The attack in Buffalo, Minnesota: a primary care physician’s perspective 


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I began my career as a family physician in Buffalo, MN in 2002. I have been an extremely productive doctor for 20 years. For context, I can assure the reader that my ratings and reviews are excellent, and I  speak to the common primary care experience. I was a very green attending when I showed up in Buffalo for my first attending job. I experienced universally superb physicians with excellent mentorship and caring staff who went the extra mile for patients. I also now work at a different organization. It is full of fair-minded leaders who participate in whole-person care and emphasize quality. It is not a malignant organization in any form. So why are people being gunned down in clinic lobbies? I  can tell you what got us to this point. 

1. Let’s talk about controlled substances. They are bad. We get it. Full agreement. Road to nowhere. Get everybody off. Great idea. But now what? Is there a plan? Chemical dependency programs are prohibitively expensive. The people who need them don’t have the insurance or money to cover them. Consequently, primary care physicians are left on the front lines alone to wean people off medications that they have been on for years which we often did not prescribe in the first place. And we offer what instead? NSAIDs? Acupuncture? We don’t provide any great cost-effective alternatives. Integrative medicine is a powerful and awesome completely non covered option. So, unless you are exceptional at communication and have a  really reasonable patient base, there are endless stressful encounters happening in offices. We now have a lot of angry people in pain and nothing good to offer them. I can see that not ending well.  

2. Let’s talk about mental health. Where is it? I can’t find it outside of an e-consult. I have multiple teenagers right now that I cannot even get into a psychiatrist. I spend sleepless nights hoping that they don’t get suicidal. Patients that are on medical assistance? The private psychiatrists won’t touch them. So here I am again – doing my best with limited resources and no specialty help. The coverage for psychology and therapy is better but not fantastic. Add to the mix a global pandemic, during the winter in the Midwest, and throw in social isolation with job loss. Let’s keep the kids home from school too. Why not add an attack on the capital and general rioting through the summer. We just got ourselves a lot of people at the breaking point. When people are hopeless, they typically pick from two choices. Self-harm versus harm to others. A gun can get you either or both. And those seem awfully abundant in the U.S. right now. Add in a president who incites a riot with no accountability and deep political divide. I  am fairly surprised this scenario is not happening more often.  

3. Yes, you do work at Burger King. It is not McDonald’s because their fries are better. People want what they want, and they want it now. With a smile please. And they usually get it.  Because if they don’t get it, they might leave a nasty review about you that impacts your pay or reputation. Here is the truth. It hurts us when our neighbors and friends can see a terrible review about us on social media that was likely left by a patient whom we refused to provide narcotics. This is made worse because we do not have the ability to refute bad reviews that last forever on social media. It makes a provider think twice before saying no. Is that good medicine? No. Patient reviews need to go. There are other measurement tools we can utilize to make us accountable. This isn’t it.  

4. Welcome to medical messaging. As a patient, I can now demand immediate care for free. Just watch. I send a message to my family physician and tell her or him what is wrong with me and what I need. I then demand the labs or prescription that I want and dictate my care. I may have gotten that information from a friend or google or my aunt who is in health care. What! I need to make an appointment! But I know what I need because I know my body. Why would I  pay for an assessment when I can demand care for free? We have set quite a precedent for patient satisfaction and demand culture. It is also way easier to send an abusive message than tell me to my face. It is not easier to read it, though. Where is the line drawn? What is reasonable care?  

I fear this is just the beginning for health care.  

The author is an anonymous physician.

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