The one patient that drives physicians to burnout

We all have that one patient. That one patient who can always find a way to turn a good day bad, who just knows how to push your buttons in all the wrong ways.

Who’s that patient for me? Let’s just call him Elton Reed.

Oh, Mr. Reed … where to begin with him?

When we first met, I remember being so excited and energized by him. He just had this fresh feeling about him. Not only was he young, handsome and always well-dressed, he was really smart. Finally, someone who actually knew what he was talking about! He could recite for me all of the medications he was taking by heart. Hell — he even carried a list. Not just that, he always had a super-organized portfolio in which he carried the records from all his prior clinic visits and hospitalizations. That way, he told me, I wouldn’t have to ask him for every drug he’d had prescribed or immunization or procedure he’d had done in the past. I was so smitten. He was immediately one of my favorite patients. He just seemed so knowledgeable and savvy. I thought to myself, wow, he’s going to save me so much time and headache, and we’re going to get along just fine.

And I was right, at least initially. As a matter of fact, things were great in the beginning! We were just starting to build up our doctor-patient rapport, getting to know each other’s personalities and idiosyncrasies. But slowly as time went on, I began to realize what an unreasonable, needy and flawed individual Mr. Reed was. Now don’t get me wrong, I care for all my patients; I try to care for them all as equally as possible, in fact. But Mr. Reed, he demanded a special kind of attention.

For one thing, whenever my staff would take his vitals or his labs, or if anything on his labs had come back remotely abnormal, he’d always call me into the room immediately, claiming that he thought he had “sepsis.” I didn’t even know how he’d come up with that diagnosis in the first place; I almost never thought he had an infection. And even though he always had all his records on hand, sometimes the information he provided about his history or prior diagnoses was wildly inaccurate or just straight up false.

And for some reason, Mr. Reed was strangely obsessed with his diagnoses — he called them his “problems.” But he didn’t care to know how I’d arrived at a conclusion or any of the subtleties in building a differential; he just wanted to know what was wrong with him, by name – by oddly specific name, really. And whatever his “problem,” he always wanted it to sound as severe as possible, for some reason. I secretly believed he got a masochistic pleasure out of hearing it out loud.

Mr. Reed had no boundaries, either. When I’d get behind on things, he would send me incessant emails about all the paperwork I still hadn’t completed for him. He’d even bother me when I was at home, and the random tasks he’d place on me would keep me up late at night. He’d call it “delinquent” — he loved that word — if I fell behind on putting things in for him. He even threatened to report me if I didn’t “comply” — his words, not mine — by some made-up deadline of his.

He was also extremely litigious. Everything I said to him I’d have to word very carefully. It was like I was always walking on eggshells with him. I couldn’t say what I really thought because I knew it would only come back to bite me in the ass a couple years later when he undoubtedly would sue me. He’d even make me keep track of how long — exactly how many minutes — our visits were just so he could ledger it in some sick journal of his.

Worst of all, Mr. Reed was the type of patient that would keep you at work late. Somehow, no matter what my schedule looked like, he’d always make his appointments for the last possible time slot. Even if I was having a great day and I thought for the first time, I was on time, or even (gasp) early, without fail he’d always keep me at the office late, keeping me from caring for all my other patients and more importantly, being with my family.

By the time I did get around to seeing him that last appointment of the day, he didn’t care that I’d just spent the whole day seeing 20-30 patients before him, some of whom were actually sick! No, he’d take his sweet time. I can’t tell you how many times I’d have to cut my other patients’ visits short just so I’d have enough time to spend with him at the end of the day.

We all have a Mr. Reed on our panel. That needy, demanding patient that has somehow managed to turn you into his own personal secretary, whom every minute you spend with sucks the living soul out of you and drains any desire you have left to practice medicine. He’s one of the main reasons that we’re all burning out, why we all spend so much of our precious time doing things we never were trained to do in medical school.

We all have that one patient. Mine is Elton Reed.

Elton’s middle name is Miles, by the way. That’s right, Elton Miles Reed: EMR.

Patrick Wu is an infectious disease fellow.

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