Being a hospitalist sucks, and I'm quitting

[VA Hopeful Dr]

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Well, let me rephrase…Epic is by no means perfect - it certainly does have flaws. I think a lot of the menus are too crowded, I think there are a lot of unnecessary features packed into it, and some of the navigation is a bit kludgy and confusing if you haven’t used it before.

I’ve heard some other smaller scale EMRs out there (Athena, etc) have a lot of what makes Epic good in a more streamlined package. I’ve never tried those, though. But I can say Epic is worlds better than a lot of cheap crappy EMRs (Centricity, Intergy, Allscripts, Meditrash, etc) out there.

At this point, most docs that I see complaining about Epic fall into a few categories:

- Dinosaurs who all wish we were still on paper (that was awful, I don’t wanna go back to that)
- Docs for whom Epic is the lightening rod for everything else they hate about modern medicine in America. It’s not really the EMR, guys. (Also, Epic is by no means the only EMR that allows pts to message you. Centricity does also, except that the way Centricity handles the messages is confusing and kludgy and makes the whole thing much harder to deal with.)
- Docs who have never tried anything else and think Epic sucks. It gets way, way worse than Epic, believe me.

I worked with Athena for a bit, it's easier but has less extras than Epic.

 

[stohn_jamos]

Quite a cathartic read for internal med docs/specialists

 

[glorifiedresident]

Let me start by saying I respect all the hospitalists out there who have been grinding it out for years

The post that led me to start this thread is this one:



Let me just start by saying - I think that patient's have lost their minds (and manners) post pandemic. Every working day, I am astounded by the absolute arrogance, entitlement, and sheer stupidity of patients and their families. It seems that the collective neurosis of the general population has boiled down to self-soothing via checking BP and blood glucose. Patients/families either delude themselves regarding end stage conditions because "his blood pressure is good!", or abuse me because their otherwise well mother who was kept NPO for a procedure had BG of 90, and "you can't starve a [type 2, obese, with extensive fat reserves] diabetic!"

The 21st Century CURES Act only catalyzed the collective deterioration into mass psychosis. We don't fully trust interns - graduated doctors, may I add - to reliably interpret labs and diagnostic studies. Now, any patient/family, regardless of education level, can accost you about a hemoglobin "falling", or an eGFR "that used to be >90, but now is 87???!!!!!" Almost every patient encounter feels like I am an academic attending teaching to pre-meds who think they are my boss. Patients/families expect the utmost of respect from their hospitalist, no matter how much they fail in holding up their end of 2-way courtesy. It's funny, because none of them would allow for being told how to do their own jobs (typically at some cushy public servant job, where there is no accountability). But if you dare insinuate that they shouldn't tell a physician how to do his/her job, their jaw drops in shock, and their eyes immediately scan your name tag (in order to run to the system and report you)

There can't be any job more infuriating than hospitalist other than being a bedside RN. My stint as a hospitalist has only made me more empathetic towards our bedside RNs. At least I can leave after a brief interaction with delusional families and their actively-dying-since-2010 loved ones. I can't imagine being helpless RN subject to the mercy/wrath of these freaks. This is not even to mention the absolute abuse endured by ancillary staff such as nurse techs and food service - the patients/families treat these people like simultaneous emotional punching bags.

The job would be better if there was any sense of collegiality. Instead, it seems like all the specialists, ER physicians, and hospitalists around me have descended into a "F*ck you, I got mine" mentality. There is no minimum standard of care that we are trying to achieve - everyone just seems to be scraping the bottom of the barrel: anchoring diagnoses on whatever the minimum wage EMT said, not seeing patients but documenting as if they did, documenting that workups/treatments are ordered but not ordering them, and failing to even look 2 days in the past at prior records in order to fit a story together. On this point, if I have to admit another 100 year old that is on beta-blockers and eliquis for symptomatic bradycardia and GI bleeding, I am going to lose my mind. It seems that nobody has any common sense that even a high-schooler could summon regarding our patients. Instead, we admit and have Cardiology, EP, and GI consultations, only to discharge on some weird mixture of follow up instructions involving checking in with a Cardiologist in 7-14 days on whether the patient born in the Great Recession should resume her eliquis for net negative -1% risk reduction in annual stroke prevention

Maybe the families could center us intellectual, ivory-tower physicians, with their grit and common sense. But no - MeeMaw is a fighter, and provides a $800 social security check that can be used for jet-ski leases. So full code, and every aggressive measure possible, please!

Soupbone (the quote I included above) would agree - this job has only deteriorated over the years. I suspect the deterioration must be more than tangentially related to an overall societal decline. From what I see, the only hospitalists who stick it out are those with a ton of resilience. But, in this context, resilience is being mistaken for emptiness.

