Is It Time To Join the Drop Out Club?

“You’re all F****** idiots!!!  I’m going to report Dr. M to the state board and get her medical license revoked!  You’re just after our money, trying to make us come back to get re-examined again!  You’ve just lost four patients, you F****** M************!!!

…

To repeat this message, press 7.”

I sighed, handing the phone back to my medical assistant.

“Well… I guess just try to document that in a phone encounter and censor it a bit.  We still need it for the patient’s chart.  Also, don’t delete the message.”

Happy Friday!

Last week was just one of those weeks.  Again.  Week after week after week. 

I kept telling myself it would get better, that situations like this would resolve and I’d be back to some semblance of normalcy.  But, inevitably I’d have another situation pop up, like the next voicemail after the 5 minute cussing spree I just listened to, during which another patient was upset that I wouldn’t increase the dose of his narcotic AND give him a sleeping pill.

“I thought you were different and that you cared, but it’s pretty clear that you don’t!  You just lost this patient!”

I’m pretty sure if we could still hang up by slamming our cell phones down, both voicemails would have concluded in such a manner.

It’s time to face the music.  This is my new normal.

Again, another weekend spent talking it out with J, and by talking it out I mean complaining endlessly until he finally said,

“I guess I don’t get why you’re so upset.  It’s not like you really want to take care of patients like that.  They’re doing both themselves and you a favor.  You’re clearly not a good fit.”

My brow furrowed and eyes narrowed in response, but words escaped me.  He was right.

He also didn’t want to hear me griping anymore.

So I turned inward

Is it me?  Do I continuously put up with this type of behaviour and constantly give in so I can please people?  Then, when I finally stop because of some arbitrary line I’ve set for myself, have I just invited these explosions of anger that my medical assistant then needs to translate into something electronic health record appropriate?

I tried to think if there was a pattern of this and realized this felt very familiar.

The hostile work environment, the intimidation, the “I can’t believe someone let you be a doctor” comments.  My contained rage under a facade of still water, just absorbing the cannonballs of insults without a sound while they tore me apart.

Yeah, that was residency

Flashbacks to my pediatric clinic came flying back to me.

I was in my third year of my Med/Peds residency just a year and a half away from graduating, but that wasn’t on my mind.  My primary concern that day was to get through my Internal Medicine hospital rotation as a senior.  My pediatric outpatient clinic was interfering with my ability to supervise my interns, monitor my patient’s failing kidneys and check in to see if another patient with congestive heart failure was able to breath on his own without needing a BiPAP machine shooting air into his lungs.

I remember getting to the hospital at 6:30 am to get a headstart on work so I could hopefully actually eat lunch before heading out to my pediatric clinic, but alas, that was a pipe dream.  Running from the hospital to the clinic with no time to spare, I stuffed my face with a MRSA laden granola bar hidden in my white coat pockets for times like these.

Upon arrival to the clinic, my heart sank.  The two attendings present that day were my least favourite to work with – one who was the nicest and most knowledgeable pediatrician I’ve ever met, but had no concept of efficiency, and the other a condescending jerk who loved to listen to himself talk, all while having a captive audience.  Residents and med students just had to sit there and nod in agreement when prompted, lest they risk a bad review.

In 4 hours, I needed to return back to the hospital to finish the rest of my work day.  7 hours left.  I just needed to survive 7 more hours, then I could go home and not make another decision.

Finally my last patient of clinic came in.  It was a 2 year old who hadn’t pooped in a week and parents were beside themselves.

“He won’t eat veggies, he won’t eat prunes, he won’t eat any oatmeal!  He won’t drink anything we try to put that fiber powder in!  All he’ll do is drink milk!”

After parents and I discussed that anything over 20-24 ounces of milk can be quite constipating as well as cause low blood counts and troubleshooting ways to help him poop, it came time for me to discuss the case with the attending.  I went to the back room and saw him, sitting all by his lonesome because nobody wanted to interact with him: the jerk.

I weighed the pros and cons of approaching him in my mind:

• Pro – You’ll probably get done sooner so you can return to the hospital sooner.
• Con – You’ll probably feel worse about yourself afterward.

I picked efficiency and sat next to him to talk things over.  Midway through my story, he interrupted,

“But, how do you even know he’s constipated?”

“I’m sorry.. I don’t understand?  He hasn’t had a bowel movement in a week.”

“So there’s that, but true constipation starts off with little pellets, like rabbit turds.  Haven’t you ever seen rabbit poop before?”

