I want a divorce.
Let’s face it, you and I were young, idealistic, and naive when we met. Everyone said we were perfect for each other: valedictorian and humanitarian. We thought we could change the world, one sacrifice at a time. Sleep deprivation, grueling academic hurdles, delayed gratification. We proudly wore those badges as a testament to our commitment together when we started our board certified family medicine profession in 2003.
I should’ve signed a prenup.
Slowly, the tendrils of distrust curled around our world. Insurance didn’t trust our decision-making, so formularies became a paradoxical, rigid moving target. Patients wouldn’t trust our recommendations, certain that their latest Google search was far more medically sound. Hospital administration stopped trusting. Our world became a time and date-stamped arena, visible to all, helpful to none. Once a pillar of scientific benevolence, doctors were now stripped of power and treated with public skepticism.
To reign in this metastatic distrust, you suggested we collect and curate data. Surely, this would “improve” our nation’s floundering healthcare system, right? Never mind the suicidal grandfather in room 3, but did he agree to get his colonoscopy and tetanus updated? Who cares if the basal cell skin cancer was recognized and treated on Mrs. Jones, did she sign up for a mammogram? My resentment grew with each step into this minefield of check boxes.
This wasn’t the life I planned for us. The inequality felt oppressive. I gazed longingly at our neighbors: The Specialists. Their grassy-green lives appeared unfettered by regulations because they could just advise, “Follow up with your primary care doctor. They’ll take care of it all.”
But I couldn’t.
Your expectations of our relationship had morphed into something unrecognizable. Gone were the moments I hoped to bask in the glow of empathy, caring, and healing. Do you recall the vows we took, Hippocrates? “I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.”
A far cry from your modern version. Today’s words are icily brisk as we shiver past each other in the crowded hallways. You speak in modifiers, ICD-10 codes, and triplicate forms. My love languages are touch and words. Yours is EMR. Your eyes practically glow brighter than the screen when a new data collection feature is unveiled, lengthening the nurse’s duties from 15 to 20 minutes for each patient check-in. It’s obvious you love to flirt with inefficiency.
You shift the boundaries of our relationship on a daily basis, expecting me to jump through unnecessary hoops against the backdrop of “more patient access.” How can I detect the insidious hemochromatosis, or educate the infertile polycystic patient when I’m interrupted with your ridiculous demands to answer every message or refill with neck-breaking speed?
First, do no harm, correct?
Yet, I continued to adapt my workflow to be more efficient, clinging to the knowledge that if I didn’t care, who would? I work harder; you pay me less. (Even less as a female physician.) And now all we do is fight over money, when we really should be fighting over the real downfall of us: your adultery. When you stepped out and had an affair with Press Ganey, you changed the tapestry of our relationship forever.
In your short-sighted effort to measure value based on antiquated patient satisfaction scores, you adeptly placed my vitality and compassion in hospice. How can my worth be stripped down to a number, when I’m pressured to see more volume, squeezing as much as I can in 15 minutes? I feel under appreciated, and I deserve better.
It’s not about the money, Hippocrates. It never was. No matter how many miles I run, sun salutations I cycle through, or glasses of wine I sip, I decided: We have become incompatible.
Our core values have diverged so far apart, it’s impossible to reconcile our differences. Despite the tone of this letter, I am not angry, I’m disappointed. However, I’m filled more with gratitude for our chapter together. Relationships aren’t measured in time, but rather the amount of growth and meaning. Because of you, I have an amazing skill set, memories to fill my heart, and a clear foundation to pursue my next passion, customizable to my definitions.
“In the end, only three things matter: how much you loved, how gently you lived, and how gracefully you let go of things not meant for you.”
Your American family doctor
P.S. You can keep my stethoscope, but please return my boxed set of the Walking Dead. The moment those zombies hit, I’ll volunteer to be everyone’s Hershel.
Lara Salyer is a family physician.
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