Before I took this job, I was advised that "hospitalist is only for those with thick skin"

I thought I had thick skin, but this job showed me that "having thick skin" is more about becoming a numb and hollow shell of who you once were. I feel sorry for my fellow hospitalists who grind it out, day in and day out, being abused by various specialists, patients, families, insurance peer 2 peer scheduling agents at the call center, janitors, and pretty much everyone you can think of. We are simultaneously secretaries and "the doctor!", expected to solve any acute problem at a moment's notice while simultaneously attending to "families highly concerned about why there hasn't been a 14th CT Head ordered" and knowing our role by slinking away while the slick specialists give their recommendations (without having any clue what their partner recommended 1 day prior, because chart review is for suckers and hospitalists)

One of the greatest reliefs I ever felt was turning in my notice of leaving this field. I feel sorry for whoever has to stick it out in this grind. I look forward to the posters who are as equally delusional as our patients/families, who will chime in with snide remarks about how great their specific job is, and how they are respected, and how they get paid $1M / annum to see 2 patients per day. I'll call a Psychiatry consult in for you, only to get snubbed by the Mental Health ARNP who thinks they are smarter than me.

I'm leaving, and never looking back. Last warning to graduating residents: don't do it, unless you're catatonic.

-helpfulApu

I think it's important to acknowledge the profound lack of empathy in this post. Patients and families are often scared, medically uneducated, and navigating an unfamiliar and emotionally overwhelming system. Their misunderstandings and behaviors, while sometimes frustrating, are usually not driven by malice or stupidity, but by fear and confusion.
Physicians do carry a heavy burden, but part of that responsibility includes bridging the knowledge gap with compassion.

 

[dozitgetchahi]

I think it's important to acknowledge the profound lack of empathy in this post. Patients and families are often scared, medically uneducated, and navigating an unfamiliar and emotionally overwhelming system. Their misunderstandings and behaviors, while sometimes frustrating, are usually not driven by malice or stupidity, but by fear and confusion.
Physicians do carry a heavy burden, but part of that responsibility includes bridging the knowledge gap with compassion.

While I agree with you to an extent, I think the practice of medicine today in America has spiraled into a mess that none of us really signed up for.

OPs sentiments are very common among most docs I know today. Is this some sort of mass psychosis among physicians? A widespread dereliction of duty? Nah. Ours is the profession with the highest suicide rate and with astronomical odds of burning out.

It really doesn’t matter why today’s patients behave the way they do. Fear, anxiety, frustration, loathing, confusion, actual malice etc etc all start to feel surprisingly similar (and quite exhausting) when you’re constantly on the receiving end of it as a physician. Physicians are also humans - and like any other humans, we have limits. We are not bottomless pools of energy, empathy, compassion, patience, etc. These things can be depleted. And I can tell you that the behavior of so many patients after the pandemic depletes my stores of this stuff much more quickly than it did previously.

Chastising doctors for feeling this way is not the answer.

 

[glorifiedresident]

While I agree with you to an extent, I think the practice of medicine today in America has spiraled into a mess that none of us really signed up for.

OPs sentiments are very common among most docs I know today. Is this some sort of mass psychosis among physicians? A widespread dereliction of duty? Nah. Ours is the profession with the highest suicide rate and with astronomical odds of burning out.

It really doesn’t matter why today’s patients behave the way they do. Fear, anxiety, frustration, loathing, confusion, actual malice etc etc all start to feel surprisingly similar (and quite exhausting) when you’re constantly on the receiving end of it as a physician. Physicians are also humans - and like any other humans, we have limits. We are not bottomless pools of energy, empathy, compassion, patience, etc. These things can be depleted. And I can tell you that the behavior of so many patients after the pandemic depletes my stores of this stuff much more quickly than it did previously.

Chastising doctors for feeling this way is not the answer.

you make a good point, however the tone of the post indicates a deep seated anger/cynicism towards patients and their families. It's probably best he or she is no longer a hospitalist.

 

[Crayola227]

I think it's important to acknowledge the profound lack of empathy in this post. Patients and families are often scared, medically uneducated, and navigating an unfamiliar and emotionally overwhelming system. Their misunderstandings and behaviors, while sometimes frustrating, are usually not driven by malice or stupidity, but by fear and confusion.
Physicians do carry a heavy burden, but part of that responsibility includes bridging the knowledge gap with compassion.

Lack of empathy is also a diagnostic sign of burn out. It's dangerous for not only physicians but patients as well. But the current profit driven medicoindustrial complex squeezes it and grinds it (profit, and empathy) from the bones of all within in it.

