I walked down the hospital corridor listlessly. My feet dragged as they fought each attempt to lift off the ground. My body was tired and achy. The phone calls the night before had been relentless. Each stolen moment of sleep was interrupted before a deep, restful state could be reached. It was Monday morning.
I sat at the nursing station, flipping through charts. A colleague across the table was staring intently at his computer screen. He previously had been a private practitioner like myself, but he shuttered his practice to become a hospitalist. He glanced over at me appraisingly, taking in my disheveled hair and unshaven face.
I nodded in his direction and looked up from the progress note I was struggling to complete. I wasn’t making much headway.
So why did you leave your practice anyway?
A look of pity came over his face as he stared down at a coffee stain on my wrinkled gray lab coat.
I was tired!
He went on to explain that it was not physical but rather emotional fatigue that spurred his decision. He was tired of fighting with his patients.
As I exited the hospital, I pondered my interactions with my patients over the past week.
A healthy, 35-year-old woman called my office daily complaining of a benign upper respiratory tract infection. During each conversation she demanded that I prescribe an antibiotic, and each time I explained how it was inappropriate. I cited studies, explained the possible harm to herself as well as society, and gave a number of recommendations for alleviating her symptoms. She responded by saying that all her friends’ doctors gave them antibiotics. Eventually she decided to leave my practice and find care elsewhere.
A 100-year-old woman with dementia experienced a devastating stroke that left her unconscious. Her physician ordered the placement of a feeding tube and transferred her to a nursing home for further care. Last week her kidneys began to fail, and her son demanded that hemodialysis be initiated. I invited the family to the nursing home and spent an hour discussing futile care and its consequences. We talked about how individuals aged 100 do not tolerate dialysis well and that the patient’s quality of life was already poor. Following this, the son stormed out of the room and accused me of trying to kill his mother.
A 60-year-old woman with chronic back pain came to my office for a refill of a narcotic prescribed by her orthopedist. I talked to her at length about the pain and explained that narcotics are not effective for long-term control of musculoskeletal pain. I looked her up on the Illinois prescription monitor and learned that she received more than 250 hydrocodone pills from 3 different physicians over the past week. When I refused to write another, she stormed out of the office and threatened to call the local medical board.
The doctor-patient relationship can be difficult. At it’s best, it is a mutual, symbiotic connection between client and consultant. Sometimes, however, being a physician is like trying to parent 2000 teenagers. Although there is great affection on both sides of the examining table, the perspectives are markedly different.
I admit that I can never know exactly what my patients are feeling; I haven’t walked a day in their shoes. On the other hand, I have years of experience treating just the sort of complaints for which they come to my door seeking help.
There are days when I fervently wish they would let me use this experience to help them.
And there are days when I wonder if I should have ever decided to become a physician in the first place.