runs to the hospital, your own health, family time, and sanity, and a fuck-ton of your own and everyone elses money, all go down the drain because the person you're trying to help doesn't care.

And, every time this happens, a little piece of you dies. You never stop caring, but it gets harder and harder to do so. Some of your compassion and fire goes away. Occasionally you meet a medical student with the fire you once had, and wonder what happened to it. They probably look at you and wonder the same.

This is where it goes. Cut out of you in little pieces by years of working hard to help people who don't want your help. Or who take advantage of your concern for their own greed.

At the end of some shitty days I think back to the 19 year old with 3 and 1/2 kids many years ago, and how I felt after leaving that day. Sometimes I hate her for being the first cut. Sometimes I hate myself for feeling the utter contempt for her that I did. And most days I'm just too tired to think about it at all.

But when the alarm goes off in the morning, or my iPhone rings at 2:00 a.m., I still go back and do it, and give it my best shot, all over again. Just like a million other doctors and nurses around the world every day. Because, win or lose, that's why we're here.


Anonymous said...

Thank you.

I am sorry that I am not the only that feels this way sometimes. It really is a thousand little cuts by the callous and uncaring. All I can do is treasure the good people and good experiences. They make most days worthwhile. I like to think if I am upbeat and caring, I am helping others have a good experience too.

Don Parker said...

A few years back I worked with a man who I had worked with 10 years earlier on another contract. Both of us had become diabetic in that 10 years, and his symptoms were far worse than mine. He tried to get disability, but kept getting turned down, while other people in the engineering office got it for real or imagined "back pain." Their secret? Hiring the "right" attorneys, who sent them to the "right" doctors, and so on. My co-worker refused to play by those rules, and was denied the disability, even though the numbness in his hands and feet were such that he could no longer drive.
I've gotten solicitations from law firms telling me I have the "right" to get disability because I'm diabetic. I just throw those in the trash, or delete the emails.
Thank you, and the others like you, for still caring and doing your best every day. We understand if once in a while you have a bad day; that's life, and we all deal with it.

Anonymous said...

This post really hits home. I worked in healthcare for many years as a pharmacy technician. Then I left and took a job at social services. Which is just as hard as you might think it would be. I left because I found myself having to suppress laughter at yet another dramatic sob story- for which the reality was, like always, that the individual had made a mess and demanded someone else clean it up. I don't know what to do career-wise now because I have compassion burn-out.

Anonymous said...

So, imagine for a moment that YOU are the patient right after the one who's just finished a screaming fit at the doctor (or his/her staff) over something...yeah, it's REAL fun walking in after that.

I am a regular pain patient. In fact, I'm so 'regular' I can spot the drug seekers from a mile off. It's the only entertainment I get sometimes if I forget to bring my book with me while I wait, and wait, and wait for the overworked, often callous, pain management doctor to squeeze me in for 5 minutes before writing a 'script and sending me on my way - sometimes as I'm in mid-sentence.

From my side of the door, I may be confused or frightened by some new symptom. Maybe I'm wondering about the long-term effects of the medications I take just to function every day. Or maybe I'm nervous about meeting a new doctor/PA/nurse and explaining my fibromyalgia, seven ruptured discs, CFS, ad nauseum, wondering all the while if they are hearing me or are they looking past and wondering if I'm the one seeking disability for a phantom ailment. Or maybe I support myself by pretending to be in pain so I can get the meds and sell them on the street. OR maybe I'm an addict, and my sweaty palms and shallow breathing - accompanied by high BP - are all signs I'm up to something, instead of what they are...anxiety.

I'm a patient. I'm also a person, and I'm not the person who just refused to take your advice, demanded drugs, or screamed at you for being an idiot because I figured out what was wrong with me by asking Dr. Google and obviously your 10-12 years of schooling were all for naught.

A little piece of your soul is crushed by the callous, uncaring, stupid, arrogant, or just plain mean people you treat.

My soul is crushed by every doctor I meet with a chip on his shoulder.

Sorry, Dr. G, but what you deal with comes with the territory. I didn't sign up for the backlash.

Anonymous said...

I am convinced that the first two years of med school are designed to remove all sense of curiosity, and the second two years (and all residency) are to remove all sense of compassion.

J said...

I feel better now that I've decided I've had enough. I'm retiring at the end of this year.

Anonymous said...

"The problem is that the one crappy person in a day of 10 good ones can dwarf the nice people to nothingness and make you forget about them."