Patients are definitely more difficult now than before.

 

[glorifiedresident]

I went back and re-read the original post that started this thread. Frankly, the level of cynicism expressed there is so extreme that it borders on offensive. Yes, of course we all encounter difficult patients, but to characterize the majority of patients and their families as arrogant, entitled doesn’t align with my experience. I’ve been a hospitalist for 20 years, and the majority of patients I see are appreciative, polite, and grateful.

Do patients or family members sometimes ask questions that reveal a lack of medical knowledge? Certainly. Just last week, a patient’s spouse asked me why the lymphocyte and monocyte counts were elevated on a CBC differential. It was a completely reasonable question, why would that irritate me? The question came from a place of concern, not confrontation. There’s no justification for physicians reacting with anger to benign questions rooted in curiosity or anxiety.

In my experience, the most chronically unhappy physicians tend to view their role in rigid, hierarchical terms—"I’m the doctor, you’re the patient"—or they approach interactions with specialists and colleagues through an adversarial lens

 

[VA Hopeful Dr]

I went back and re-read the original post that started this thread. Frankly, the level of cynicism expressed there is so extreme that it borders on offensive. Yes, of course we all encounter difficult patients, but to characterize the majority of patients and their families as arrogant, entitled doesn’t align with my experience. I’ve been a hospitalist for 20 years, and the majority of patients I see are appreciative, polite, and grateful.

Do patients or family members sometimes ask questions that reveal a lack of medical knowledge? Certainly. Just last week, a patient’s spouse asked me why the lymphocyte and monocyte counts were elevated on a CBC differential. It was a completely reasonable question, why would that irritate me? The question came from a place of concern, not confrontation. There’s no justification for physicians reacting with anger to benign questions rooted in curiosity or anxiety.

In my experience, the most chronically unhappy physicians tend to view their role in rigid, hierarchical terms—"I’m the doctor, you’re the patient"—or they approach interactions with specialists and colleagues through an adversarial lens

None of our experiences are universal. It's great that your patients are on the whole appreciative and polite.

It's not like that everywhere.

 

[Crayola227]

Do patients or family members sometimes ask questions that reveal a lack of medical knowledge? Certainly. Just last week, a patient’s spouse asked me why the lymphocyte and monocyte counts were elevated on a CBC differential. It was a completely reasonable question, why would that irritate me? The question came from a place of concern, not confrontation. There’s no justification for physicians reacting with anger to benign questions rooted in curiosity or anxiety.

Not sure this is the kind of thing annoying doctors. When patients ask questions in a suspicious and accusatory manner because of conspiracy theories, too much time on crystalhealingmedicine.com, while discussing how their cousin is a nurse and they know most doctors are goons for big pharma, and you must be too if you don't agree with me, it's not really the same at all.

 

[chessknt]

I went back and re-read the original post that started this thread. Frankly, the level of cynicism expressed there is so extreme that it borders on offensive. Yes, of course we all encounter difficult patients, but to characterize the majority of patients and their families as arrogant, entitled doesn’t align with my experience. I’ve been a hospitalist for 20 years, and the majority of patients I see are appreciative, polite, and grateful.

Do patients or family members sometimes ask questions that reveal a lack of medical knowledge? Certainly. Just last week, a patient’s spouse asked me why the lymphocyte and monocyte counts were elevated on a CBC differential. It was a completely reasonable question, why would that irritate me? The question came from a place of concern, not confrontation. There’s no justification for physicians reacting with anger to benign questions rooted in curiosity or anxiety.

In my experience, the most chronically unhappy physicians tend to view their role in rigid, hierarchical terms—"I’m the doctor, you’re the patient"—or they approach interactions with specialists and colleagues through an adversarial lens

You sound like you are ready to become the new resilience CEO. How many shifts you working a month boss and how many people are you seeing a day?

 

[Crayola227]

Us --->>

Lol at arguing with this guy how much being a hospitalist truly sucks, and doing so by saying how much it sucks in all fields, while also saying it isn't that bad

Also overall irony saying the solution is to stop being a doctor that cares

Yes, of course we all encounter difficult patients, but to characterize the majority of patients and their families as arrogant, entitled doesn’t align with my experience.

Also us --->>

"Screw you, it really is that bad!"

Also lol at someone who has been a hospitalist for 20 years how bad it isn't while at the same time with a username "glorified resident" 😅😅😅

Never change SDN, never change

 

[glorifiedresident]

You sound like you are ready to become the new resilience CEO. How many shifts you working a month boss and how many people are you seeing a day?

