“Hey M, you’ll get a kick out of this,” the nurse practitioner I work with said to me last week. “I saw one of your patients when you were on vacation last week and she said the funniest thing. She was upset that she was seeing me for the appointment and said,
‘I can’t believe I can’t depend on my own doctor to help me when I need her! I think I might have to find another doc.'”
“Really? She said that? What were you seeing her for?”
The guilt for going on vacation started to set in. This is exactly why I wanted to work while I was on vacation!
“That’s the kicker.. it was just for a sinus infection. She wanted you to cancel your vacation so you could treat her sinus infection! Aren’t people a trip? Gosh, I can’t remember her name.. let me look it up.”
Guilt made way for irritation. I could feel the heat in my cheeks rising.
“You know, I actually don’t need to know who it was.. it might cloud my next interaction with her, that is, if she hasn’t found another doctor already.”
The patient always comes first
Ask anyone who works in healthcare what their top priority is, and they’ll tell you the patient always comes first.
This is what compels us to come in to work with raging fevers, coughing up a storm or having vomiting and diarrhea contracted from our patients. No big deal, we just pump ourselves full of Dayquil, Zofran and Ibuprofen, throw on a mask and carry on – Patients come first, even if we’re actually sicker than they are.
This is why I’ve spent several hours of my weekends talking to parents about concerns they have regarding their child’s recent congenital heart disease diagnosis and upcoming procedures.
This is why I stay in the office until 6:30 some nights calling patients regarding lab results, because if it were me, I’d appreciate knowing that night rather than waiting until the next day.
This is why I had a specialist call me while I was on vacation to discuss a complex adult patient’s case so we could figure out what the next best step was for him.
I try my damned hardest to be there when my patients need me.
Which is why it was such a slap in the face to hear how upset this lady was because I had the audacity to go on vacation.
At what point is it OK for healthcare providers to put themselves first??
When patients come to us, they’re not thinking about whether or not we’ve had a chance to eat lunch that day or if we’ve spent the last 6 hours putting fires out left and right.
They really don’t care if we’ve just started our shift or if we’re 30 hours into it, mentally exhausted from decision fatigue.
They’re not wondering if we’re in the right emotional mindset to care for them in that moment or if we’re struggling because we just told someone they have cancer 5 minutes ago.
When people come to their doctor’s office, ER or urgent care during holidays, they don’t stop to think that this is a daughter/son who couldn’t fly back home to spend time with their family, or that this is a mother/father who is missing yet another Christmas with his/her children.
Doctors, PA’s, NP’s, nurses and medical assistants only exist to help people in their time of need.
This is what we signed up for. This is what I signed up for, and I did this knowingly with my eyes wide open.
I just didn’t anticipate the toll this would take on me now in my 7th year since graduating from medical school.
I didn’t anticipate I would actually want a life that wasn’t consumed by medicine in its entirety.
I didn’t realize my humanity would be stripped away, reducing me to an antibiotic PEZ dispenser at patients’ beck and call.
Another doctor becomes the patient…
The same day I had the discussion with the nurse practitioner, I received a message from another physician in my office.
“By now, you’ve probably already noticed I have significantly cut back on my hours and have put several holds in my schedule. Thank you for taking care of my patients during this time. I have recently been diagnosed with breast cancer and will be starting chemotherapy soon, followed by radiation.
I’m not sure how significant my fatigue will be, so I’ve limited the number of patients I’ll be seeing over the next month and will add more spots if I’m able to. I will be neutropenic on days 5-7 after my chemo, so please don’t schedule any sick visits those days since my immune system will be down…
… I just wanted to let you all know now since it will be hard to hide when my hair starts falling out from the chemo!”
I shook my head in awe and disbelief.
What dedication! Isn’t she such an amazing physician? To still think of her patients first while she’s anticipating going through chemotherapy and radiation – how inspiring!
But, that is ridiculous!! Why should we expect her to continue working through this time? Why would she expose herself to illness that could put her recovery from chemotherapy at risk? Why would she not want to spend this time surrounding herself with family instead of going to work?
Apparently the patient always comes first… unless the patient is a doctor.
Thinking of it now, this says more about me than it does her.
Who am I to try to understand her reasons for wanting to continue to work despite her breast cancer diagnosis? I’m sure they’re very valid, and I have no right to judge her.
But if this were to happen to me, I would have no qualms in not returning to work.
I would decide my remaining time is precious and not meant to be spent on another day of clinic until I recover.
Does this make me selfish?
Does this make me a bad doctor?
Did taking a vacation mean I don’t care?
When do the healers get to put themselves first?
***
Photo: Geometric, minimalist bird. San Diego Zoo.
The answer is now.
If you don’t put yourself first, if you wait for them to put you first, they never will.
If you have to leave primary care, do it.
If you need to kill your debt first, do it and get out.
I’d tell my NP to stop sharing “funny” stories. Some people can laugh it off. I can’t do that easily. Better not to hear it at all.
Dr. John Crosby talks about three doctor friends who committed suicide. One of them missed a European vacation because a patient waylaid him in the parking lot on the way to the airport. No joke, I think it was for a sinus infection, and he didn’t complain. He missed his plane so he could go in and treat her.
It’s a tough and lonely road. Ping me any time.
As horrible as that story is about the doctor who committed suicide, I totally get it. When we feel like we are no longer able to attend to our own humanity and self care, then what’s the point?
I haven’t gotten to that precipice, but I know where the road to burnout leads. I definitely am working on the student loans first and am on track to being done in less than 2 years!
My husband and I have joked about starting up a tiny house commune in the middle of the woods and living off the land, but it’s helped me realize that I don’t really see medicine as having a big role in my future.
We shall see! Medicine may be relegated to my side gig, and perhaps something else will take up a bigger role in my life. Thanks so much for commenting – it’s made this road seem less lonely 🙂
Being so early in your career, I’m guessing that your internal voice that tells you what a great and caring doc you are is not yet authoritative. That voice tends to get drowned out by interactions like the one you opened your post with. Or by patient satisfaction scores that don’t seem to reflect your in-office experience. It’s amazing how an entire day of mostly positive interactions can be tainted by one very negative episode.
It takes years to develop a thicker skin and to internalize that you’re awesome. Not that I’m a master at this. People can still get under my skin and make me question what I’m actually accomplishing – but that is less often nowadays.
It’s definitely something I’m working on – trying not to have one bad interaction derail my entire week. The last 6 months have been hard, but I’m realizing it’s because I’ve been saying no to more things and not allowing people/patients to bully me into things that are not appropriate. Apparently you’ve been a yes person for so long, people don’t like it when you start pushing back. The interaction I wrote about in this post was really the last straw in that context for me.
I’m working at developing a thicker skin, but even if you chisel at a rock long enough it starts to wear down 🙂