Before quitting medicine, consider the children

There’s little doubt that many doctors are frustrated, with some compelled to leave medicine altogether.

And with the myriad of obstacles intruding on the doctor-patient relationship, combined with the factors contributing to burnout, that’s certainly an understandable stance.

So, why do so many continue the uphill climb to practice the best medicine they can?

Emergency physician Edwin Leap gives his explanation, in a poignant column from Emergency Medicine News:

We may rail against so much that we do. But our smallest patients truly need us. They have not contributed to their own dysfunction. They have not abused their bodies or abused the system. They do not threaten me with harm or call me names. And unlike so very many, they don’t even want to be in the emergency department. They almost never ask for pain medicine, and they have little to no interest in disability.

They need us because they are sick and dying. They need us because their parents are too young or inexperienced, and they just need to be helped through a stressful time. A few need us because their parents are dangerous and stupid, and they need to be identified and rescued.

Despite the anger that doctors feel, the children keeps Dr. Leap going. After all, he writes, “If I quit in anger, what example will that set to my own, who may yet be physicians? If I decide that even the children aren’t worth my own discomfort, what message will that send to my sons and daughter?”

Powerful reasons indeed, and certainly something to keep in mind as physicians face a growing number of challenges to best care for their patients today.

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  • rezmed09

    The system is broken and the question is how to change it. Right now the only way to vote effectively is with our feet. The emphasis of the article is toward those in practice. The long term problem is with those in training right now. Let’s see how “Consider the Children” flies in med schools across the nation…

  • stargirl65

    Most physicians are not frustrated with the patients. They are frustrated with the system.

    The insurers demanding paper work to authorize medicines and tests that are clearly indicated. Medicare requiring paperwork for canes, wheelchairs, scooters, diabetic supplies, diabetic shoes, etc. MVA forms for handicapped plates. Letters to get out of jury duty. Forms from therapy centers, home health care, adult day care, nursing homes, hospice, and other programs that need to be reviewed and signed. Forms for employers who don’t believe their employees were sick and need a 6 page form to confirm they really needed to miss work. Papers certifying a patient actually came their appointment and their taxi ride was for health care. Camp forms, sports exams, college exams etc. FMLA papers. Audits from health care companies for HEDIS measures. Records requested from insurers because they don’t believe you actually saw the patient or they want to prove it wasn’t work related (and covered under workmens’ comp) or car accident related (and covered under car insurance policies).

    Most of this they want for free. Including after hours care, weekend care, phone care, internet care. All for the same low price. Which is really low since they have not significantly increased their rates for several years and have decreased their rates earlier this decade(Medicare).

  • Frank

    What if the physician doesn’t treat children? Is he free to quit because adults/elderly aren’t worth it but kids are? That’s the take home message here. It’s ok to quit if your patients are elderly but if you treat children, you’re a bad person if you quit.

    • jsmith

      Amen Frank.

  • Patient

    I feel this contempt every time I walk into a doctor’s office. This is why I chose a nurse practitioner for my care.

    • fam med doc

      thats nice. but your NP doesnt have anywhere near the training an MD has. I have 8 yrs of training compared to the NP. By all means, go to a NP. The more enlightened patients will select a physician as s/he has tremedously more training, skill, and knowledge base.

      • Patient

        It doesn’t matter how much training you have if you don’t care. The more enlighten patient will find that human connection. It’s worth so much more than that knowledge base.

  • http://paynehertz.blogspot.com Payne Hertz

    We may rail against so much that we do. But our smallest patients truly need us. They have not contributed to their own dysfunction. They have not abused their bodies or abused the system.

    What about the ones who are overweight, smoke, do drugs or endanger their health and lives with risk-taking behaviors on skateboards, bikes and diving platforms?

    Do they merit classification as contempt objects?
    If so, are they sufficiently contemptible to justify doctors leaving the profession?

    They do not threaten me with harm or call me names.

    Do you ever threaten your patients or call them names? Write nasty things about them in the chart? Stereotype them on your blog?

    And unlike so very many, they don’t even want to be in the emergency department.

    Because there’s nothing “very many” people would rather do on a Saturday night than get sick and spend 12 hours in a crowded and uncomfortable ER waiting room waiting to be seen by a doctor who despises them.

    They almost never ask for pain medicine,

    Is there anything quite as contemptible as a patient going to a doctor and asking him for medical treatment for pain? What are these patients thinking?

    As an aside, I guess we have discovered one more explanation of why pain in children is severely undertreated…they are just too lovable to need it!

    and they have little to no interest in disability.

    They also have little to no interest in paying for rent, utilities, food, clothing or medical care.

    They need us because they are sick and dying.

    What about adults who are sick and dying? Should I even bother asking about people in pain?

    Perhaps you would be more comfortable in pediatrics where you don’t have to deal with as many autonomous, assertive adults who have lived less than perfect, Donnie and Marie lives.

  • d

    I don’t know how to treat your disease/make you better, but I can SYMPATHIZE with you.

    It doesn’t matter how much training you have if you don’t care. The more enlighten patient will find that human connection. It’s worth so much more than that knowledge base.

  • Molly Ciliberti, RN

    If you have burnout for any reason it is time to quit or at least stop practicing until you heal. Burnout is real and it hurts you and your patients. It hovers over you and any hope of really connecting with your patient. You can miss important clues to the patient’s problem because of burnout. There is no shame in being burned out. Physicians, nurses and EMT/Paramedics have a high rate of burnout; it comes with the territory.