I average 10-12 patients per day, 18-19 shifts per month. I recognize I have a good hospitalist job, and I'm not questioning that many hospitalist positions are extremely difficult and unsustainable. However, I am questioning the cynical, almost hateful attitude toward patients expressed in the original post. There's a difference between acknowledging systemic problems in hospital medicine and developing genuine contempt for the people we serve. Calling patients and families "freaks" and "delusional" crosses a line from understandable frustration into something more concerning.

 

[Crayola227]

I average 10-12 patients per day, 18-19 shifts per month. I recognize I have a good hospitalist job, and I'm not questioning that many hospitalist positions are extremely difficult and unsustainable. However, I am questioning the cynical, almost hateful attitude toward patients expressed in the original post. There's a difference between acknowledging systemic problems in hospital medicine and developing genuine contempt for the people we serve. Calling patients and families "freaks" and "delusional" crosses a line from understandable frustration into something more concerning.

I think you might need to wake up and realize how many delusional freaks this nation has right now. And patients are always going to reflect gen pop. Maybe it's only 1/10 but then you'll see one everyday. It doesn't take many bad apples to spoil your day.

I think as written the person was focusing on the most bleak view, everyone has those moments when it's all dark. Written in black and white it can seem razor sharp. My own writing takes on that tone of melodrama sometimes.

Sometimes it's actually the most idealistic and loving of us that becomes the most disillusioned and burnt out. The extreme negative view could be a kind of distancing protective tactic. Again, like you said, if it comes to this it is probably best the person steps back, and they are.

Continuing to devalue the job in their mind and words is probably helping if they did have some ambivalent feelings about it. Which most doctors checking out of clinical medicine owing to struggles with the system and mean people (meanness IS in fact common in medicine) have, because most of us who came in wanted in, so leaving because it sucked the marrow from your bones is still hard.

 

[anonperson]

Patients and families are often scared, medically uneducated, and navigating an unfamiliar and emotionally overwhelming system. Their misunderstandings and behaviors, while sometimes frustrating, are usually not driven by malice or stupidity, but by fear and confusion.

If they were scared and unfamiliar, why do patients constantly fight good medical advice?

I get push back on vaccines, weight loss, etc on a routine basis.

I went back and re-read the original post that started this thread. Frankly, the level of cynicism expressed there is so extreme that it borders on offensive. Yes, of course we all encounter difficult patients, but to characterize the majority of patients and their families as arrogant, entitled doesn’t align with my experience. I’ve been a hospitalist for 20 years, and the majority of patients I see are appreciative, polite, and grateful.

Do patients or family members sometimes ask questions that reveal a lack of medical knowledge? Certainly. Just last week, a patient’s spouse asked me why the lymphocyte and monocyte counts were elevated on a CBC differential. It was a completely reasonable question, why would that irritate me? The question came from a place of concern, not confrontation. There’s no justification for physicians reacting with anger to benign questions rooted in curiosity or anxiety.

In my experience, the most chronically unhappy physicians tend to view their role in rigid, hierarchical terms—"I’m the doctor, you’re the patient"—or they approach interactions with specialists and colleagues through an adversarial lens

No one's getting annoyed when a patient or their family is asking about the lymphocytes on a WBC.

We get irritated when patients fight us on stupid stuff. I'm not a hospitalist but I feel bad for any specialty that gets patients dumped onto them in an inpatient setting. ED, Hospitalists, OB GYNs who cover unassigned patients etc.

Do we have some very nice/pleasant patients? Yes.

But there is a large contingent of dirt bag patients that wear us out. Not to mention wearing out nursing staff as well. I sometimes feel really bad for them when they have a terrible patient for 12 hours.

 

[HemeOncHopeful19]

Not sure this is the kind of thing annoying doctors. When patients ask questions in a suspicious and accusatory manner because of conspiracy theories, too much time on crystalhealingmedicine.com, while discussing how their cousin is a nurse and they know most doctors are goons for big pharma, and you must be too if you don't agree with me, it's not really the same at all.

Respectfully disagree, patients and families (and NP PCPs!) asking about irrelevant minutiae of CBC abormalities after I’ve already said “your labs look good” definitely gets irritating because they rarely will take “that MCHC/Red Blood Cell # is irrelevant” for an answer and seemingly imply I’m not thorough enough.

I mean realistically it’d be interesting to do a study of what % of CBCs actually come back with completely normal range values. I’d guess it’s less than 30-40% but maybe I’m biased?