I don't know much, but I think it's our human nature to tend to focus on the negative, not the positive. It takes effort to shift one's thinking but perhaps your statement could look something like this. "Despite the problem of one crappy person today, I want to remember that there were 10 nice people that dwarfed the crap and for those 10 worthy people, this is why I do what I do."

Wishing you peace.

Officer Cynical said...

Squad car. 10 hours a day, and OT about half the time. For years and years. Almost no "good patients". Call me Officer Cynical.

Packer said...

It has always been the duty of the responsibles to shoulder the burden of the irresponsible. You have to choose if you are going to be counted among the responsibles or the irresponsible. Take your pick, choose wisely for each group has its own pitfalls. Years back I chose the first group, years later after being chewed up pretty good (barely made it earlier this year) by the demands I am still happy with the choice. I have had a good life and as it nears end I realize it was right for me. what troubles me going forward is the idea that fewer and fewer seem to be willing to make the sacrifice and that does not bode well for our future. BTW, I have rarely seen such heartfelt emotions either in the blog or comments as today. Like J I know I am nearing the point of saying I have had enough, but there is still a little of that if not me, who? in play.

Roy said...

I was going to mention the comparison to policing, but Officer Cynical got here first.

I have known many police officers who went into the profession with the same attitude you did when you went into the medical field. They were in it to help people - to better society. Two or three years later it had all changed. Dealing with the underside of society day in and day out will do that to you.

bobbie said...

Amen. And bless you for speaking the truth.

NV Teacher said...

You can change the profession to teaching and you'd be right on the money again.

Unknown said...

Dr. G, thanks for the beautifully articulated candor. I have often wondered how you doctors do what you do. Managing to greet each patient, all day long, as if he/she is the most important one. As an outsider, I am in awe of how much composure and compassion you, and most medical professionals, are able to show and extend to patients.

My husband died a few months ago after a 2 1/2 year battle with glioblastoma, and, as you can imagine, I became acquainted with several doctors and nurses. I got to witness, first hand, how difficult and demanding a doctor's job is. I have the utmost respect for what you do. I am so grateful to the doctor who showed so much compassion and concern for my husband and me. I tried to let him know, as often as I could, how much his work has meant to me, and that his efforts are not unnoticed. As far as I'm concerned, he is the best doctor ever!

That being said, I hope you have people in your practice and in your life who provide you with some encouragement. I think all doctors need that. I think all people need that. And, for what it's worth, the fact that you get up everyday, go in at all hours of the night, fit patients in at the expense of your own time shows that somewhere deep inside (even if it's masked by cynicism or marred by apathy) your compassion is still alive and well. You are doing a great job. Your openness and honesty prove you are a good doctor.

BendySadness said...

As a long term, fairly regular patient who is obese and has mental and physical health issues, I'm so thankful for the doctors who try and stay compassionate. I'm not always a great patient, especially regarding my weight, but doctors who saw only my weight meant I had health issues go undiagnosed or improperly treated for years.

My current doctor is amazing. He knows I'm doing my best, he tries his best to help me, and for the first time I'm making progress - even on my weight. Not being made to feel like a waste of time and space has helped me a lot.

The point is, a doctor can make or break a person's health at times, and have far more influence than just the drugs they give out. Knowing somebody cares even a little is a wonderful gift sometimes. I do believe a doctor who doesn't try would never have written such an informative, passionate post.

Jive Talkin Tool said...'re ok Dr. G. Your well written post reminds me of the hospital admin character from the film, "Bringing Out The Dead":
"Sir, you say you've been snorting cocaine for three days and now you feel as if your heart is beating too fast and you would like for us to help you. To tell you the truth, I don't see why we should. Correct me if I am wrong here--if I'm mistaken...'Did we sell you the cocaine?''Did we push it up your nose?'"

Oh, and to the bitchy whiny patients with chronic pain issues that post conjecture regarding Dr. G being wrong...shame on you for making such baseless allegations. Anyone who has read this blog for absolutely know better than to allege Dr. G is writing any aspect of this post about being embittered toward those in true chronic ceaseless pain. One is advised to get over one's self, or to perhaps change out one's meds--they may be impacting one's cognitive abilities for reading comprehension.

Dr. Pissy on the other hand...

Just Me said...

This is when you know you need a vacation!

lbparker said...

