The Hidden Lives of Doctors, Part IV: The Thrill is Gone
As part of our continuing series on the mysteries of the medical profession we bring you the following tale of a sad situation when a doctor’s heart is no longer in his work. For those interested, parts I, II, and III of the “Hidden Lives” series can be found stuffed somewhere in a drawer in the archives of this website, which is just another way to state that the blogmeister is too lazy to link to them.
[Editor’s note: the following observations were made by a patient living in an average city somewhere in America.]
“I went to my doctor today and after leaving his office had the most amazing revelation.”
“What - you discovered that you had left your trousers hanging on the back of the exam door?”
“Har, har. No, not that, silly. It’s just that I realized that he doesn’t enjoy his work anymore. I think he’s on his way to becoming a victim of doctor burn-out.”
“I suppose you had to wait forever to be seen.”
“No, he came in right after the nurse closed the door. He was as punctual as always.”
“So did he pay any attention to you or just shuffle his papers?”
“No, he asked me about my pain meds and such. He even noticed that I have lost weight and wanted to know how my appetite was - and my swallowing.”
“What about the scans you had last week. Did he know the results?”
“He did. He reviewed the reports with me and told me what things I should be on the lookout for over the next few weeks. He always is thinking ahead of what might go wrong. He says I need to ‘Be Prepared’ just like the Boy Scouts.”
“What’s wrong with that? He sounds like a good guy to me. Why do you think he’s burned out?”
“I was in and out of that room within five minutes, I swear. It seemed like he was in a hurry to move on to the next patient or whatever was next. That’s not like him.”
“Maybe he was just behind schedule, or had a bad night. Doctors are only human, you know.”
“Maybe, but I got the impression that he just didn’t care about my case. It seemed like he was just going through the motions. I felt bad all the way driving home.”
“Why don’t you ask him about this the next time you see him?”
“Well, this isn’t the first time I’ve noticed this change, and frankly I’ve decided to switch doctors. My sister wants me to go to the Medical Center to see an expert there, and I’ve already made an appointment for next week.”
With the reader’s kind permission The Cheerful Oncologist would like to weigh in on the above vignette. Without further ado then, here is his astonishingly insightful and sagacious commentary:
I sympathize with both the patient and the doctor in this story. The doctor mentioned above does seem caring, but the fact is he lost a patient today because of his detatched mien and hurried pace. The practice of modern medicine is more intense now than ever, and the pressure placed on physicians is enormous what with obeying Kafka-like rules and regulations, trying to please the high and higher expectations from patients, and second-guessing treatment decisions under the threat of malpractice lawsuits. The potential for physicians to burn-out and lose their desire to pursue excellence, let alone mediocrity, in their daily work is as great as ever. Since no one wants to have a lost soul for a doctor, it behooves us here at T.C.O. to provide a little helpful advice to patients who just might be wondering whether or not their local practitioner still has enough fuel inside to keep the fire burning bright, to ward off the deadly chill of apathy or anger.
Rather than list the signs of doctor burn-out (after all, this is supposed to be a cheery rest stop for voyagers of the blogosphere), let us instead identify the clues that one’s physician is definitely not embittered, worn-out or fed up. These characteristics are as follows:
1. The doctor uses your actual name when addressing you, not some idiotic condescending title like “Sweetie,” or “Buddy.” What, has he mistaken you for his pet dachshund? An even worse scenario is when the doctor never calls you by name, as if you’re completing a transaction in front of a fast food counter.
2. The doctor makes eye contact with his audience, whether it be one person or a dozen, and maintains it throughout the visit.
3. Whenever feasible, especially when the news is not good, the doctor sits down before beginning a discussion.
4. The doctor asks questions about his patients’ lives - their children, their vacations, any good books they might have read lately. He is genuinely interested in his patients, no two of which are alike. For World War II buffs like myself, this is a great way to learn a little bit of history from one who was actually there, if not personally court-martialed by General Patton for not wearing a proper uniform.
5. Lastly, the most important clue of all in my opinion is that the doctor smiles, chuckles, makes you laugh, uses humor to break the ice, to form a bond, to provide encouragement or diffuse anger, to charm the crowd. When they say that laughter is the best medicine they aren’t just referring to patients. The doctor who truly loves his job cannot help but see how he has the unique opportunity to bring a grin to someone who just might be in desperate need of one today.
As we now return you to your normal lives, please remember these words of wisdom - “Fight burn-out now - tell your doctor a joke today!”
At a recent quarterly medical staff meeting of our small rural hospital I surveyed the approximately 65 physicians
present and realized that, including myself, I could not name a single doctor present who intended to encourage their children to pursue a career in medicine. Some were third-generation physicians.
