I love medicine - the puzzle of it all, the thrill of getting to the right diagnosis, the fact that my skill set can actually help people. But what I'm doing now is no longer medicine. Perhaps it's time to break up with my primary care medicine experiment.
It all seemed simple back in medical school. X + Y = Z.  All the possible answers were available in multiple choice: A, B, C, D or E. But I wasn't warned of these times - the space between the question set up and the answer.
The last week has been a little surreal. My KevinMD post: Should we encourage people to go into medicine went viral in a way I hadn't anticipated with more than 2000 shares! It's been a roller coaster of conflicting emotions: Happiness that my writing resonated with so many people Horror that someone called me a "thought leader" for the millennial generation Guilt for making people in med school/residency aware of their regret for going into medicine
"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." It's time to face the music. This is my new normal.
For the last week and a half, I've been lost.  After experiencing compassion fatigue and realizing I wasn't even close to pulling myself out of burnout, I've been racking my brain trying to rethink my situation yet again.
When I went into primary care, I had dreams of being able to prevent disease. I had dreams of doing my part to help this broken, expensive healthcare system - chronic diseases directly attributable to obesity make up 80% of healthcare spending in the US. If I could just catch deadly habits before they caused harm and set people on a better course, I could do so much good, I told myself. What I didn't take into account was for this to work, the people I took care of would need to also buy into this dream.
I've been ready for it to be Friday since Monday afternoon. It's been a trying week, and as I came into the office this morning, I was readying myself to make it til 5 o'clock through sheer willpower. I charged up my computer and opened the electronic medical record. Welcoming me were 10 online messages from patients sitting in my inbox from overnight, some of them sent at 2 in the morning. I sighed, knowing my 2 cups of coffee I chugged this morning was not even going to be close enough.
Today, you came to me with a chief complaint: right breast lump. You told me there were no overlying skin changes or strange nipple discharge. What you didn't relay was the countless hours you've spent researching on WebMD, where all roads lead to cancer. Cancer.
When I first started working in my primary care clinic after residency, I was adamant I was NOT going to prescribe long term narcotics.  Unless you've been living under a rock, I think most people are aware of the opioid crisis that is storming across America. I'm talking about Oxycontin, Morphine, Norco, Vicodin, Percocet, etc. During training, I already had my fill of drug-seeking patients in my residency clinic, ER and the hospital - there was no way I wanted to continue that trend in my new big girl job. If anyone wants to talk about things that immediately suck the empathy right out of young doctors, I've got two words for you: Opioid abuse.
This horrendous cold and flu season has been an exercise in running on auto-pilot. Running from room to room every 10-15 minutes has been a blur of declaring, "Virus - no antibiotics needed. Virus - no antibiotics needed. Ear infection - here's your amoxicillin. Flu - Tamiflu sucks and you're going to feel like dying for the next 7 days, sorry. Maybe take me up on the flu shot next year." This was my life for two weeks after making the mistake of not taking any time off Christmas/New Year's at the end of 2017. (Note to self: Worst . Idea . Ever. Take a vacation already!!!) Just as I was ready to go insane from the monotony, the palest toddler with the most crystal blue eyes brought everything to a screeching halt.