Thank you, Dr G, for such an insightful post. I hope your recent vacation, and spending some quality time with your family, helped. Everyone needs a "sanity break" once in a while. I know it sounds trite, but try to concentrate on the good patients, and "consider the source" when you have a bad one. There are many people who respect you, and appreciate what you do.

Anon for today said...

This post needs to be re-posted on KevinMD. Could you submit it? You very nicely (if heartbreakingly) describe a common reality and internal struggle for most physicians who entered medical school with compassion as their primary motivator.

I'm a very compassionate person. The wonderful and curious patients and even just the somewhat polite ones remind me why I once loved medicine. But many of the very difficult ones in addition to daily beat-downs from a system that adds more unfunded mandates every year (and steals proportionately from my sleep, eating, and personal time) prompt me to consider quitting. Haven't yet figured out if I'm good for anything else in this world but the clock is ticking against me as I attended medical school late.

In response to Officer Cynical often thought of how police officers encounter very few nice, "normal" folks who take pride in being good citizens and neighbors. They also see the impact of poverty, crime, and drug abuse initially innocent children who too often follow in their parents' footsteps. I doubt my capacity to care deeply would survive such a traumatic, depressing, anger-inducing job.

Unknown said...


Lizard said...

You say it perfectly.

I tell students all the time, your good patients, the ones who realize that you are also a person with a life, they will never make you miserable. They may sometimes ask a lot, and they may annoy you, but they will also always be really grateful and appreciative.

The patients who barely know you when they ask you to go out of your way, above and beyond, you will always regret doing it. They will be mean, and ungrateful, and entitled and you will never, ever do enough over the top care for them.

Mary said...

My attending and I talk about this a lot. We have both been in practice for 25 years. It is getting worse, too. What can we do? We try to focus on the ones who want help and do the work. The others we try to change. It is a losing proposition. And yet we toil on, hoping we can change the world. It is frustrating and degrading. I now have stress-related health problems. But, boy, when we get it right, it is awesome.

Pam said...

I really respect you, Dr. Grumpy.

Unknown said...

Wow, SO well put. I'm a Physical Therapist and I struggle with the same things every damn day. Thank you for putting the heartbreak and conflict into words. I really want to believe that most people do the best they can with what they they have and that the ingratitude expressed towards health care professionals stems largely from ignorance. I want to believe that most of our patients don't have an inkling of the pressures we face every day. I hope for all of us that we can do our best every day and not let the anger and helplessness and frustration warp our souls.

Anonymous said...

Thanks for your post, Dr. G.

I sometimes am amazed by stories of organ recipients knowing the wait lists are highly priortized.

Working in pharmacy, sometimes, there's the added disadvantage of dealing with pharmacy management, never mind issues of the patient. I will think I've gotten over 'taking it personally' then a mandate coming from far 'above' invalidates my judgment, and informs my options. By the time I got out of pharmacy school, I think I was rather hardened.

I will never forget one of our student interns who went on to medical school. It was a Christmas night and we were the only pharmacy department open in town. (The next year someone decided that someone in retail should be open, and we've had 24/7 shops ever after. Anyway, we didn't have a way to sell products at retail for those not connected to the hospital in some way, and a guy came in around 5 PM looking to buy a Fleet's enema. The older retail pharmacist on duty hemmed and hawwed about providing it, and I could hear the student in the background, "It's an enema, for ... sake on Christmas day--it's even in a green box, just give it to him, already."

gloriap said...

I know the feeling. I burned out on social work after three years. It is so hard to feel compassion when so many of the problems you see are brought on by people walking into bad decisions with their eyes wide open.

You want so badly to believe they are telling the truth even after you've heard so many lies. It does bad things to your psyche.

Keep it up. Dr. G. Once in a while you will still hit a home run and some patients will appreciate you for the miracle worker you are.

Oldfoolrn said...

When I was a young scrub nurse, bad surgical outcomes used to really haunt and discourage me. A wise old surgeon told me "You did a good job and tried to help. That's all that really matters." You must be a very good and sensitive doctor because negative experiences really bother you. With aging I have a different perspective and can't remember much of the bad stuff. This is one of the most honest and moving posts I have read.

Moorewood said...

Shorter version: you must always treat me as a person with feelings and needs, but don't expect the same from me

Moorewood said...

What convinces you of this?

Unknown said...

Veterinarians too, Dr. G.

Hugs from someone else in the trenches

Anonymous said...