  • BobBapaso

    “Burnout” is the new word for depressive illness. In this context it comes largely from over work. It effects judgment. If you have enough that you notice it everyday, you shouldn’t be working. “All work and no play makes John a dull boy.”

    In the old days some doctors had to keep farming, because they couldn’t make enough from medicine to live on. Why did they study medicine in the first place?

  • http://www.instant-painrelief.com/category/Blog/ Girl Gone Healthy

    I guess, it can come to a point where we reach our threshold, but to quit because of them spontaneously can be a mistake in all its entirety.

    If they are practicing medicine, and is experiencing frustration over it, they probably should spend some time in evaluating their decision, before making a rash decision. It shouldnt be just because of the children, it should be about their inner peace of mind.

  • http://www.notebookingdiscovery.org/wordpress Alice Robertson

    I enjoy Edwin Leap’s writings very much, and his love for children does shine through…..and…..yet I felt a sense of frustration while reading his gripe (patients and doctors have what I call that “invisible blanket” separating them). Doctors are at a disadvantage these days. Because they are paid for their services, and they have government regulation, administrators, lawsuits, ornery patients (and, apparently, some stupid parents….hmmm…….I struggle with that……..I am the product of really stupid, abusive parenting and I can’t justify it……thank God kids are resilient. I believe if I were being raised in this current culture a doctor would remove me from that environment. There are no cookie-cutter answers, nor cookie-cutter kids, nor cookie-cutter parents, yet we think doctors should be cookie-cutter and they aren’t…….and I am really grateful for that).

    We search for a one-size-fits-all answer and, surely, we are going to get what we asked for as everyone becomes more government regulated, or just plain regulated. I see articles like this as a way to bring about change on a personal level, because I tend to dread the outcome of more regulation, or even litigation (knowing I have this sticking point about doctors not apologizing, or being dishonest…….it sorta clouds my view of the whole issue when your child is facing more surgery for cancer. I need and like our doctors……..but my friends constantly wonder why I am so patient and not demanding with them. Having a sick child does not entitle me to display bad behavior. I am unsure that I like the new breed of patient, but I tend to like the side-benefits all their screams are producing. Then again, the shouting is so loud doctors can’t function and start to vent, cover up, and get the same rotten attitude they decry. Groveling doctors may placate patients (or keep themselves employed), but really……is that what we want? In truth, we need something…..and it will be legislated…..so I guess screaming is worth it……..but sometimes we need to watch what we ask for….because there are still mere mortals on each end of this and lives at stake (I doubt the public cares that much if doctors walk away……we are playing a tug-of-war here).

    As I read the article by Edwin Leap what went fleeting through my mind was the psychological test they give to Police Academy potential applicants. Many are sent packing. Do pre-med students take a similar test? It would weed out those with no social skills (or send them safely from the public into research! :) , or those who will find patients like big pieces of sandpaper…….because one wonders if Dr. Leap didn’t like kids so much………how would he treat adult patients if he had chosen a different speciality (kids are so easy to love…gosh…we were terrified of having so many [six] and now wish we had more. I miss their special way of viewing the world)?

    As long as patients, or the government, is paying for services doctors are going to have to consider themselves servants and that may mean feeling a bit like an indentured servant to the government, their employer, and even patients.

  • Alice Robertson

    FormerTeach writes:
    “They have not contributed to their own dysfunction.” HA! You need to your ass into a public school, where the students are out of control, shouting at teachers, cursing out principals and beating up classmates. They break items, throw glass, etc. then they get sick, and some nice doctor takes care of them. And, when the child is groggy from sedation, they are calm for once. And the doctors says how nice. Sorry, the majority of today’s children are horrible and don’t need lifesaving techniques. Get out out homeschooling environment, and see the world with wide eyes. [end quote]

    Wow…..what a diatribe! I think you shared your frustration with a segment of students well…..it certainly is hard to work in the public schools…….but why the smug remark about homeschooling (and really quite pigeon-holed)? I have homeschooled for 22 years and never experienced anything like the scenarios you shared above, and I have the most wonderful adult children (homeschool graduates, and none of them were drugged…imagine……). It’s great to identify problems with doctors, patients, students, and yes teachers……but you offered no resolutions, and homeschooling is one resolution that produces some fantastic kids who aren’t bugging teachers, nor the source of irritation you seem to think students are, and seemingly not some future juvenile delinquents driving teachers wild (my assumption from your post).

    Are you upset with undisciplined kids, doctors, or just the world in general? I hear there are some drugs for this problem! :)

    And to think these pesky, drug-induced kids may end up being doctors. Hmm…..what’s the world coming to? :)

  • FormerTeach

    As a former educator, too many of today’s children do not need medical care. They are entitled to everything! “They have not contributed to their own dysfunction.” HA! You need to your ass into a public school, where the students are out of control, shouting at teachers, cursing out principals and beating up classmates. They break items, throw glass, etc. then they get sick, and some nice doctor takes care of them. And, when the child is groggy from sedation, they are calm for once. And the doctors says how nice. Sorry, the majority of today’s children are horrible and don’t need lifesaving techniques. Get out out homeschooling environment, and see the world with wide eyes.

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