Feeling disillusioned with medicine

[Dro133]

I know this isn't the first time this topic has been brought up here, but I feel like I'm coming at it with a slightly different perspective than the most recent post...

I'm a brand new MS3 and I just started my first clinical rotation. It's a short elective in an outpatient internal medicine subspecialty clinic, and my clinic days aren't even very long. For the most part, I still don't really know what I'm doing at all. I want to acknowledge my naivety, and a lot of what I write here, I'm writing with the understanding that I might be looking at it from a perspective of someone who is very naive in how clinical medicine works. So please, correct me if you believe that my perspective is flawed on anything I write.

Today, I worked with an attending who embodies a lot of the things that I dislike in some people, in terms of mannerisms and general personality, but mostly stemming from a general air of paternalism that he took with most patients. He would also order labs without really explaining why he was ordering them. He didn't really seem interested in listening to patients. I'll admit that I understand it's not all his fault -- I understand that in clinical medicine, most providers simply don't have the luxury of spending a lot of time with each patient.

Still, it rubbed me the wrong way how focused he was on getting in and out so quickly. I left the room feeling guilty after each encounter, because I felt that the patient was spoken down to, and I had a feeling that the patient didn't feel heard, or satisfied with the encounter. Also, there seems to be this thing in medicine called a "difficult" patient -- a patient who comes in with questions after having looked up data themselves. There were a couple of these today, and it was clear that the attending lamented their presence. But wouldn't any of us do the same thing if we had a serious condition and were consulting a specialist? Shouldn't we be encouraging people to take control of their own health? Just with my short time in clinical medicine so far, I'm seeing that there are so many inefficiencies in the system, and a single doctor can only spend so much time thinking about each patient. Why shouldn't the person who cares most about the well-being of the patient -- the patient him/herself -- be more involved in the care?

I'm probably coming off as too ideal and/or naive, I get that. But I walked out of clinic today not feeling like we really helped anyone, that people didn't walk out of the office feeling better than they came in. Maybe I'm wrong. But I'm having a hard time wondering if there's a place in medicine for me after my experience today. Is there? I kind of wish that I had become a clinical psychologist instead.

---

Members don't see this ad.

 

[BGDino]

Hang in there. Everyone I know has had times like this in med school and residency. You’re not alone. I had several periods in med school and the beginning of residency where I seriously considered giving it up, but please remember what it’s like now isn’t going to be forever. There is a light at the end of the tunnel. Maybe you won’t decide to keep going and will turn off the med school path and choose another journey, but what you’re going through now will pass.

 

[W19]

All of your issues can be solved by doing academic medicine...

 

[Moose A Moose]

He might’ve been just like you at some point, OP. Not everyone can walk on water forever. You don’t know what he’s gone through to get to the point he’s at, or the stress he’s under on a continual basis.

It’s not like the movies because it isn’t the movies. Not saying he should be a jerk to patients, or that it’s okay, but things aren’t always clear-cut as we’d like them to be.

 

[startswithb]

You will meet doctors you do want to emulate. Don't doubt the process so soon.

 

[Durty-Trixxx]

You're on your very first rotation so YES --- you are overflowing with naivete and idealism. We all went through it when we started rotations. This is no longer "book learning" --- this is the real world of healthcare. Just keep an open mind and focus on learning as much as you can, and in the blink of an eye you'll be on to your next rotation with a whole new set of challenges, joys, and disappointments.

Once you get close to graduating, you'll look back on ALL your rotation experiences and have a better perspective on how things are, how they should and shouldn't be, and all the other stuff in between. You'll be wiser and more confident as you head into residency.

 

[Dares Dareson]

Sure, you will have to compromise your ideals somewhat, but there is no hard and fast rule saying you have to end up like that attending. The trick is, you get through med school, through residency, and then you be the exact opposite of that guy once YOU are an attending. I promise you will meet attendings who more closely embody what you believe is the right way to practice medicine. I'm nearing the end of my third year and I've worked with plenty.

 

[Dro133]

Thank you guys for the replies, all of you. They give me some hope that I can be an attending that doesn't feel like a sell-out, and who can sleep at night.

I think one problem I'm having is that I see (or at least perceive) that sometimes in this system, arrogant people, or, ahem, kiss-asses, seem to be rewarded. Maybe I'm just bitter that they're better at playing the game than I am. I guess I've always believe on getting by on hard work, competence, and doing things the right way. I hope I find examples of attendings/residents/fellows who embody that ideal.

 

[Durty-Trixxx]

I think one problem I'm having is that I see (or at least perceive) that sometimes in this system, arrogant people, or, ahem, kiss-asses, seem to be rewarded. Maybe I'm just bitter that they're better at playing the game than I am. I guess I've always believe on getting by on hard work, competence, and doing things the right way. I hope I find examples of attendings/residents/fellows who embody that ideal.

You will definitely meet attendings and residents that restore your faith in humanity. Some of them will seem like they walk on water and are superhuman. I worked with a busy IM attending who handed his business card to EVERY single patient and told them to call him ANY time they wanted day or night at his home or cell number. He didnt have a partner so he was taking call 24/7 every day for the past 30 years. Still blows me away to think how dedicated he was.

Sadly, you're gonna meet a LOT of people who are bitter and unhappy and downright nasty slimeballs in this profession. They will make you miserable and question your dedication to your chosen career. Keep the faith and get a thick skin! Remember, you're only doing this to learn as much as you can to pass boards and move on to residency. Stay focused on the core mission and keep chugging along.

 

[smiledoc1]

I'm a pre-dental student but I strongly relate to the bit of feeling "disillusioned" and frankly disappointed by the behavior of some doctors in their interactions with patients and just their general mannerisms.