I think I need to go tell my doctors how much I value their help and support!

Anonymous said...

Wow. Slut shaming. Who'd have thunk it?

And before you protest, do examine your reason for including that particular bit of personal history. Why else would you feel the need to point out the exact number of sexual partners the young woman had at date of evaluation? It's not like having sex with 20 men increases a woman's risk for having an implantation outside the uterus. Can you even verify it was PIV sex with all 20 men? Or that all 20 were men?

Off to reevaluate whether this blog is worth reading. What a shame.

Moderate or don't, it's all the same to me as regardless you'll have read this.

Anonymous said...

I surely do understand what you are saying, as I am a nurse of 35 years. I recently read a book called "Saving Simon". Simon is a donkey that went through horrible neglect and abuse. He was rescued and is doing well. The rescuer went to visit the bad farmer and came to realize how this happened - what had happened in the bad farmer's life. It slapped me up side the head how I need to look past the bad in a person's life to see what made them what they are. I needed to have more compassion. I highly recommend this book to any one - it is short, funny, a very good read. And remember - it is all good.

Anonymous said...

NV Teacher:

I was thinking the same thing. I remember the exact time, day & person I turned to & questioned, "I'm only 7 years into this should I already be so bitter?" I loved my job but just like doctors, pharmacists, law enforcement, etc., we can only handle so much. I tried to let the 20 great override the 7-10 not so great (it was NEVER the students) but those NOT so great would just sucked the life out of you.

Though, those 20 great families got me through another 10 years (more than my medical team preferred), I'm glad I stuck it out.

The biggest issue (which I'm sure all the above mentioned professions would agree) was ENTITLEMENT. I had a parent call the Superintendent because I told a student they'd have to put their Starbuck's Frozen Coffee Drink in the freezer & I'd give it back @ the end of theAy day (I even gave her a granola bar because her Mom told her it was her breakfast & she could have it during class), because I wouldn't let their precious child eat chips & drink a Mountain Dew for morning snack (again let them pick an acceptable snack from my stash) & one of my favorites.....I took the child's peanut butter crackers away (I had three Epi-pens in my classroom due to peanut allergies & we were a peanut free school because there were so many in the school) again, replacing it w/ something from my stash.

In all cases the students told me,"I told my (insert offender) that it probably wasn't a good idea but they told me they'd handle any problems!"

It's a crazy world we serve in, huh?

Loki said...

I just want to thank you for continuing to care, and to provide the care you do, even when you're feeling so frustrated and like all your compassion has been spilled out in a million unnoticed pools.

Thank you for keeping going. And if you come to an end of your ability to continue that - thank you for all you've done.

Anonymous said...

someone brings up the concept of 'slut shaming' ... under what context does a healthcsre provider condone promiscuous behaviors that result in children that cannot be cared for properly? Don't the two words 'slut' and 'shame' go together? You will notice, if you read any of Dr.G's blog posts he tends to 'celebrate' responsible behavior; that would be ... people making the right choices in caring for life ... don't the licentious usually have some choice in the matter? ... if they don't, then perhaps the people involved are NOT really 'sluts' but victims ... and you will notice, if you read much of Dr. G's blogs, that most of those defined as 'healthcare' workers tend to support concepts of 'justice' as well as 'freedom'

it's just an observation, perhaps it's wrong ... but, I don't think that it's in the interest of physical, mental, or any other health-related topic to suggest that degeneration is a goal in life, and one would certainly hope the next generation is not interpreting what is seen in the popular media is more than 'entertainment'

Anonymous said...

I can't help but wonder if the 15-year-old girl might have been a trafficking victim.

W said...

Wow. Slut shaming was not my take home message here. Dr G described a typical patient - a young woman who, a product of a society which does not empower girls to value themselves, does not teach human sexuality and contraception to our children, and in which there are not enough social services for those who strive to escape poor circumstances, has found herself in a terrible position - mother to too many children at too young an age, at risk of STDs, without a loving partner to help her through it. But since these train wrecks just keep coming, it's near impossible to keep caring and as caregivers we lose our human compassion. That's what I heard Dr G talking about here. But just keep on jumping to negative conclusions about people if that is working out for you.

WL Emery said...

I survived cancer. Weight loss from the cancer treatments cured my diabetes. It wasn't much fun, but the entire medical staff worked hard to give me a longer life span, and a better quality of life.

