Rounding the corner from the offices to the shared workstations, I overheard my medical assistant talking to a patient on the phone.
“Yes, we have received your message about your Klonopin, and we will have the on call doctor sign it when she gets a chance.
Yes, I know this is the 3rd time you’ve called this morning. But we only have 2 providers in today, and she will get to it when she gets to it.
…Oh, ok. Yup, yup. I’ll let you know when she gets to it.
Yes, I understand. I’ll let you know when she gets to it.
Ok. Yes, it will be done before the holiday weekend.
Yup. Ok. I’ll let you know when she gets to it.”
I felt sorry for the on call doctor.
Oh shit… wait, that’s me
I locked eyes with my poor medical assistant as she tried to hang up for the 5th time.
“Ok. I’ll let you know when she gets to it. Bye now. Bye.”
Shoulders shuddering in relief to finally be off the phone, she stated,
“Dr. M, she’s called 4 times since yesterday afternoon.”
Pursing my lips to prevent some choice words from coming out, I flatly replied,
“We have a 3 business day policy on refills.”
Her eyes pleaded with me to just sign the damn prescription she held out as a white flag in front of me.
Squeaky wheel gets the grease
Well not this effing time.
Her anxiety is not any more important or real than the 3 other people I saw with anxiety this morning. I’m not going to make patients in the office wait while I get to her refill that I technically have 3 business days to get to.
God forbid she makes it more than 4 hours before her next hit of Klonopin so she can escape her life.
Does she know she’s making me want to escape mine?
Stop, M
I had been on edge the entire morning.
I even caught myself looking around my office in between back to back Follow up mood appointments, trying to figure out how I could slowly pack up all my things without anyone noticing. Because if I was going to have a dramatic exit, nothing would suck the victory out of it more than having to sneak in 5 minutes later to collect my stuff.
Maybe one book a day, I settled on.
On second thought, I didn’t need the books. Or my medical degree and diplomas on the wall, for that matter.
I’M OUT.
No you’re not
Don’t throw a tantrum M. If you had just signed the prescription, you could be done with this by now. Stop being so emotional.
I signed my illegible signature and gave it back to her. Did she hear the internal conversation I just had with my petulant self in those last 10 seconds?
“Please remind her of our 3 business day policy. I mean, not like that matters because she’ll just do this again next time. Sooo… I guess just do what you want.”
“Thank you, Dr. M. Thank you!!”
Yeah, yeah. I’m the greatest.
What happened to establishing boundaries?
I’m just so sick of saying no.
No, you can’t have antibiotics for a viral cold.
No, I’m not sending in that referral – we haven’t even started the first steps yet.
No, you don’t need testosterone/estrogen/progesterone/ground up pig thyroid hormone your naturopath told you about.
No, we don’t need to do ALL of the labs. You don’t have Lyme disease. You cannot contract that in this corner of the country. Could I interest you in doing your research at the CDC website rather than the article you found on Pinterest?
No, you don’t need to numb yourself into oblivion. Maybe… actually try dealing with your shit. How about counseling? Maybe? No? Too hard? OK.. here’s your Klonopin.
I’m tired of practicing evidence based medicine
Whoever made up all those guidelines has clearly never practiced real clinical medicine on the front lines.
They’ve never had to deal with patient satisfaction scores or Google/Yelp reviews. They’ve never had to explain why we don’t just order everything, over and over and over again in 10-15 minute increments. They’ve never had to deal with people who are willing to burn through thousands upon thousands of health care dollars to figure out why they don’t feel 100%, because they’re only on the hook for their $10 co-pays. They’ve never had to come face to face with the fallout when we don’t find anything wrong after I finally give in to the demands:
You didn’t order the right tests! You put me in all this medical debt! You’re not listening to me! YOU DON’T CARE!
They don’t know how much saying both Yes and No wears you down. How it makes you fantasize quitting your job to go work at a fast food drive thru window because it’s so much easier than doing drive thru medicine. At least the customer walks away happy at the end of the interaction with a handful of fries.
Reset
Clearly the cynicism was not helping. Perhaps I’d find my solution in empathy again.
If she was really having a panic attack, of course she would frantically be trying to get her refill. Would I be any different?
I don’t know, M. How do you feel right now? Like the walls are closing in on you? Like you want to get out? Escape?
Where’s my easy out?
***
Photo of Egg Lake, San Juan Island, WA
Sometimes there is no easy way out, M. But you can do this. Just keep it all in perspective.
My wife always reminds me of what we call “The Doctrine of Charity,” though she likes to call it the “Casserole Rule” while we are driving – because bad drivers make me super angry.
She says, “Baby, they are probably driving really slowly and erratically because they have something they are carrying in that car that they don’t want to fall over or get hurt… like a casserole.”
Just last night I had to remind my resident that this needy substance abusing patient was sick. It just wasn’t their heart, or their diabetes, or their blood pressure. It was their brain as they suffered from addiction and the consequences that has.
You are a great doctor and do a lot of good. Unfortunately, the complaining is often much louder than the praise. Looking forward to seeing where it all goes for you.
TPP
You and your wife are saints.
I remember the time when I’d be able to slip into “look at it from the other person’s perspective” much more easily. But, doing that for 16-18 patients a day for 3 years has sucked that ability dry.
Hopefully the changes I’m making now will help me gain that back – definitely not the easy way out, but a way out nonetheless!
As a side note, I’m sure Portland drivers could challenge your wife’s charity because they are quite possibly the most unpredictable, erratic and awful drivers I’ve ever encountered. And I’ve been in traffic in the Philippines where they have no driving laws it seems.
M
I really enjoyed the internal dialogue. So authentic. Anyone who tells you that they are not thinking the same thing is not being truthful.
Thanks for the reassurance, VBMD. And here I was, thinking I was the only person who had these awful thoughts daily.
Goodluck with finding a new job! Hopefully a change will bring back some of the joy to clinical medicine.
As a hospitalist a lot of the BS gets done by the residents which keeps me from going crazy. Most days I see 8 or fewer kids and have the great fun of teaching the residents. Plus my pts are kids. Kids make me happy.
It is a neat mix up of patient care, teaching, administrative. I highly recommend hospital medicine if being a generalist is your jam but the outpt grind is too nutty.
TPP, nice reference to the principal of charity I like your wife’s adaptation.
I do a lot of QI and the principal of charity is one that I often focus on. I view it as both assuming the best of intentions and interpreting another’s actions in the most generous way even when errors occur. None of us went to work with the intent of causing harm and most of our actions are perfectly reasonable given the situations we find ourselves in. This is very hard to do as it goes against one of my favorite cognitive biases, the Fundamental Attribution Error (if I do something wrong it’s not my fault, but if you do something wrong it’s your fault).
I’m going through Brene Brown’s Rising Strong book for the 2nd time, and there’s a part where she talks about struggling with the concept that everyone’s doing the best they can. I guess I’m more of a pessimist than I thought/wished I was, because I’m struggling with that as well. Again – you, TPP and TPP’s wife are all saints 🙂
At any rate, I am looking at a hospitalist position so fingers crossed! Except I don’t believe in that, so I suppose I will take your well wishes instead 🙂
I just love reading your stuff. Seriously. Your rant-y internal dialogue is my favorite, so please don’t do anything that makes your job more tolerable. Your writing will suffer and then where am I to get the day’s entertainment? Think about ME, for Pete’s sake!
LOL.. well, you know I’m just here for your entertainment 🙂
I’m sure I’ll find something else to get fired up about. My generation is supposed to be offended by most things anyhow. I’ll find something, promise.
Misery does love company.