I worked in rural Kentucky for 20 years, all of it in poverty clinics. I suspect I got to know my patients better than someone working in a specialty clinic in a big city. The challenges and rewards of doctoring are unique to each specialty. But these are the challenges and rewards I experienced in primary care in the backwoods.
I learned that doctoring is hard. People always come in complaining of pain or fever or something. You are always listening to sad stories. The lady who is charming and well dressed, and you think when you see her, “A woman who has floated easily through life.”
Then it turns out she’s been dealing with lupus for years, and it’s been a rough road. With the specter of kidney disease hanging over her and impending dialysis.
The ones dealing with depression or anxiety are a challenge as well. Their stories can be even sadder. The young woman whose daughter died in a house fire. You are thinking, “Please do not tell me the story again!” as she starts reciting the story of how her daughter slipped from her grip as she climbed out the window to escape the fire.
It takes stamina to be the backboard against which patients bounce their stories. You need some tricks for maintaining your own equilibrium.
It helps to have a real connection with the patient. Not to dismiss their stories, not to skip over their concerns. To make sure they are getting the help they need. That the rheumatologist patient #1 sees has been supportive. That the young woman in grief is on SSRIs. And has a therapist.
In the last ten years of doctoring, I noticed that the EMR is a hindrance, not a help, in trying to connect to patients. Your attention is split between what they say and what the EMR demands as the next click.
It would be lovely if someone were to design an EMR that actually helped the doctor provide good care to the patient. As opposed to collecting data points for the insurance company or whomever. I am not sure we will see such a system soon, but it would be nice.
I learned I had to protect myself from burnout.
It helps to have family or friends. Other people to talk to about things other than doctoring. Raising small children can be especially helpful. They do not care whether you are a success or a failure. They love you no matter how your day at work went.
It helps to have a physical fitness routine, to leave the intellectual space and enter the physical one. The endorphins are real.
It helps to have help. A physician assistant on staff takes care of the easy cases – the otitis media, the refills for COPD meds, or blood pressure meds.
It helps to make sure you are scheduling the number of patients you can handle (which is often 16 to 20 per eight-hour day) without feeling you are stinting your patients on the time you can spend with them and the attention you can give them.
The rewards of doctoring are all part of the equation, of course. Getting to know the intricacies of the human body and the myriad ways in which disease can present. The new findings in genetics and immunology have expanded our ways of treating disease. The opportunity to apply your hard-won knowledge to actually help people.
The latter is the reason why most medical students go to medical school in the first place. It is a privileged position to be a doctor. It is akin to being a priest or a lawyer. Probably more like the priest. People share things with you. The clinic is a privileged space protected by patient confidentiality. And you learn, over time and with facing life challenges yourself, not to judge. Not to lecture the alcoholic about the evils of drinking. They know it is destroying them. Your role is to gently prod them towards getting help – Alcoholic Anonymous, for example.
At the end of the day, or at the end of a career, you walk away with a whole font of knowledge about medicine and the necessary stages of life. So, while the patients take away from your hoard of strength and patience, they also reciprocate and give you a breadth of understanding of life and death and how people age and face difficult situations. It is a bonus to have this long view of things. It helps as you go through the Sturm und Drang of your own life — the ups and downs that we all face, whether we are the physician or the patient.
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