 

[Crayola227]

Respectfully disagree, patients and families (and NP PCPs!) asking about irrelevant minutiae of CBC abormalities after I’ve already said “your labs look good” definitely gets irritating because they rarely will take “that MCHC/Red Blood Cell # is irrelevant” for an answer and seemingly imply I’m not thorough enough.

I mean realistically it’d be interesting to do a study of what % of CBCs actually come back with completely normal range values. I’d guess it’s less than 30-40% but maybe I’m biased?

This is true, definitely didn't consider that. Although it might fall under "suspiciously ask." It's definitely true once upon a time we valued expert opinion and we don't any more.

 

[glorifiedresident]

It's interesting that we often expect understanding from our patients about our difficult working conditions, yet sometimes fail to extend that same understanding to them

 

[VA Hopeful Dr]

Respectfully disagree, patients and families (and NP PCPs!) asking about irrelevant minutiae of CBC abormalities after I’ve already said “your labs look good” definitely gets irritating because they rarely will take “that MCHC/Red Blood Cell # is irrelevant” for an answer and seemingly imply I’m not thorough enough.

I mean realistically it’d be interesting to do a study of what % of CBCs actually come back with completely normal range values. I’d guess it’s less than 30-40% but maybe I’m biased?

That's what kills me. If I've already sent a mychart message saying "All of your labs look great", that means that everything looks great. No, your basophil % being 0.1 above normal doesn't mean anything.

 

[VA Hopeful Dr]

It's interesting that we often expect understanding from our patients about our difficult working conditions, yet sometimes fail to extend that same understanding to them

Even when I was burnt to a crisp several years ago, I didn't take it out on anyone I was receiving services from. I didn't yell at waitresses, the yard guy, or the check out person at the grocery.

And look, we all know that being a patient can be stressful - health is serious business and most of us grant a lot of leeway to patients and their families. But there is a limit and it gets crossed all the time.

 

[HemeOncHopeful19]

It's interesting that we often expect understanding from our patients about our difficult working conditions, yet sometimes fail to extend that same understanding to them

Who said I blame the patients?

I blame the 21st century cures act and big tech companies who convince society that they too can be a doctor with the power of information at their fingertips supplied by Google!

I fully struggle with the same issues when I take my car to the shop or my dog to the vet. As a result I purposely try to avoid doing much talking and let my wife lead the way in those types of settings.

 

[gutonc]

Who said I blame the patients?

I blame the 21st century cures act and big tech companies who convince society that they too can be a doctor with the power of information at their fingertips supplied by Google!

I fully struggle with the same issues when I take my car to the shop or my dog to the vet. As a result I purposely try to avoid doing much talking and let my wife lead the way in those types of settings.

100%. I am a very good medical oncologist, great possibly. But I am a crap mechanic, veterinarian, plumber, electrician, finish carpenter, etc. There are some things I like doing (small home repair projects that don't require messing with things that have the chance to kill me, orchard management now that I paid a guy to beat it all into submission after 5+ years of being ignored, etc) and will take the time to learn more about from both experts and the intarwebs. There's a lot of other stuff that I have no interest in learning or doing so pay experts to do it.

 

[glorifiedresident]

I actually like it when patients take the initiative to educate themselves on their conditions, it makes for more interesting discussion and can break the monotony. Even if they are wrong, it is at least more interesting to have some discussion.

 

[Crayola227]

It's interesting that we often expect understanding from our patients about our difficult working conditions, yet sometimes fail to extend that same understanding to them

Or to the physicians experiencing the difficult work conditions, amirite??

 

[sloh]

I actually like it when patients take the initiative to educate themselves on their conditions, it makes for more interesting discussion and can break the monotony. Even if they are wrong, it is at least more interesting to have some discussion.

Dunning Kruger makes these interactions quite draining

 

[MD46]

I actually like it when patients take the initiative to educate themselves on their conditions, it makes for more interesting discussion and can break the monotony. Even if they are wrong, it is at least more interesting to have some discussion.

Sounds like you have a very Niche practice, most people I have worked with and clearly the tone on this forum is quite opposite to your observation. Good for you though, however I am a 4th Generation Physician/Doctor and after discussing with my family, there has definitely been a shift in how patients perceive physicians, their expectations and behavior towards us.

Also, I have rarely met a Doctor that has lack of empathy and doesn't mostly go above and beyond for the patients.

However just to give you an example, 3 weeks ago got a call at 230am as an Oncologist on call, patient stating that they had finally decided they will quit smoking and wants me to send him patches etc. Patient is in his 60s, lucid, coherent, educated based on my previous interaction 4 weeks or so ago. Tell me is this appropriate? will they call their Lawyer at 230am and ask them a similarly absurd question to their respective field?