When my treatments were finished, I wrote every provider, including the pharmacist, a personalized thank you letter. I also wrote to the hospital administration to tell them about the excellent care I received.

My hope is that I brightened someone's day a little.

Bobbi said...

Excellent post, Dr. G. I worked in corrections and can relate to most of what you said. Only difference -- no matter how cynical I get and how angry at the adults, my heart still always breaks for their children.

Similar to WL Emery, I wrote thank you emails and and/or gave small gifts to several medical providers. Going by their responses, I'd say it brightened their day way more than a little.

Packer said...

During the time of Mayor Bloomberg in NYC, he attempted to preach the values of virtue of self respect, don't get knocked up at 16, spit out 4 kids by 20, have 20 sex partners, don't do drugs, stay in school, work hard at improving yourself--- he said , and rightfully so, that if you do all those things you doom yourself and the next generation and somewhere it has to stop. The media would not touch the story, they only wanted to chastise him because he wanted 40oz cokes banned. In his paternalistic way he was trying to get young people to up their game. We all need to respect ourselves enough to take care of ourselves.

Christine said...

I work in the clinical lab. When talking about my job, I say "I get to help people without being in contact with them." Otherwise, all the patient stories weigh too heavily on me. I read a lot of medical blogs, books, etc., and I really admire the work that health care workers provide, but it also reinforces that I made the right decision for me.

Ryan said...

Yeah, the slut shaming comment is ridiculous. People should be allowed to carry on with risky health behaviors and society just needs to pick up the pieces? I get that some people have mental health issues, poor parenting or role models, etc but at the end of the day personal responsibility still needs to exist.

AnimalDoc said...

Very true for veterinarians as well. I had one of those days where the one negative outweighed the positives yesterday.

McDuckGA said...

I've been a veterinarian for 26 years (yeesh). There are days (in my case, nights - I work emergency) when I don't know how I manage to keep from biting my tongue in half.
I have 3 rules for how to prevent burnout. I suspect most vets have some variation of this for themselves.
1 and 2 aren't important, but
3. You can't be responsible for others' emotional health.

The last one is why I am SOOO thankful that I went into veterinary medicine instead of doing people stuff. I don't know how you do it, and I respect the hell out of anyone who can do it.

I have to remind myself constantly that the nice clients overwhelmingly outnumber the asshats. And I try not to let that one asshat have the power to ruin my mood. I'm not always successful.

Besides, people are gross.

Anonymous said...

Re slutshaming, Dr Grumpy doesn't give his opinion on the men who fathered that 19-year-old woman's children, but apparently AREN'T taking care of them like their mother is, because those men weren't his patients. Or the 15-year-old girl's sexual partners who also didn't use birth control. He didn't see those men/boys. He only sees the damage they co-create, as do we all.

Anonymous said...

"It's not like having sex with 20 men increases a woman's risk for having an implantation outside the uterus."

Wrong. A woman's risk of ectopic pregnancy is greatly increased by having had salpingitis or pelvic inflammatory disease. Most often these result from chlamydial or gonococcal infections, for which the patient is at increased risk by having had 20 sexual partners. Please do some basic research before you cry "slut shaming," or else you make it painfully clear you have no clue what you are talking about and are simply looking for reasons to be offended.

Geno said...

The hurts from small slices
stills compassion and caring
Yet far beneath the pain
Aches a soul wanting
to make it all ok

It may be the difference
that we only help one
in a thousand
without you, where would he be?

Focus on the positive
and you will find
the solution
focus on the problem
you will only find ....

Anonymous said...

Re: slut shaming

Umm Dr G did not call her a slut. You did.

Anonymous said...

It took me a long time to understand that, yes, there are some (a lot) real idiots out there and there is nothing I can do for them. Now, I just sigh and move on.

OTOH, I know a person who had three children by the time she was 18.5. This dates me a bit though. She was on the pill and the docs kept telling her to quit lying about the fact that she wasn't taking it. She kept saying that she thought her prescription for acne was preventing the pill from working. Lo and behold, she was right. It took the medical community quite a while to discover you shouldn't mix tetracycline and the pill.

Anonymous said...