Comment by anonymous — March 2, 2006 @ 2:49 pm
I used to feel a bit “unimportant” or routine in the day of a pediatric specialist. I brought my son a long way to see him and it seemed to me that he was just another typical, runofthemill case—but the medical problems were a pretty big deal to us….after all, we were sent off to see a specialist. We continued the runofthemill treatment until the rare, underlying problem was identified. Suddenly, my son was the unusual case. The specialist and team were fascinated, the radiology images had WOW factor. Corrective surgeries were scheduled. Students and residents were visiting. I will never forget the director of pediatric radiology walking us down to do an immediate consult with the specialist. Moral of the story—-If you are feeling like a “runofthemill” patient seeing a “going thru the motions doc”, count your blessings. The flip side is pretty scary. And PS–my kid is doing great and the team who fixed him (like most medical professionals) are the most FABULOUS people I know.
Comment by misha — March 2, 2006 @ 5:05 pm
I always marvel at the level of physical, intellectual and emotional commitment it takes to be a physician. And to be able to sustain that across the life of one’s career is truly something. Even when patients aren’t being demanding, their needs can drain the physician dry. So it takes a real commitment not to become blase or burned out.
While a smile or a thank-you or a positive attitude from a patient can help, I think it is important to draw the line. At a certain point patients cannot be asked to take responsibility for dealing with a physician who is approaching burnout. It is an unhealthy dynamic that can lead to a) patients getting disgusted and leaving the practice; b) role reversals that have patients caretaking the physician’s emotional needs; or c) patients becoming reluctant to report their symptoms or voice their needs because they sense they are viewed as a burden.
I had the misfortune of having an onc who seemed to be burning out. Whenever I went in for a visit I never knew what I was going to encounter - sometimes he was flippant, other times he was cranky or impatient. On one occasion I witnessed him getting short-tempered with an elderly couple who was struggling with making a decision about hospice care; the door to the exam room wasn’t even closed. It was more than a little disturbing. Most of the time I just wanted to get out of his office as fast as possible. I never reported some of the chemo side effects I was having, and I certainly did not report that I was depressed - because it would have meant asking him to do something about it and I didn’t want to be the straw that broke the camel’s back.
I’m afraid that jokes and humor will only get you so far. Administrators and colleagues also need to create an environment that supports physicians and has the guts to intervene before a troubled physician’s problems spill over to the patients.
Sorry this is a long response. Guess I had to get it off my chest.
Comment by Kitty City — March 2, 2006 @ 9:45 pm
That’s probably one of the advantages to being in a partnership or group practice - when self-evaluation fails, you’ve got a peer there to nudge you and say “pal, I think it’s time for a little vacation.”
Comment by Ali — March 3, 2006 @ 11:43 pm
Cute. My husband has a good relationship with his GP. They don’t see each other very often…one or twice a year. My husband is an avid gun collector and his doctor always asks something about guns or the caliber of a gun. I actually have never had a doctor ask much beyond what is wrong today, but I think my husband definitely trusts his doctor which is important.
Comment by Mollydog — March 4, 2006 @ 3:12 am
this is precisely why I would up with an ANP as my primary care provider. i was bone tired of being treated as less than a person.
Comment by angie — March 6, 2006 @ 8:45 am
I have maintained good relations with my doctors over the years. I think it’s important and I’m blessed to have met a few good ones.
If I’m with a new doctor and find him/her mechanical or indifferent, that’s the last time I’ll be in that clinic. I move on.
Comment by norma guerrero — March 6, 2006 @ 10:52 am
When I came in for my labor induction two weeks ago, I brought my OB a loaf of freshly-baked homemade rye bread, just to be nice. There have been times during this pregnancy when I was less than pleased with his bedside manner, but I knew I was hormonal and not at my best, so I let it slide. My dad was an OB too, so I know what it’s like to interact with a cranky, overtired OB who’s been up all night delivering babies and is now facing a full day of having to be polite and diplomatic and make the right decisions about patient care. But whether it’s a doctor or anybody else you’re interacting with, it’s a good thing to be kind and understanding. We are all human and none of us are perfect.
Comment by Wacky Hermit — March 8, 2006 @ 5:00 pm
My late husband’s oncologist (I think of him as “Dr. Death”) was so zoned out one day that when I was talking to him, after he had examined my husband and sent him off for tests, he turned to me and said “What kind of cancer did your husband have again?”
I felt like not only my husband’s life, but my life was in the balance. Although we realize the oncologist is not all-powerful, I’d hoped he’d cared enough to glance at the chart before revealing to me that he didn’t even know who/what he was treating.
I know his caseload was huge, but I lost confidence in him after that.
Comment by ThirdDegreeNurse — March 11, 2006 @ 1:40 am
Sometimes you can lift a your doctor’s spirits by actually taking his advice! Mine recommended a book on stretching for my aching back. I actually bought it, AND the DVD to go with it! I think he was surprised!
Comment by Kim — March 31, 2006 @ 4:30 am