I gave a TED talk. Okay, it was really a TEDx talk, done right here in Augusta, GA (the garden city...which sounds good until you realize New Jersey is the garden state) on February 3. The talk was entitled "Hi, I'm Rob and I'm a Recovering Doctor," and it focused on how two basic changes in how doctors are paid can totally change the patient experience
“Don’t worry, doc. It’s just one eye. I’ve got two.”
My stomach lurched to hear this statement. A guy who has done nothing wrong aside from choosing self-employment (and perhaps inheriting less-than-stellar genes) is left with the choice: financial devastation or blindness in one eye. He works hard, has served the country, didn’t complain to me at all, yet here he is about to be swallowed by the ever widening maw of impossible medical expense.
I am normal.
OK, aside from that llama thing.
I have good days and bad. Some days I am content, connected, focused, and motivated. On those days I enjoy my job, I enjoy the people I’m with, I am willing to be inconvenienced by interruptions.
On other days…not so much. I wake up grumpy and (despite multiple cups of coffee) continue it through the day. I keep score of all the ways in which life has conspired to make the day difficult. Too many red lights. Too windy. Clearly terrible things going on. I am not patient with people, and am distracted by little things.
Like I said: I am normal. I do my best to not let these things stand in the way of the care I give, and I try to hide my emotions from my patients. It’s a necessary part of the job. But there are still days I’m better at it than others.
I recently went hiking in a beautiful national park outside of Columbia, SC. This park was in a swampy area and contained all sorts of wildlife (called “critters” down here) and plant life (called “trees and those other things” down here). When I was young, my dad would take us kids on hikes through the Adirondack Park in New York, and so being on hikes in nature hits my soul in a very deep spot. It’s emotional, it’s physical, it’s a treat to my senses, and it’s a spiritual experience for me.
Being a doctor involves hearing a person's narrative and working to direct it in the best direction possible. There are some people for whom I have become a significant part of their narrative, and others whose narrative I know better than anyone else. It's a bond that doesn't happen anywhere else.
I hate dealing with opioid pain medications. They are one of the worst parts of being a primary care doctor. Many patients come to my practice on chronic opioids, expecting me to continue these medications. Other patients have the expectation that any pain should be treated with a narcotic. Some people sell the stuff, others continue in current pain despite being on daily medication. There are contracts to be signed, urine to be tested, and pain management doctors to consult, most of whom don’t prescribe narcotics.
Nobody is happy. It is absolutely miserable.
One of the questions people ask is whether or not I see patients in the hospital. I assume they aren’t are asking about my eyesight in the inpatient clinic. I can see quite well in the hospital, thank you. But what people are really asking is if my care extends to the hospital, or most importantly, will I still be their doctor if they are hospitalized? The answer is yes, but not in the way people are asking.
Go to a typical primary care practice (like the one I was in for 18 years) and try to find out the cost of anything and you will only get shrugs and obfuscation. It’s not only that they don’t know what things cost, but the design of the system on which care is built goes out of its way to hide those costs. Why? Because it would be infuriating to people to see that their insurance pays 100% more than someone else’s plan and it would be equally mortifying to some physicians to realize just how bad their pay is compared to the docs down the hall.