I have many more examples, maybe because I see more than twice the patients you see in a week and been a physician a good 15 yrs also now.

My 2 cents

 

[dozitgetchahi]

Lack of empathy is also a diagnostic sign of burn out. It's dangerous for not only physicians but patients as well. But the current profit driven medicoindustrial complex squeezes it and grinds it (profit, and empathy) from the bones of all within in it.

Patients are definitely more difficult now than before.

This is the other half of the story.

Working in the modern “medical industrial complex” is not exactly pleasant. There was a time in medicine where we were not necessarily expected to kowtow to every whim and demand of patients, and where highly unrealistic expectations and wants were more easily dismissed. Now, with the advent of pt satisfaction scores, Press Ganey, Obamacare mandating that hospitals care about all this, admin pressuring everyone to pump the numbers etc etc, all sorts of ridiculous and silly issues and beefs have to be taken seriously, and that becomes exhausting. It’s not just the patients, it’s very much the system.

 

[HemeOncHopeful19]

I actually like it when patients take the initiative to educate themselves on their conditions, it makes for more interesting discussion and can break the monotony. Even if they are wrong, it is at least more interesting to have some discussion.

Ok sure but try this experiment:

Go to google and type in

“What causes low lymphocytes?”
“What causes high lymphocytes?”

Now consider that probably 90%+ of “low lymphocytes” and 50-75% of “high lymphocytes” referrals I get end up going absolutely nowhere… do you feel like Google’s information reflects that? Is the patient being helped or harmed by having access to this “education?”

 

[Crayola227]

I've rarely felt like anything information a patient came in with from their buddies or interwebs helped whatsoever (except the rare patient that are our equals intellectually and understand something about science and how it's done and openness to expertise.) Only an open mind is helpful.

My gripe is not having enough time to talk to patients. If I have the time with people, I vastly prefer their ignorance and open mind if it gives me a blank slate to teach and give pertinent info. I prefer to shape their understanding - this is not paternalism, this is how it should work, doctor means teacher in Latin. Qualified doctors, experts, should be the ones shaping medical understanding and helping patients understand their conditions, not RFKJr or crystalhealing.com

I might help if a patient comes in with a high school health 101 background, like basic anatomy. I had to explain to a friend that without a uterus she could not get pregnant. But I also find folks at that level will listen, she understood it was a dumb question so she takes what doctors say seriously.

 

[glorifiedresident]

Ok sure but try this experiment:

Go to google and type in

“What causes low lymphocytes?”
“What causes high lymphocytes?”

Now consider that probably 90%+ of “low lymphocytes” and 50-75% of “high lymphocytes” referrals I get end up going absolutely nowhere… do you feel like Google’s information reflects that? Is the patient being helped or harmed by having access to this “education?”

I'm presuming that those referrals came from other physicians(?)

 

[sloh]

I've rarely felt like anything information a patient came in with from their buddies or interwebs helped whatsoever (except the rare patient that are our equals intellectually and understand something about science and how it's done and openness to expertise.) Only an open mind is helpful.

My gripe is not having enough time to talk to patients. If I have the time with people, I vastly prefer their ignorance and open mind if it gives me a blank slate to teach and give pertinent info. I prefer to shape their understanding - this is not paternalism, this is how it should work, doctor means teacher in Latin. Qualified doctors, experts, should be the ones shaping medical understanding and helping patients understand their conditions, not RFKJr or crystalhealing.com

I might help if a patient comes in with a high school health 101 background, like basic anatomy. I had to explain to a friend that without a uterus she could not get pregnant. But I also find folks at that level will listen, she understood it was a dumb question so she takes what doctors say seriously.

Brandolini’s Law, also known as the Bull**** Asymmetry Principle. It states:

“The amount of energy needed to refute bull**** is an order of magnitude bigger than to produce it.”

This informal “law” was coined by Italian programmer Alberto Brandolini in 2013. It highlights how misinformation, once spread, can be extremely difficult and time-consuming to correct—often requiring far more effort, evidence, and explanation than the original falsehood needed to spread.

This concept is especially relevant in fields like public health, politics, and media, where myths can spread rapidly but correcting them demands careful debunking, trust-building, and education.

 

[dozitgetchahi]

Ok sure but try this experiment:

Go to google and type in

“What causes low lymphocytes?”
“What causes high lymphocytes?”

Now consider that probably 90%+ of “low lymphocytes” and 50-75% of “high lymphocytes” referrals I get end up going absolutely nowhere… do you feel like Google’s information reflects that? Is the patient being helped or harmed by having access to this “education?”