I've shadowed many different dentists and it has been quite easy to tell who does their work with integrity, and who probably went for it just for the moola and are now miserable. Doesn't help that the US healthcare system is extremely corrupted and profit driven.

Luckily, there have been some wonderful doctors that I have met along the way which have allowed me to maintain my faith in the profession. 🙂
I chose to look up to them, and use the others as reminders of the kind of provider NOT to be.

 

[AlbinoHawk DO]

These are exactly the consequences of the lies pushed by the PhDs and the medical academics that never practice real medicine. They sell students this lie about professionalism and idealism in medicine. Then they encounter the reality that is medicine.

I completely agree with the approach that physician has. No point in wasting more than the necessary time to address their medical issues. While it would be ideal to make them feel pampered, there is not enough time for this and see patients. And no, I don't care that you know how to google. I don't have the time to waste on vetting every patient to see if they are the idiot that googled cough and concluded cancer or the one that has more in depth knowledge. You come to me for my expertise and I'll give it to you. I don't go to an engineer building my house and give opinions on how the foundation should be made.

If you want to live in a bubble, there are places like academia that will allow you to do this. Want to be in the trenches and actually treating patients? Better learn how to be efficient even if it comes at some cost.

 

[Perrotfish]

These are exactly the consequences of the lies pushed by the PhDs and the medical academics that never practice real medicine. They sell students this lie about professionalism and idealism in medicine. Then they encounter the reality that is medicine.

I completely agree with the approach that physician has. No point in wasting more than the necessary time to address their medical issues. While it would be ideal to make them feel pampered, there is not enough time for this and see patients. And no, I don't care that you know how to google. I don't have the time to waste on vetting every patient to see if they are the idiot that googled cough and concluded cancer or the one that has more in depth knowledge. You come to me for my expertise and I'll give it to you. I don't go to an engineer building my house and give opinions on how the foundation should be made.

If you want to live in a bubble, there are places like academia that will allow you to do this. Want to be in the trenches and actually treating patients? Better learn how to be efficient even if it comes at some cost.

So this is a good example of why I support the HMO model of healthcare, rather than a fee for service model. I'm willing to bet my empanelment is the same as many physicians with your attitude, but I spend significantly longer with each patient that I see. The result is that I see each empaneled patient far fewer times per year than a fee for service practice. When you explain why an illness is just a cold, rather than just telling them that its just a cold, then they don't come back for the next cold. But physicians who see URIs (or equivalent) as easy money layups have no incentive to do that, so they don't.

 

[AlbinoHawk DO]

So this is a good example of why I support the HMO model of healthcare, rather than a fee for service model. I'm willing to bet my empanelment is the same as many physicians with your attitude, but I spend significantly longer with each patient that I see. The result is that I see each empaneled patient far fewer times per year than a fee for service practice. When you explain why an illness is just a cold, rather than just telling them that its just a cold, then they don't come back for the next cold. But physicians who see URIs (or equivalent) as easy money layups have no incentive to do that, so they don't.

You are introducing a very different variable here and that is physicians that are actively dishonest to make a buck. That's different than the physician that is more efficient. I also bet you practice in a nice office with patients that have some really good health plans. That is nice and all, but there are many people out there without access to a physician. Like I said, you can choose to practice in a bubble or you can go into the trenches.

 

[Newyawk]

These are exactly the consequences of the lies pushed by the PhDs and the medical academics that never practice real medicine. They sell students this lie about professionalism and idealism in medicine. Then they encounter the reality that is medicine.

I completely agree with the approach that physician has. No point in wasting more than the necessary time to address their medical issues. While it would be ideal to make them feel pampered, there is not enough time for this and see patients. And no, I don't care that you know how to google. I don't have the time to waste on vetting every patient to see if they are the idiot that googled cough and concluded cancer or the one that has more in depth knowledge. You come to me for my expertise and I'll give it to you. I don't go to an engineer building my house and give opinions on how the foundation should be made.

If you want to live in a bubble, there are places like academia that will allow you to do this. Want to be in the trenches and actually treating patients? Better learn how to be efficient even if it comes at some cost.

The worst are the standardized patients. the most critical pieces of ****s ever. You forgot to ask what they like being called? Ah crap bro better luck next time.
Wanna know the difference between an SP and a real patient? The real patient actually has an issue that theyre asking you to help them with. Theyre not just analyzing your every move to their fake problem.

 

[siliso]

Just keep swimming. Maybe this first preceptor of yours is really the odd jerk that you’ll run into occasionally, or maybe you’ll look back on your current reaction and laugh, with time and experience.

Remember that the average IQ is 100 and even gifted persons have their own areas of interest and disinterest. Most people are perfectly content to trust their physician to decide what labs are indicated, and that is a good thing.

 

[Perrotfish]

You are introducing a very different variable here and that is physicians that are actively dishonest to make a buck. That's different than the physician that is more efficient. I also bet you practice in a nice office with patients that have some really good health plans. That is nice and all, but there are many people out there without access to a physician. Like I said, you can choose to practice in a bubble or you can go into the trenches.

For reference I'm seeing a full clinic and taking call in a small military hospital in the middle of nowhere with an empanelment that's higher than the non call taking physicians in town.

This isn't about dishonesty. People just do what's incentivized. If I can get my patients so healthy that fewer of them come in then that means I leave earlier. Therefore I happily address half a dozen complaints in a single visit. Asthmatics get at least one full hour teaching session at least annually. New parents get a 30 minute teaching session about what is and isn't worth coming to the hospital for. And then, and this is key, they don't come back very often. If I did that stuff in town I couldn't keep the lights on. Most of the clinics in town don't even break even for the day until the 15th appointment, so they rush and see 25-35 a day with much less stuff in each individual appointment. "Hi, ear infection, bye" is a perfect appointment in the fee for service model.