As part of the interview for my book, I asked why it is difficult to be a doctor. Some of it has to do with integrating information and making decisions.

“The public thinks that we know more or can do more than we can. Ultrasounds don’t mean it’s a perfect baby. All of the tests and technology moves so fast that we don’t know what we see.” A doctor explained, “You cannot know everything about everything. You have to know what you don’t know. You have to decide who needs care and who doesn’t. And you have to know where to go.” Another doctor said, “Every day I am making decisions. I am not in the OR, but I am making decisions about tests and medication.”

Also, “Trying to balance so much information and integrate information that matters for life or death. Trying to get information from people who don’t want to give it to you and all in 15 minutes. Trying to balance what each patient wants. They each think that they are your only patient.”  Underneath it all you are dealing with issues that could affect the patients’ outcome of life while simultaneously trying to fix boo-boos and convince people they don’t have cancer. You are mother, healer, teacher all in 15 minutes. You are dealing with life and death. Every person thinks that they are the most important person in the world. I am triaging all the time. This is more important than that.”

Indeed, “All of the stuff that goes on behind the scenes and the stress of how peoples’ lives are in your hands.” Another concurred, saying, “All of the things that happen behind the scenes, not just the exam room. And there are so many more things that we need to keep track of while we are in the exam room.”

Medical decision making is not easy.

“It is not pure science. It is a lot of intuition and experience. Experience counts a lot because you have seen a lot. Another interviewee added, “Because medicine is an art, not a science. There is science, but there is no binary code. Things are not black and white. No diagnosis is absolute. People want an immediate answer. Things have to play out over time.”

Being a doctor is stressful emotionally.

As explained by one interviewee, “People do not understand the mindset of a doctor and the amount of toil and labor both physically mentally and financially that it takes. They do not understand that we have no control as a profession, that others rule us. We are used as pawns in a system. No one cares about the doctors. One doctor said, “They do not understand that we function under this burden of responsibility and if we screw up bad things will happen, and we are very aware of it.”One doctor said, “People do not understand the risks that we take even emotionally when bad things happen. That kind of responsibility is very stressful, it’s a good thing, but it’s hard.”

As one example, “A patient with MS wants me to do the quarterbacking and help make the decisions. I have a patient in a clinical trial for cancer and the patient and her husband come to me to help with difficult decisions. The trust is overwhelming sometimes.”  One doctor said, “You need to be able to step outside of your own comfort zone for the needs of somebody else regardless of how tired or unhappy you are feeling at any moment. You have to be on.”

A number of interviewees mentioned the “24/7” reality of being a doctor. “There are physicians who go to sleep thinking about them. Most physicians do care what happens to their patients. They call them at 8 p.m. even though they should be at their son’s baseball game. I am very thorough and don’t get paid for it. There are certain things that I do not have to do. And I do it, and I don’t get paid for it. I have a million phone calls, and it is hard to answer all of them. We do the best we can and try and reach out and take care of as much as we can.” Another doctor explained. “You spend nights up thinking about your patients. Patients call. Patients have my cell phone. That’s life. I have to leave the movies if I get a call.” And one more said, “Because nobody appreciates the degree of stress, thought, and time that goes into it. The sleepless nights when I am afraid for someone and worried, and maybe I forgot something. It’s hugely demanding with little compensation.”

What does the public need to understand? “The public needs to understand that your whole life is dedicated to caring for patients, putting in long hours, calling patients at night. Dealing with families who are dealing with sick patients and dying patients.” A particularly powerful quote, “I don’t think that they realize about being baptized in the blood of human suffering and what it does to you. The sounds of human suffering in hospitals.” And of course, “Wherever something doesn’t go right with health care it is the doctor’s fault.”  Further, “The system of “accountable medicine” is creating people more interested in criticizing and attacking others that focusing on the patients.” A repeated theme, “I don’t think that you can understand unless you do it. Everyone expects you to just be for them.”

I suggest that we need to understand, if we want to continue to have doctors. How can health care reform be effective without listening to the doctors?

Peggy A. Rothbaum is a psychologist and can be reached at her self-titled site, Dr. Peggy Rothbaum.  She is the author of I Have Been Talking with Your Doctor: Fifty doctors talk about the healthcare crisis and the doctor-patient relationship.

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