I went into the medical field to make a difference in the world and to help people. I am a family practice doctor who has won numerous awards for the care that I provide. Different episodes have also occurred along the way that have stolen a piece of my compassion; however, in the last couple of years I feel patients have become increasingly selfish and mean and treat all of us in the health care field as if we are disposable. I give everything I have got to help my patients everyday (and night and weekends for that matter), but yesterday a patient literally wrote an email threatening to sue me because I didn’t come to take a phone call immediately when she had called. I was seeing patients at the time. Believe me, for what she was calling about it wasn’t necessary to come to the phone right that second. I get that patients are tired of doctors who “have a chip on their shoulder,” but as one of those physicians who really does care I am tired of being taken advantage of, treated in a demeaning matter, and threatened. This takes place on a daily basis. I am relatively young, but there is a good chance that I will be “getting out” as many of my colleagues have already done. That will be a shame because I am one of the ones who went into this for the right reasons. I am sorry that pain patients don’t get their pain meds easily, that “free physicals,” aren’t always free, and that the cost of medications are high. But, to you patients that treat us as if we are the ones that made all of these negative things happen – remember that we didn’t. The greed of the industry and nation that has is in control is responsible for this. Doctors are getting fed up- we didn’t create these problem. If you have a caring, kind, and competent doctor you are lucky and should act accordingly.

Dr.M said...

Gag me with a spoon. Go complain elsewhere, Anon.

Dr.M said...

I can guess who the TV charlatan was, lol. I can't stand how people follow and repeat everything that wacko says.

It's so true, the assholes are not as prevalent as they seem, but one can overshadow an entire day's worth of nice people. I'm taking a Staycation this week to avoid burnout from compassion fatigue. And I'm only 4 years in.

jan said...

I'm assuming it was Dr. "I'm off to see the Wizard." I seriously can't believe the man still has a license.

Unknown said...

Thank you for sharing these unpopular views. I agree. If the "average patient" knew what we had to deal with on a daily basis, they might have a bit more patience for our frustration with the mountain of crap (administrative, insurance, "entitled patients") that we deal with each and every day; maybe they would be a bit more patient with us. Or not. It slays me that the people who get the best access to medical care are those who get that care courtesy of my tax dollars (and don't give a crap and don't take care of themselves) and those who really need it can not afford the care that they need. Every bright-eyed smart student who tells me that they want to be a physician is strongly rebuked by me to seek a more lucrative and rewarding profession. I would never want my children to have to deal with the shambles that is our current American medical system.

Anonymous said...

I quit being a veterinarian. Many people have asked me why, thinking that being a veterinarian would be fun. I always tell them I loved my patients but about 3% of my clients were assholes, and 3% was enough to ruin my whole week, every week.
So now I just breed my own healthy animals and my veterinarian lets me have 'mates rates' :-)

Anonymous said...

While I understand Dr. Grumpy's point of view and think that he and other care providers face a very difficult job and struggle to stay compassionate in trying circumstances, the examples of the patients in this article was a little off-putting. A 15 year old is still a child. If she has already had 20+ sexual partners there is something seriously wrong in her life. The odds that she is a victim of rape or abuse of some kind is very high. The same with the 19 year old. She was almost certainly not an adult when she became a parent, and at 19 with four children, she is facing a very difficult task. We don't know anything about the circumstances that led that girl to be in that situation except that something went terribly wrong in her life. Poor choices perhaps, but in order to make good choices you have to have the opportunity and the knowledge to do so. This teenager is facing a lifetime of consequences, and negative judgments and shame just add to the burden.

I have a lot of empathy for the care providers in the situations described. Those are difficult situations and it's understandable to have feelings about them and experience compassion fatigue.

I'm really uncomfortable with the negative judgements centering on the sexual activity of young women, though. Numerous people were having sex with these girls, but the girls bear the physical and social burden. It's a 1950's mentality that is neither fair nor right.

I became pregnant as a teenager after a date rape. It was a horrible time, made all the more difficult by the judgement and humiliation heaped on by people who saw me the way you see those girls. I went on to get a college degree, work gainfully, marry, buy a house, pay taxes. My child attends an elite college. We are good people.

edgaralgernon said...

Thanks for posting this!

My father is a, now retired, doctor and I would see this from time to time. How the one really annoying patient could ruin his day.

It's a major reason why I always treat the doctors and staff I see as nicely as possible. Who knows how badly they're day is going, how much they have to paste on that smile, etc. So I try not to be that patient for their sakes. :-)

Hope others read this and get the point!

Anonymous said...

