Disillusionment

When I went into medicine, I had clear goals in mind. Helping people. A stable income to provide for a family. I grew up under the spotlight of my father, who is a neonatologist, and lived in awe of his work. I remember being in restaurants with my dad - people would come up to him reverently and sing his praises (to his obvious embarrassment). Talk about their son or daughter that he had taken care of, and fill him in on how they were doing now. Once, in a small town in college, I was filling out a check at a convenient store. The clerk recognized my last name as the same one as the doctor that saved their premature baby. "Your dad is amazing. It must have been wonderful growing up with a father like that - one who hung the moon."

So although my path was a little wayward, I found myself starting medical school at 23 years old - not too bad after taking three years post college doing B.A. level psychiatric jobs and taking pre-med requisites. I thought I might be a psychiatrist, but quickly changed my mind because I worried about the burnout I might experience taking on the burden of other's emotional and mental issues. Then I decided to be an ophthalmologist, but changed my mind at the last minute - fall of senior year. This is why. I was on a month away rotation in a different state, and worked closely with an ophthalmologist at the general clinic. She was elegant, razor-sharp, and efficient. I watched her manage the clinics with grace and ease - quickly entering and exiting each room, performing eye exams, dictating notes for the chart. She took me out to lunch. Here is what she said.

"Don't do it. Did you see how many patients I plowed through? It's like that every day - you have to see more and more. Some days I squeeze in 60 or 70. It didn't used to be this way. Did you see me get to talk to a single patient?"

I didn't.

"The techs do all the talking. I don't get to know them at all. I'm like a machine, getting briefed by the techs and looking at their eyes. It's all I get to do. Then I tell the techs what to write in the chart, and have to rush to the next room. Job satisfaction is nil."

My best friend in medical school ended up going into ophthalmology - I'm going to take my kids to visit her this weekend. She works in a small town, and seems to have good patient interactions, but her job is not without its challenges. Overall, she seems happy.

I am reminded of another experience my third year when I was considering orthopedic surgery. I had the grades, and the strength to manipulate the hardware. I was surrounded by encouraging attendings, but they and the residents were all male. I asked if anyone knew any female orthopedic surgeons I could talk to. One of the attendings gave me the name of a woman that rotated once a month from a practice in a smaller town. I called her. She was in her early 50's. Here is what she said:

"I made great sacrifices, for my family, in order to do what I did in my career. If I had to choose all over again, I would choose differently."

The one girl I knew who went into ortho, she was a year above me - bailed for radiology as soon as she started a family.

I encountered a lot of frustration on the pediatric wards when I rotated. The pediatric residents, especially those in the SICU, liked to stay up late talking about how hard they worked and how little money they would get in return, when all was said and done. Massive debts, burnout, and destined for salaries that barely scraped the bottom of the physician barrel. Many residents in the primary care fields appear to share this sentiment.

I was watching a film tonight that my friend Ramona Bates shared with me called "The Vanishing Oath." It messed up in the middle (I think it was my player Ramona), but what I saw was this. An ER doc who sacrificed for many years to study - missing important life events of family and friends along the way - and is now overworked and bogged down in bureaucracy. He feels he has no time to spend with his patients from all the charting and hospital hoops he encounters. A few years out of med school, having barely made a dent in all of his debt, he is ready to get out - or at least take a big sabbatical. I need to give it another shot so I can do a proper review, but the little I saw inspired this post.

I work in the field of pathology. I do have a little patient interaction, but most of my work does not involve patients. I love my job - wouldn't trade it for the world. I have become somewhat disillusioned by how much of a money game it is between hospitals and doctors. I spent a day in a special session of legislature last year, watching a battle, and that was an eye-opener. I am also disillusioned by the lack of teamwork involved. Dr. Gawande said it better than I can in a med school graduation speech at Yale called The Velluvial Matrix that I read earlier this week. It's not that we don't try to work as a team, the system is just set up against us. And it really is our job to figure out how to fix that.

Sometimes when I get really angry and jaded I try to remember that little girl that sat in awe of her dad, through all those chance encounters with the parents of the many babies he helped that would not otherwise have lived. Now I'm doing my own part - although somewhat more behind the scenes. I love calling doctors and telling them the results of their procedures so they can move on to treat the patient. This week, I got to help an enigma of a young girl being treated for a brain tumor with fever and neutropenia. The pulmonologist was so happy when I called to tell her there was pneumocystis all over the GMS (fungal) stain. Something to treat. A cardiothoracic surgeon called me three times, hanging on my assessment of a CT-guided lung biopsy. When I finally called him late in the day to tell him that yes, me and my partner agreed we could name that cancer on three cells so he did not need to proceed to mediastinoscopy - he was overjoyed. One less procedure, and one more step toward treatment. Every day I get to supply a big piece of the puzzle that can help the clinicians move on. That is extremely satisfying.

So my question (after blogging way too much) is - what were your goals when you started medicine? And how have you been disillusioned along the way? What keeps you going?