“No, I can’t say that I have.”

“Well how are you supposed to talk about constipation if you don’t know what the normal consistency of stool is?!  Do you even know what we’re supposed to tell people we’re aiming for?!”

His voice rose higher as the awkward silence spread across the work room.

“PEANUT BUTTER.  People are supposed to have peanut butter consistency stools!  Are you really in your third year of residency and don’t know how to ask these questions??  This is not what I expected from you.  That’s why we keep Med-Peds another year, I guess.”

So many thoughts ran through my head in response.

• “Must be nice to just be an outpatient pediatrician and not have to worry about actual medical problems.  Excuse me while I go back to my adult patients in the hospital who’s organs are literally failing as we speak.  I’ll be sure to ask what variety of poop they’re suffering from.”
• “So what exactly do you get out of being an asshole?  Do you even know what that is??  On the jerk scale of 1 to 10, it’s a 100.”
• “Who chose to marry and procreate with you?  Does she know your greatest pleasure in life is to tear into people who can’t fight back?”

Of course, none of that made it out into the open.

Instead, I nodded like a soul-less bobblehead.  Yes, thank you for the feedback.  May I please have another “constructive” criticism?  Please enlighten me on how to achieve your level of genius.

I just took it – hit after hit after hit for 10 minutes.  I didn’t want to get a bad clinic review.  I didn’t want to be labeled “doesn’t respond to feedback well”.  I didn’t want him to know he was getting a rise out of me – after dealing with several during my journey in medicine, I’ve found that to be the quickest way to deflate an asshole.

When it was all over, I walked out of the building.

To my left was the parking garage.

To my right was the rest of my 14 hour day, back to my adult patients with the real medical problems that couldn’t be solved, only stabilized until the next time they were back in the hospital yet again.  A lifetime of futility sprawled out before me.

What would I choose?

I almost walked out of medicine that day.

My rage almost propelled me left to the parking garage, where my car was waiting to take to me to the safety of home.  It almost made me turn my back on 7 years invested into this career.  It almost convinced me I could flee the country and default on my student loans because they wouldn’t be able to find me hidden in the jungle somewhere.

But no, I pushed forward.  And no one had a clue that anything was wrong.

It was my little secret for the longest time.

I didn’t say anything because if none of the complaints about this guy had stuck and gotten him kicked out of his teaching role, why would mine?  I didn’t tell anyone until after I was done with residency because that’s not even the worst thing an attending has ever said to me.  But this particular moment has stuck with me, even 4 years later.

This was the closest I had ever come to walking out on everything I had worked toward.

And now, I have enough self-awareness to see I’m approaching this precipice yet again.

Hello, old friends

The rage, the fury, the helplessness – these all still feel very much the same.  Though I am now in the attending role and I have the power to protect myself against such a siege, I don’t.

I keep taking it.

I’ve been conditioned to accept this type of behaviour as just part of the job.

Remnants of my training have been embroiled even down to basic things like using the restroom.  I still feel guilty for taking bathroom breaks to relieve my bladder during my clinic day.  In residency, interns and residents are asking for permission from their superiors.

Let me say that again: Grown adults with medical degrees are still asking for permission to go to the bathroom.

Some days I wouldn’t eat for 8-10 hours because things got so busy in the hospital – now I feel guilty for having hour and a half lunches.  Granted, I still work through an hour of that, but what right do I have to complain when I have it so good now?

The damage has been done

Those cannonballs of old insults and old hurts are still there, underneath the surface of it all.  They’ve made an underwater mountain, man made, just ready to explode.  As my reservoir containing them all is diminishing day by day, week after week, they’re starting to peek through the surface.

This is the long game of burnout.

11 years in the making since I started medical school.

How do I fix this?

There has to be some purpose to my endless complaining, especially on this platform.

Am I hoping someone will commiserate with me and tell me I’m right when these awful encounters go down?

Am I hoping someone else will benefit from my story, to at least realize that they’re not alone?

I know I’ve found benefit in reading and listening to other people’s stories of burnout myself.

In doing so, I’ve gotten to the point where I know what I need to do.

I’m going to start by limiting my exposure to the trauma – I’m cutting back again.

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For your listening pleasure, please listen to The Heart Failure Podcast which has quick 20-30 minute stories on different physician’s burnout stories.

Also, if you’re interested in learning more about the Drop Out Club (it’s a real thing!), click HERE.