When medicine gives you PTSD

I immediately noticed upon awakening that the intense jaw pain was gone.  I guess the TMJ was on hiatus.  Than I reached my hand down to my waist to make sure that the pager hadn’t fallen off during sleep (as I do every morning): it wasn’t there!  It took a few moments for me to remember that I had dispensed of it the day before.  For the first time in years, the buzzing, beeping, insistent mistress had been silenced.

And the rest of the week has been just like this.  No headaches, no jaw pain.  When I see a patient for a visit, there is no ringing or buzzing interrupting my thoughts.  There are no overhead pages.  I can actually sit across from another human being and listen, you know, like regular people do.  Like someone has lifted a hundred pound weight from my back and all the sudden I can breath. I am light as a feather.

I feel like a first year medical student.  Free from the chains of overwhelming responsibility, I can return to thinking abut medicine for the pleasure of it.  No one pages a first year student out of the room for an emergency.  No one rushes him through an interview or scolds him for being too generous with his time.

All the things I hated about my job have suddenly disappeared.

How long can this last?  When will some malevolent force descend on me and take away this newly found joy that, until recently, I didn’t even know existed?

Can I tell you how much I hated that pager?  That insidious soul sucker that buzzed against my skin in the middle of the night and woke me with heart racing: the bringer of bad news, evil things, death and disorder.  I started to jump even when the calls were for the most banal of issues.  I should have smashed it.  I should have snuck onto the train tracks and left it idling.

Yes, I know, it wasn’t the pager.  It was the lifestyle that was giving me PTSD.  The lifestyle that was sucking every ounce of my soul and leaving me hollow, empty.

It is the lifestyle that most physicians still lead today.

Jordan Grumet is an internal medicine physician and founder, CrisisMD.  He blogs at In My Humble Opinion.

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  • Ron Smith

    Hi, Jordan.

    I think the only thing that I despised more than the pager was the page at 6:30 in the morning about fever for which I could do nothing or give any opinion about save “call the office when they start answering the phones and lets take a look.”

    Now I understand that parents are just nervous about fever, but it seems as time has gone on for the last thirty years, the itching to see and talk to a physician about even the least little thing has gotten, well…intensely itchy!

    When I was growing up we just didn’t go to the doctor that often. Culture and technology along with it has changed. But I for one gave up the beeper as quickly as I could!

    The beeper was not a mistress for me. It was a slave driver! The beep meant that I *had* to stop then and there and take care of something, perhaps important, but more than likely something that was not serious at all.

    That’s when I started using email primarily to communicate with parents. And it has worked out well. Email is something that cannot force me to stop what I’m doing until I check it!

    Parent though know and understand this. What they tell me they like is the amount of access they get to me! Imagine that. I abandon, that time-honored shackle, and my parents love me for it!

    What I can not understand is why so many physicians choose to remain shackled to a beeper rather than be freed by email? Maybe non-adopters think there is a HIPAA issue? There probably would be if I was initiating the contact, but I’m not. The parent is the initiator and I’m simply responding to their request for information and advice within the scope of their request.

    Are physicians who are non-adopters of email simply set in their ways? Do they not want to learn something new? Or are they just afraid?

    Warmest regards,

    Ron Smith, MD
    www (adot) ronsmithmd (adot) com

    • southerndoc1

      I don’t understand your argument.

      Why are you less shackled by e-mail than by a beep? Neither of them has the inherent ability to force you to stop what you’re doing. The decision as to what time frame in which to respond is always yours, regardless of the medium in which you receive the message.

      • Ron Smith

        No the time frame to reply to pages is 30 to 45 minutes. Parents will often call back repeatedly. They have different expectations perhaps for Pediatrics, but the beeper becomes my scheduler and controls my every moment.

        Email may be answered when I check it. That may be 2 or 3 times a day. Parents have different expectations for email than they do a beeper where they think the beeper entitles them to an immediate callback.

        The other thing that is different is that sometimes I simply don’t have to return an email at all. It is not unusual for pages to come simply for refill requests.

        Plus I can see images and every parent can send images. About half the time I can have some idea about a rash for example.

        Remember we are talking about children who at the patients and not adults. Their parents tend to be easier and quicker to roll on to the ER or urgent care for things that really don’t need to be seen there at all.

        Warmest regards,

        Ron Smith, MD

        www (adot) ronsmithmd (adot) com

        • southerndoc1

          Thanks for the reply, but I’m still confused.

          How do you get urgent patient calls, calls from the ER about patients, calls from the lab about panic values, calls from other docs if you check your e-mail as infrequently as every 12 hours?
          It seems to me that the point is not which system you use, but how well you train your staff, the operators (if you use them), and your patients to deal with things appropriately. We still carry beepers (7 days at a go, covering about 8000 patients) and we rarely get more than 1-2 pages in an entire week.

          • Ron Smith

            Hi, Southern Doc 1,

            The email is an alternate way for parents to contact me. They have the choice of the phone or email. Guest what they prefer! Email almost invariably.

            They don’t have questions usually answered at the speed of a lightening page anyway.

            They do know they can page me.

            I have multiple devices that can check my email. Most importantly is my iPhone.

            The other thing is that I no longer see babies in the hospital nor do I admit patients.I might get some 4 or 5 pages from an ER doc in a year.

            I run a tight ship at the office (er, my practice manager does! -hi Linda!)

            Initially if you are adopting email you will probably be a little slow in the first 2 to 4 weeks depending on the age of your patients, but email is everywhere.

            What happens in patients minds is that actually downgrade the urgency of their need to accommodate email. That is the critical part in training patients to loosen their grip on the after hours phone call line.

            More and more patients are finding that easy and prefer interacting with me by phone than a nurse advice line where the are going to often get the advice to go into the ER anyway.

            Warmest regards,

            Ron Smith, MD
            www (adot)) ronsmithmd.com (adot)

  • buzzkillersmith

    Your post about pager-induced PTSD is giving me flashbacks and will likely cause nightmares. A pager-induced PTSD story causing PTSD in another doctor? Perhaps it should be written up as a case study.

  • Beth Boynton

    I remember my pager as the oncall nurse for home health on week ends…OMG! There was no end to it. It would go off in the middle of the night and my heart would race for a while afterwards. I remember one friday night someone called at 10pm b/c they hadn’t had a bm all week! I was so frustrated I went outside and shook a tree!

    This almost constant sense of rushing, urgency, and interruptions is so unhealthy for doctors and nurses. Can we please slow down?

    Here’s a 12 min youtube: “Interruption Awareness: A Nursing Minute for Patient Safety: http://www.youtube.com/watch?v=PGK9_CkhRNw

  • leslie fay

    You don’t have to be a Dr. to have PTSD my husband and I were both respiratory therapists for 35 years. We retired a year ago and we both still have nightmares about patients, workloads and BEEPERS!

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