Lately, I have been seeing a lot of writing from Pamela Wible, MD. And today, I re-read her article about doctor suicides. As I read and reflected on how medicine has changed during my lifetime, I am struck by the degree to which the humanity scrubbed out of the system. I think about the times when I thought, “You know, it is not worth it anymore to do this, I should just go.” It is not so much that I wanted to be dead, really, I just wanted out. The urge just to get out, I have heard that urge voiced by many people, they have not wanted to die, they wanted an opportunity to leave a life that lacks good choices, opting to start over. There have been times, where I was, in fact, one of those people.
Lots of doctors kill themselves in hospitals.
When I look at the “causes” she has assembled, they ring true. I feel the pain of losing a patient, still remembering the first patient who ever died “on my watch.” The family had already gone ahead to Salt Lake City, we waited for the helicopter, and I remember how we worked to keep her alive. I remember sitting in my office afterward, crying hard because I had let her down, I had failed her, her family, myself. Each death has held a little more sorrow for me; each has given me the opportunity to see suffering up close and notice how it flows within my system as well as those around me.
Malpractice suits can be devastating.
I recall being brought before the College of Physicians and Surgeons to have my work reviewed and questioned.
I was feeling judged: for the work I did, for giving my very best, and feeling that somehow my best was not good enough. It’s not good enough, so you will be punished for my failures as if failure itself was not punishment enough. The opportunity to have others review my work, point out shortcomings, has a heaviness to it that cannot be erased.
In these cases, even if the tribunal finds that you did what you should, there is a taint that lingers, you are somehow not that good, you are somehow not living up to your potential, that you are letting people down. And the fatigue that comes from the relentless second-guessing after these moments wears upon your soul.
Assembly-line medicine kills doctors. Pressure from insurance companies and government mandates crush these talented people who just want to help patients.
Having your practice audited by billing authorities, as they review your documentation, finding fault with the way that you record your work and their approach — guilty until proven innocent —hurts. It has a familiar feeling that somehow you are not doing what you should. The process leaves you feeling you somehow committed fraud — a feeling that lingers long after the process is completed. You feel like the work you have done is somehow not enough, and the efforts you have made to do the right thing are insufficient. You are caught between doing the work that patients need and producing the work that the system needs to justify your payments.
The relentless grind of the work, never really knowing if what you are doing is enough, if the efforts you are making will satisfy the examiners, so you second guess, again and again. Once again,
wondering if what you have done is right.
There’s no time for our own pain.
There is always a pressure in this work. There is the pressure to see just one more person, to work one more person into a schedule that is already full, to just take one minute and call in that prescription. There is pressure when after a long day, the hospital calls and the families want to talk; they want to understand why their loved one is sick, what is being done and how it will all turn out. There is pressure when patients want answers as to why they are sick, and, when the work-up has been negative, “we don’t know” is not a good enough answer. There is pressure when people want something that I feel uncomfortable giving them when they are asking me to do something I feel is bad medicine. There is that sick feeling at the end of the visit when they walk away mad; you feel like you have once again let people down by trying to do your best. And when you take a moment, when you take some time to take care of yourself, there are always those who are mad that you are not available exactly when they need you.
These decisions, these pressures, so many that do not in any way involve taking care of the person in front of you, they take more from doctors than many suspect. It is hard enough to treat the illness, have the compassion when your levels of fatigue are high, be present in this moment with the suffering in front of you, then step out and move on to the next person in need.
It is hard enough just to do the actual work of being a physician, so much so that I wonder at times why anyone would choose this path. And so, I sit here, having once again read through an article about how so many doctors leave this world behind, I am sad. I am sad for those that left, for the suffering they had to endure, for the suffering they leave behind and for myself as I see the ripples of these same difficulties flowing and swirling around in my life. Once again, I turn my attention back to my breath. And back to my heart, I ask what is needed at this moment, and I give to myself those things that this world cannot give to any of us.
Gil C. Grimes is a physician and can be reached at Doc Grimes.
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