At the end of the last school year (and a few others before) I've considered leaving teaching. Dealing with entitled students and parents, administration more concerned with test results than education, the student who believes that what he one she wants us the only thing that matters has become tiring both mentally and physically. The majority of my students are not bad apples but the few that are make everything more difficult.

RebeccaH said...

This happens to cops too, with the added fillip that some of the "clients" may try to kill you.

Debbie said...

Thanks Grumpy for having the ba@@s to write and post this. I am 57 and wondering if my compassion will last until my retirement. I think the toughest, most entitled patients are just wearing me down. For all the nay-sayers above, understand that compassion fatigue is a real problem. The stress is real and will affect our health, if it hasn't already. When we left school we were ready to save the world!! But our broken society will eventually spill over into everyone's lives, even those critics above. I still love my job, and am fortunate enough to work with other caring professionals. We take good care of every single patient, every single day. Thanks for putting into words what so many of us are feeling and living.

Debbie the nurse practitioner

Annette said...

Gutsy piece Dr Grumpy. Reading Rebecca's comment above, I'm reminded of the neurosurgeon gunned down in the ER and the PCP recently stabbed in Virginia. We have a long way to go before we catch up to the law enforcement pros in terms of physical risk, but I think we may be on the way....

Spook, RN said...

Many years ago, I was a student nurse (gosh! Has it been that long ago?!)

Working our first peds rotation at Children's Hospital. This rotation was always in high demand - I picked it for no other reason than to see what peds would be like (and definitely for the instructor. I loved her - she was just completely awesome! )

Up until that time - I really didn't have an idea of what I wanted to do once I got done with school, KWIM?

Anyways, this was my last week of clinicals. Up until that point, the whole experience had been a roller coaster. We had some really sick kids who coded and din't make it and also some sick kids who got well and went home. Peds was starting to "affect me".

But my last patient was the cake.

She was in for a double ureter reimplant. I was assigned to her the day after she'd had the surgery. She was this really sweet 6 year old girl.

Absolutely the bravest person I've met in ages.

Ne'er a cry or whimper. She was absolutely delightful - never asked for pain meds unless it really really really hurt. Despite my assurances that it was ok to ask for something to make the pain go away - she never did.

We were assigned 8 hour shifts and I went about it my own way - general checks/assessments q2h, checking her tubes (2 JPs and 1 SP) and drains qh. Meds as ordered. Gave her baths. Linen change. Played "chance" and some other games - heck, even played with her stuffed toys!

The only thing she wanted to know was when could she get outta bed - because she wanted to go for a ride in the toy cart. She asked me all kinds of questions, from her body, her condition, to me, my background etc.

So anyways, I go back the next day; I'm assigned to her again. I walk into the room to do morning assessments and while checking her BP I could see she was trying hard not to giggle. So I turn my back to get her meds - and I can see her squirming in her bed. So I ask her what's up.

She asks me to close my eyes, she has a surprise for me.

I close my eyes and in my hands, she places this little card. Made in green paper.

It said "To Spook,

Thank you for taking good care of me


Her Mom explained that she'd spent 4 hours, painstakingly drawing with her right hand (she's a southpaw but her left hand was boarded with an IV board).

My vision was blurry. I don't cry easy but I did feel that one tear drop down my cheek. I gave the kid a warm, heartfelt hug.

I'd been having a horrible week to the point that I even came to doubt myself. I was wondering if I'd bitten off more than I could chew. Debt was killing me. Working two jobs just to barely keep my head above the water, sleeping about 4 hours a night at best etc. etc.

That card and her smile when she gave it to me changed all that.

I'm an ER nurse now. I've been one for quite a while.
Every once a while, I go through some fairly strong 'compassion fatigue' - and more often than not, its because of stupid bureaucracy than recalcitrant patients. Or on the other end of things, its giving good people bad news (metastatic cancer) or losing patients unexpectedly (like the 54 year old father who died and family rushed his kids to the bedside straight from school).
They call it death by a thousand cuts. We 'professionals' hide it under gross and utterly black 'humour'.

But when things get really bad, I pull up that card and remind myself why I do what I do.
I was born and raised in India. There is an old saying that goes: "Sukh batane se bhadta hai, dukh batane se kam hota hai." (Happiness increases when you share it, sadness decreases when you share it)

I've said this before and I'll say it again - you're a good egg, Ibee Grumpy. You're a human being. And you clearly haven't lost your humanity because stuff like this still BOTHERS YOU!
It is a good sign!

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