Dissatisfaction: whom/what is the source

[FrustratedFamDoc]

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Attendings please. Not being elitist, but perspective changes when you’re years out of residency.

I’ll limit the use of the word burnout, but that ultimately is what I’m speaking of.

I submit that it is a far more complex issue than docs give it credit for, and everyone has their own unique circumstance, and actual definition. To some it’s a dehumanizing dysphoria of working for ‘the man.’ Others end up hating everything about everything for usually a myriad of reasons. Invariably, an undercurrent of depression will flow, kind of like ghostbusters 2, until it is hopefully waded through.

To further complicate an already complicated subject, I feel like the leading contributors have and continue to change over time.

My goal of this discussion isn’t to be a whine-fest, therapy session or a solicitation of advice as that will devalue my original intent. Additionally, no arguing why one political stance is superior to another on how a solution can be accomplished. Please voice concerns regarding political constraints if needed, but I’d like to leave it at that.

i have several of my own, but am constrained on time at the moment. I’ll chime in when I get a chance.

 

[VA Hopeful Dr]

@RustedFox I believe you have the answer

 

[RustedFox]

The number one source of burnout is the patient.

 

[FrustratedFamDoc]

1. The completely uninterested in taking care of themselves paradoxically are the most neurotic ones that something bad is always going on. It used to be if you kept an a1c over 10 for a couple decades, things kind of worked themselves out naturally… then we got so good at managing vascular events, these people die in a more incremental approach. It’s fallout from obesity and/or smoking. And they drag you with them.

You can usually tell how your day is going to go by how many diabetics are on your schedule. By and large (see what I did there) not a jolly crowd.

2. patient portal. Needs to be an exec portal where patients have direct access to admin’s personal emails.

Is there something about the 10 to 15 year mark that turns even the most altruistic among us sour? Is it like this everywhere?

Why do I feel sometimes like opening a private, cash up front, inpatient rehab facility somewhere with nice weather would be more rewarding? Talk about recession proof. Hopefully a $20k outlay infers some sort of motivation. And no chronic med management.

 

[RustedFox]

2. Needs to be an exec portal where patients have direct access to admin’s personal emails.

 

[VA Hopeful Dr]

1. The completely uninterested in taking care of themselves paradoxically are the most neurotic ones that something bad is always going on. It used to be if you kept an a1c over 10 for a couple decades, things kind of worked themselves out naturally… then we got so good at managing vascular events, these people die in a more incremental approach. It’s fallout from obesity and/or smoking. And they drag you with them.

You can usually tell how your day is going to go by how many diabetics are on your schedule. By and large (see what I did there) not a jolly crowd.

2. patient portal. Needs to be an exec portal where patients have direct access to admin’s personal emails.

Is there something about the 10 to 15 year mark that turns even the most altruistic among us sour? Is it like this everywhere?

Why do I feel sometimes like opening a private, cash up front, inpatient rehab facility somewhere with nice weather would be more rewarding? Talk about recession proof. Hopefully a $20k outlay infers some sort of motivation. And no chronic med management.

So the most important lesson the I have learned is that medicine is a job. Nothing more. You go to work, do what you can, and then go home to your actual life. It's not easy, but don't bring work home with you mentally.

If you can't answer a portal message in 1-2 sentences, the patient needs an appointment. You'll piss off some patients as you change to this, but its worth it in the long run. New problems don't get addressed via portal.

If patients are consistently non-compliant, dismiss them. I'm not talking about poor diet or not quitting smoking. But if they flat our refuse to take medication to help with their diabetes, I will get rid of them. "I refuse to watch you slowly kill yourself because you won't take your health problems seriously" is my go-to line in these instances.

Remember that this is not Burger King, patients can't have it their way. You do what is best for the patient first and foremost. That said, pick your battles. I gave up on antibiotic stewardship for adults years ago and its made my life way better. I hold the line with kids because its not their fault their parents are demanding. I don't start benzos, but I will continue them if the regimen isn't insane. Same with sleeping meds. In adults I will continue ADHD meds, I don't make new diagnoses - needs a psychiatrist/psychologist for a full eval on that score. I don't do chronic opioids in under 80 year olds. Pain management exists for that. I rarely fight if patients want referrals unless it is utterly ridiculous.

 

[RustedFox]

This thread get moved or something?

 

[VA Hopeful Dr]

Nope, it's in the same place it's always been.

 

[notgolfingmd]

Awesome answer VAHopeful Dr! Since healthcare is now a marketplace, some patients are more like customers trying to score the best "deal". It is great when we share practices and not get manipulated. Some act however they want and then go to the doctor for saving. Unfortunately, the ER has turned into a usual destination for those folks.

I will insist on monthly visits for any controlled substance or expensive weight loss medication. This gives me time to get to know them better. It will still be cheaper for the patient to visit me than a specialist. North Texas is a very expensive place to get healthcare.

Actually the patients can have it their way because they can just use their credit card and get what they want from websites like Roman or Lemonaide Health.

 

[cabinbuilder]

Admin who doesn't support you.
Patients who complain when they don't get what they want (steroids, narcotics, etc)

 

[Ironheme]

2. patient portal. Needs to be an exec portal where patients have direct access to admin’s personal emails.

My favorite suggestion.

I actually like most of my patients and still feel that urge of patients first, providing the best medicine/treatment that I can. I'm also at the point where patients self-selected out when we didn't agree (no, I'm not refilling your 150 MME regimen). I love the intriguing cases when I can solve them, find challenges keep the skills and brain sharp, and generally enjoy my work.

To answer the question - part of it is moral injury, eloquently outlined by Dr. Wendy Dean, a problem with the health system - profits over patients. To that end, they'll pack your schedule, nitpick you on coding inquiries, have you try to meet these ever changing goalposts of A1c, breast cancer screening rates, etc. These are important, but not at the expense of the physician (what do you mean you can't convince the patient to get a colonoscopy?? It's on you to get that rate higher or you won't receive $), or the patient's right to choose if they want it or not.

When jobs start turning into more paperwork, more mandatory lunchtime/after work/before work meetings with most not even providing food, dealing with admin, that's where the dissatisfaction comes from. They are stealing from extracurricular/sleep/family time without offering compensation for additional work.

Also, the amount of things that are dumped on family docs with the expectation you will handle things others were supposed to (H&P's for surgeons, FMLA for a condition a specialist was managing, someone called in sick? your schedule just went to 2x, etc) without time built in for them also leads to unhappiness with the job. Give me the appropriate amount of time and respect to do the work and it's fine.

 

[VA Hopeful Dr]

I've said this before, but having control over your schedule is a key point to preventing being miserable.

A few years back, I was cruising along seeing 30-31 patients per day. Didn't love it, but I felt guilty of my patients were sick and I couldn't work them in.

Turns out my patients didn't appreciate my efforts. I got called into the principal's office because of low patient satisfaction scores.

Literally the next day I cut five patient slots off my schedule. Been there for 3 years now. I'm happier, my scores went up because I'm not rushing, and on the occasions when patients complain about not being able to see me next day, I explained to them what happened and why and that's the end of that.

FMLA is irritating, but if you make them schedule an office visit and you get paid for it who cares. Same with surgical H&Ps.