While I agree that sometimes “self education” can be helpful, there are plenty of examples like yours in rheumatology too. Take the +ANA consult, which forms a major part of most rheumatologists’ new patient stream. Most of these consults also go absolutely nowhere. Nevertheless, many of these “incidental positive ANA” patients will have searched the internet about this, and a huge portion of them come in believing that they have SLE (for some reason, there is a very strong supposition among folks on the internet as well as other docs that “+ANA = SLE, even though the vast majority of people with +ANA results have no actual illness…and a positive ANA can be associated with a wide variety of other illnesses too…but I digress). Almost invariably, they will have come across some info online that tells them that SLE is a horrific, lethal disease - and thus they’re terrified before they even see me. However, most of these pts basically have nothing going on, and even if they do have an autoimmune connective tissue dz (never mind the “dreaded” SLE), internet info seems to gloss over the fact that many/most cases are mild and can be easily addressed.

 

[HemeOncHopeful19]

I'm presuming that those referrals came from other physicians(?)

Some docs some midlevels

I don’t even consider them crap referrals in 2025 nobody has time to read up on the workup if some obscurely abnormal (RED) value. But the fact remains 80-90+% end up going nowhere after whatever workup I do, but if you were the patient you’d think this is something super serious when you look it up!

On a related note about an hour ago I had a patient ask for a printout of her labs and ask me about a low RBC value (normal hemoglobin).

“I don’t know I don’t care about that number”
“Well if you don’t care doc, I don’t either!”
I wanted to hug that lady

 

[hopefulraddaddypls]

The whole point of epic is to make physicians as liable as they can for as many things as possible. After reading this thread and making it through intern year thank god I choose rads, godspeed to my medicine bros

 

[hopefulraddaddypls]

I think it's important to acknowledge the profound lack of empathy in this post. Patients and families are often scared, medically uneducated, and navigating an unfamiliar and emotionally overwhelming system. Their misunderstandings and behaviors, while sometimes frustrating, are usually not driven by malice or stupidity, but by fear and confusion.
Physicians do carry a heavy burden, but part of that responsibility includes bridging the knowledge gap with compassion.

Well maybe they shouldnt be lashing out on those who are trying to help them get through this confusing and scary time while navigating a broken system, novel thought

 

[hopefulraddaddypls]

Dunning Kruger makes these interactions quite draining

"now hold on, a Hb of 8.7 is still low, why cant my dad get another unit? Oh you're saying no? Im going to file a patient advocacy report and call the CEO"

 

[Mehena]

The whole point of epic is to make physicians as liable as they can for as many things as possible. After reading this thread and making it through intern year thank god I choose rads, godspeed to my medicine bros

Also, to the point raised by pretty much everyone here—your comments included—the burdens of IT and EMR systems, and their contribution to physician burnout, appear to be a global issue. The Economist recently published several articles highlighting the challenges within the NHS and proposed EMR or IT solutions as potential solutions.

Below is an excerpt from a physician’s letter to the editor in response:

"An all-out digital transformation of the NHS (“Intensive care”, May 31st) is yet another distraction from improving the efficiency of the service, especially of medical staff. IT initiatives have resulted in doctors undertaking the duties of secretaries, ward clerks and clinic co-ordinators, and added extra time to simple tasks such as requesting tests and writing prescriptions. This cognitive overload is a big reason for medical staff leaving the profession. In my own 40-year experience in the NHS, 30 as a consultant, I have witnessed a 50% reduction in the number of patients who can be seen in a clinic because of these ill-considered and time-consuming IT interventions.

The focus of digitisation of the NHS has been to relieve the workload of the administrative staff. Until it relieves the workload of the medical staff, no progress will be made."
Dr. Richard Motley, Cardiff

Reforming the NHS | Jun 21st 2025 Edition

Also this week, education in Vietnam, management crises, the decline of rhyme

www.economist.com

 

[glorifiedresident]

Decided to do an experiment the past few days and see how many of the patients i've seen over the past few days in the hospital were difficult, crazy, or delusional. (answer zero). I understand the instinct to gripe and complain on an anonymous forum, but in reality the majority of patients are not as described by the original poster.

 

[glorifiedresident]

"now hold on, a Hb of 8.7 is still low, why cant my dad get another unit? Oh you're saying no? Im going to file a patient advocacy report and call the CEO"

yeah, well if you're not able to explain to a patient why a particular intervention is not indicated or necessary, it's probably best to go into a non-patient facing field, bro.

 

[VA Hopeful Dr]

Decided to do an experiment the past few days and see how many of the patients i've seen over the past few days in the hospital were difficult, crazy, or delusional. (answer zero). I understand the instinct to gripe and complain on an anonymous forum, but in reality the majority of patients are not as described by the original poster.

