I passed the board exam in November 2011 to become a gastroenterologist. This is the last exam I have to take until I recertify in internal medicine in 7 years. I recertify in gastroenterology every 10 years. I now see patients in the office two days a week, and I perform procedures three days a week. I take weekend call and weeknight call on a rotating basis. Weekend call is rigorous: similar to fellowship. The positive aspects are that we can make our own decisions and do not have to run everything by an attending doctor. I am enjoying my life and am proud to have made it through this long, arduous journey. I feel like I have met my calling and am serving the greater good. I truly enjoy serving my patients and using my knowledge to help them.
Stresses of the profession
However, even after training, there are still issues that plague our profession and break us down. These are issues that threaten the hearts of practicing doctors because they add undue stress in an already chaotic environment.
One issue involves our lack of a consistent schedule and its effect on our personal lives. Our families never know if we will be home for dinner or whether we can take the kids to soccer practice, which can create stress. It’s simply out of our control most of the time. For example, I usually perform endoscopic procedures from 8:00 a.m. to 5:00 p.m. three days per week. One day, I finished my second to last case at 4:45 p.m. We were running a bit behind, as usual, due to the increasing amount of computer work required. My last patient felt it was not important to arrive on time — 45 minutes prior to his scheduled procedure — and arrived instead at 5:00 p.m. He needed an interpreter, and his required driver chose to leave the site. By the time the nurses were able to assess the patient, place an IV, and do all the preoperative history, it was 5:30 p.m.
By the time I talked with the patient through the interpreter, sedated the patient, and completed the procedure, it was 5:50 p.m. And of course, the patient’s driver was not there, so we had to wait for the driver to arrive. I didn’t walk out until 6:30 p.m.: 90 minutes late. Sadly, examples like this are typical. Doctors always need to put patients first, which explains why we miss our kids’ sporting events or school plays on a fairly regular basis. We do not clock in and out of work. We call back our patients “after work” and make sure they are safe and cared for, at whatever hour that may be. This idea of always being available hurts our health as well as our relationships with our own families. It is a mental war that we battle daily, knowing that we can be paged at any moment. But we are doctors; we can handle it.
Another issue involves the need to multitask constantly. When patients call their doctors, their doctors are busy taking care of patients. Answering their calls, their questions, adds to the stressful work doctors are already doing. The nurse triages the calls, but we still have to read her computer messages and respond to the patients. Often, we call the patient personally and try to figure out over the phone what the next steps are. Because we are seeing patients every half hour, we are doing this additional work at lunch, after work, or in between patients.
For example, I may be calling a patient about her liver failure after I just diagnosed colon cancer in a patient via a colonoscopy. I once received a call at 2:00 a.m. from a patient who had suffered from abdominal pain for three years. She was angry and said no other doctor treated her for this pain. I had never met this patient, but she wanted me to prescribe narcotic pain medication. Although I empathized with her, late-night calls are meant for urgent issues, not issues that have been present for years. These extra pages we answer at night make us more fatigued, disrupt our sleep patterns, and affect us physically the next day. Nothing is harder than having to drive to the hospital at 2:00 a.m. for an urgent bleeding case, return home at 4:00 a.m., and then have to wake up at 6:30 a.m. to work another 11-hour day.
Another related issue is that we are never off-duty: even when we are on vacation. For example, the weekend before Christmas, I had a very busy service. I finished my weekend on Monday morning with plans of having Christmas off. However, during my Christmas vacation, I spent many hours checking my nurse emails and answering pages from other doctors. If patents’ results came in while I was on vacation, I talked to them about their diagnoses. I even went in on Christmas Eve to help a colleague. I have given patients’ diagnoses over the phone while on vacation. This is what doctors do for their colleagues and patients every day. We are never off from work. I always pack my laptop so I can check patients’ results on a nightly basis and place follow-up calls. I have to ensure I have Internet access at all times, as the electronic medical record stalks us without mercy.
Relating to the idea of never being off from work, we treat patients at all hours of the day. Whether it is driving in during a snowstorm at 3:00 a.m. or driving in to save someone after they choke on Thanksgiving dinner, we are available. We do not get compensated more for treating patients during weekend, holiday, or nighttime hours. I bring this up because of a real-life example related to this overtime work.
As doctors, we do not get paid more for arriving in the middle of the night or working on Sundays or holidays. We are there for our patients no matter what or when. We see them at all times and will never refuse care. I’m frustrated when I hear that a friend was able to get double the hourly pay for working overtime or friends in the service industry can charge a premium on a weekend. But again, we are doctors; we can handle it.
Thankfully, the challenges of residency taught me to be flexible and to remain calm. This job requires patience, persistence, and a level mind. After all, we are trying to help patients at their most vulnerable moments. We need to rely on our own inner strength, training, and knowledge to synthesize a plan for them, no matter when or why they call us. We have to be on at all times.
Matthew Moeller is a gastroenteroloigst and the author of What It’s Like to Become a Doctor: The Year-by-Year Journey From Medical Student to Practicing Physician.
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