A post I forwarded to the Mothers in Medicine website:

Mothers in Medicine:

I need your help.

I am a new family practice physician.  Full-time, three years into my job, with a seven-month-old in tow.  New baby, new[er] job - life is exciting.

Or so it should be, I thought.  So when did I start disliking my job?!

Actually, I’ve always loved medicine and have been obsessed with “becoming a doctor” ever since I was in middle school.  I worked hard.  I volunteered (candy striper, baby!).  My dream became a reality.

I went into medicine because I wanted to do good.  It was a calling - not merely a job, not a money-making scheme (err.... entering primary care proves that one).  

Medical school presented its challenges - but there was always residency.  Residency presented its challenges - but there was always life after residency.  Now here I sit in the real world - and, quite frankly, I’m frustrated/disappointed/overwhelmed/[insert adjective here.]

I work for a large organization and I feel like I am on a hamster wheel, one patient after the next.  I don’t get a chance to go to the bathroom, yet alone eat lunch.  I can’t call patients myself, simply because I don’t have time.  Get ‘em in, get ‘em out - there is no triage, no discussion, it’s apparently all about the numbers.  

Really?  This is what I worked so hard for??  I am jaded (already).  I come home - exhausted - and spend an hour or two with my son.  Then back on the computer to continue working.  I fear I am not “present” enough for my son, because work is always on my mind -  there is always so much to do.

My question is - what other opportunities are out there?  I am particularly interested in public health, but do not hold an MPH.  On that note, while I would love to obtain an MPH, I already have a 2nd mortgage on my hands ( = my medical school loans) and fear adding to that debt. I had always been interested in/interviewed for community health centers, but didn’t bite - is that more satisfying?  Currently I am unable to work part-time as my husband is at home with my child, leaving me solely responsible for our income.   

As an aside, isn’t there something we, as physicians, can do to improve this as a whole?  Am I alone in how I feel?

I'm Mrs. Tangential. How very nice to meet you.

How can one be both bored and overwhelmed at the same time?   Bored by the mundaneness of it all,  yet with constant anxiety over decisions made quickly and frustrated by questions that I gave a lack-luster response.   It's only September, only the start of "cold and flu season" and I am already dreading the sick visits.  In all honesty, there is little I can blame on the public - there is often a history of having antibiotics prescribed to them quickly and repeatedly.  Plus, everyone and their mother thinks green nasal discharge = antibiotics.  Oh wait, and did I forget to mention that we have to catch the URI before it "moves into [my] chest"?!

4 years of college.  4 years of medical school.  3 years of residency.  Countless hours spent studying and in class.  Missed commitments.  Multiple sacrifices.  So if I become a bit grouchy because all I am seeing is upper respiratory infections, I'm allowed, right?  I feel as if my brain is literally atrophying with each mind-numbing encounter.

That sounds terrible - and yet I don't mean to sound terrible.  I am not a terrible person.  I went into medicine to Help People.  Yet medicine is terrifying.  There is little respect.   I am argued with on a regular basis (really?  Amoxicillin doesn't work for you?  Have you considered the fact that it's likely a VIRAL infection?!)
 
Argh.  It's not what I thought it would be.

Damn you, Dr. Quinn.  You offered me an elusive dream.

Arrivederci

Busy day today - 26 patients (and I did have a few 1/2 hour slots thrown in there for well child checks, etc). Am really starting to feel that I've-been-run-over-by-a-train feeling by mid-afternoon, usually around the witching area of 3pm. Wish I could still blame it on jet lag.

Had a patient today who was one of my "firsts"- she was a part of a group of patients who came to me after 1) having multiple physicians 2) having multiple medical issues that were not - for whatever reason - being what I viewed as not under appropriate treatment (why? patient compliance vs. personality conflict vs. medical care... it's a grab bag). A patient who walked into the office as a new office visit almost a year ago, and 1/2 hour later, I nearly crawled out of the room, feeling incompetent and completely overwhelmed.

With that being said, she told me she will be soon leaving the practice due to insurance change (err, well a temporary lack thereof) and will not be able to afford the out-of-pocket payment for our office visits.

And you know, when I heard this from you, my initial reaction was disappointment. I was sorry to see her go - not only do I enjoy her, but I looked at her chart and thought wow! Over the course of a year, look where we've come - lipids controlled, blood pressure controlled, new diabetic (controlled!), breathing improved, etc. Granted, I'm happy she is medically in a better place where she was a year ago (or so it appears), but still.... or again, I am sad to see her go.

Bad Patient Day

Out sick - yet again - earlier this week (as an aside, my immune system is shot in this new job/setting/frequent acutes). Back today, only to be sort of, well, bummed by my patients.

Message from a wife of a 25 year old who said that he was abusing the anxiolytics I prescribed him (as a bridge along with his SSRI initiation).

Sixty-some year old female patient who gave one of our nursing staff "attitude" when asking about an Rx to be mailed - and to close her conversation, my patient stated "bang bang" and hung up the phone.

Narcotics. Everywhere today. I am becoming more and more aware of this narcotic issue and I HATE it. Everything is dumped on family medicine - want more meds? Not me, go to your family doc.

Now I am getting a medication agreement on everyone. Hello, I'm your new doctor, please sign this agreement. Me - who delayed getting her DEA until the last possible moment because I despised that so-called privilege... am now becoming more and more paranoid about narcotics. Is it me, as the new doc, just a ton of patients doctor-shopping, oh she's so nice! Patients I trusted.

Who knows. Tonight I'm both disappointed and annoyed. Too much of my energy is spent on trying to determine who is legitimately in pain and who is drug-seeking. Did I really go into medicine for this?!

TGIF

End of day. I am tired - it's Friday, it's been a long week, and well, I'm beat.

End of day. New patient. Best foot forward! Garner up energy! Pull together The Charm!

I am tired.

Mom with daughter. Cute mom, very engaging, very caring, worried about her adolescent daughter - grades slipping, increased irritability.

There were times I wanted to pat the patient's mother on the back and say, don't worry - you don't know how much you are doing by just being concerned. Your daughter is a teenager. Just be there. Support here. Like you already are doing.

Of course in between my engaging laughter and empathetic nods shared with my new patient, I had flashes - or rather, glimpses - of almost sheer terror - who am I to tell this mother what to do? Guide her on her daughter's adolescent angst? Tell her everything was going to be okay?

Yet I try - and that's all I can do, right, is try? You learn medicine is so cut-and-dry, evidence-based, methodical.... There are guidelines for everything. Yet it's the art of medicine that I am trying to cultivate and trying to allow myself to feel.

Everything is going to be okay.

Content

Funny how things change.

I like my job. Guess what they said about life after residency is actually true....

It's complicated. And it's hard. And I am running to the computer half the time to look things up (umm, excuse me, I need to delve more into your chart - will be back and we can discuss a gameplan). But I like it. I actually like it.

Maybe part of it is the whole new campaign - people are coming to me because they want to (or just need a new doc)... but even with that, I get asked, can I bring this family member to you? etc.

It's a huge compliment, and I am beyond flattered.

Anxiety. I deal a lot with anxiety - more so than depression around here. And speaking of anxiety, I have my own - like I can't live in the moment and appreciate it, like I almost am waiting for the other shoe to drop. Ironic. And annoying.

Hopeful

So it's barely any time at all into my new job, but I am hopeful... maybe it is coming from a training that is more urban/suburban, but I really do like my new surroundings! I actually felt beat-up in residency via patients, for whatever reason... and now that I am in a new environment, I feel like I earned all this, like my opinion actually "matters" to the patient. Which is what one would hope for, given all the training.... like it was worth it, eh?