Allow me to quote myself from a few days ago:

None of our experiences are universal. It's great that your patients are on the whole appreciative and polite.

It's not like that everywhere.

I'm outpatient primary care, I've had 3 patients this week that were at least one of the 3 things you described.

 

[dozitgetchahi]

Allow me to quote myself from a few days ago:


I'm outpatient primary care, I've had 3 patients this week that were at least one of the 3 things you described.

Hell, in rheumatology I get at least 3 pts a *day* who are like that. Often more.

 

[glorifiedresident]

Allow me to quote myself from a few days ago:


I'm outpatient primary care, I've had 3 patients this week that were at least one of the 3 things you described.

Well assuming you see 20 pts a day x 5 days. 3% difficult patient rate is a far cry from what was described in the original post.

 

[greatnt249]

Well assuming you see 20 pts a day x 5 days. 3% difficult patient rate is a far cry from what was described in the original post.

All it takes is one to wreck your day, especially if it's early in the day.

 

[chessknt]

Decided to do an experiment the past few days and see how many of the patients i've seen over the past few days in the hospital were difficult, crazy, or delusional. (answer zero). I understand the instinct to gripe and complain on an anonymous forum, but in reality the majority of patients are not as described by the original poster.

 

[hopefulraddaddypls]

yeah, well if you're not able to explain to a patient why a particular intervention is not indicated or necessary, it's probably best to go into a non-patient facing field, bro.

Hey bro I was just the intern passing through the trenches, ask the internist who got reported by the patients fam even after spending an hour with them explaining things. Anything non patient facing (including finance PE IB careers) is mopping patient facing medicine now. Its a minefield and patient pacing physicians are treated like dirt, but Im sure based on your post history you're the exception

 

[glorifiedresident]

Your welcome!

 

[glorifiedresident]

Hey bro I was just the intern passing through the trenches, ask the internist who got reported by the patients fam even after spending an hour with them explaining things. Anything non patient facing (including finance PE IB careers) is mopping patient facing medicine now. Its a minefield and patient pacing physicians are treated like dirt, but Im sure based on your post history you're the exception

Yeah nice extrapolating a broad conclusion from a single nightmare patient that you took care of as an intern

 

[hopefulraddaddypls]

Yeah nice extrapolating a broad conclusion from a single nightmare patient that you took care of as an intern

Im sure the internist making 270k a year and having his pay threatened to be cut (while a midlevel makes 140k) due to this "encounter", which seems to be happening more and more now, was thrilled and shares your view on medicine

 

[glorifiedresident]

Huh? That post doesn’t even make sense. Never heard of someone getting a pay cut from a frivolous patient complaint. If that were me I would make sure they had my full name spelled correctly to report to admin.

 

[DoctorMD1]

The competitiveness is largely driven by compensation differences between specialties though. If a physician gets paid enough, they’ll put up with a lot of headaches.

hmm... not always. I would do rads even if it would pay below peds. ability to work from home and set up you own schedule is priceless for many people

 

[VA Hopeful Dr]

Well assuming you see 20 pts a day x 5 days. 3% difficult patient rate is a far cry from what was described in the original post.

But see that's the thing. My work environment is much less likely to have patients like that.

1. You have to be able to pay or have some kind of healthcare coverage to see me in the first place.

2. I am very busy, getting appointment with me usually takes several weeks. You can't just show up when something's wrong and expect to be seen.

3. If you're a jerk, I can get rid of you and never have to see you again.

4. My patients rarely come to me in any kind of significant distress.

Not to belabour a point that I'm sure you are well aware of, but none of the above have to to hospitalist patients. They are in some kind of acute distress and or pain. This makes everyone more likely to not observe social niceties or be downright rude. Since they are not guaranteed to have money or health Care coverage, you will get a decent subset of people who have just very rough and stressful lives which can also lead to behavior that is less than stellar. Many times you're often stuck with them for extended periods. Even if there's a patient that I like who's a jerk one day, I probably won't see them again for weeks to months. If you have a patient that's a jerk, you may be stuck seeing them everyday for weeks to months.

Basically, the point I was making is that in my somewhat curated patient panel, if I still have these encounters on pretty much a daily basis it is much more likely that hospitalists will see these types of patients on a more frequent basis.

And to clarify, I'm not saying that you are misleading anyone about your personal experience. It honestly sounds like a pretty sweet place to work from what you said. But, for the third time, not everyone's experience is going to be like that. I don't think it's asking too much for you to accept that there can be doctors that are not actually burnt out that have miserable work environments in large part due to patient behavior.