Time with patients and stress?

[DDX2k]

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Greetings,

I am heavily considering entering medicine or physical therapy and of the concerns I have with entering medicine is the amount of time I would get to spend with patients. I've heard a million horror stories about people's FPs that would spend little time with them and how the patient would oftentimes feel rushed, as though the FP had a "5-min checklist". If I were to be a doctor, I would want to at least be able to spend a decent amount of time (~15+) minutes with my patients to ensure that I have all of the information I need and to build that rapport with them....but all of these horror stories I've heard and read make FP (and PC in general) sound like a black hole of paperwork with little actual 1-on-1 patient time with high stressloads. An example article I found would be this one: http://www.ama-assn.org/amednews/2009/08/03/prsb0803.htm

Of course things like paperwork are very important, but do you all find that you still get to spend a lot of time with patients and do you feel like your job is very stressful? One of the reasons I am considering PT is that it seems a lot less stressful and you do get to spend a lot of time with patients (although some say an hour-ish with each patient can be really annoying at times), but I have been told by many that my broad interest in healthcare may make that career a bit...unfulfilling for me.

I know I'm throwing a lot out there at once (this is kind of stream of consciousness) but having some FP viewpoints on this subject would help me greatly. And who knows, maybe you'll make an FP out of me 😀

 

[JustPlainBill]

Greetings,

I am heavily considering entering medicine or physical therapy and of the concerns I have with entering medicine is the amount of time I would get to spend with patients. I've heard a million horror stories about people's FPs that would spend little time with them and how the patient would oftentimes feel rushed, as though the FP had a "5-min checklist". If I were to be a doctor, I would want to at least be able to spend a decent amount of time (~15+) minutes with my patients to ensure that I have all of the information I need and to build that rapport with them....but all of these horror stories I've heard and read make FP (and PC in general) sound like a black hole of paperwork with little actual 1-on-1 patient time with high stressloads. An example article I found would be this one: http://www.ama-assn.org/amednews/2009/08/03/prsb0803.htm

Of course things like paperwork are very important, but do you all find that you still get to spend a lot of time with patients and do you feel like your job is very stressful? One of the reasons I am considering PT is that it seems a lot less stressful and you do get to spend a lot of time with patients (although some say an hour-ish with each patient can be really annoying at times), but I have been told by many that my broad interest in healthcare may make that career a bit...unfulfilling for me.

I know I'm throwing a lot out there at once (this is kind of stream of consciousness) but having some FP viewpoints on this subject would help me greatly. And who knows, maybe you'll make an FP out of me 😀

Interesting -- there's a study that's been done that shows if you sit down at the patient's eye level, talk in a soothing tone, listen until they shut up (usually about a minute) and then inform them of your plan, they'll love you and think you spent 25 minutes with them.

I realize I'm making a generalization here -- the patient's I deal with have a laundry list of problems and social issues and no one to talk to -- I could get in and out of a room dealing with medical issues only in about 5 minutes and see my 25 patient's in a half day....it's the other 15 to 20 minutes of them talking about their social issues (which do have a place in medicine) and not answering the questions that takes so long.....

building a rapport with your patient's is fine but your job is not to be a life counselor, your job is to deal with their medical issues and you need a rapport that will facilitate that....too many patient's forget there's a waiting room full of people that feel exactly the same way they do in terms of demands on a physician's time and part of continuity is that we deal with all the problems, just not all RIGHT NOW....

With you not being in medicine, having the desire to build a rapport is understandable. I had the same thing. I'm an intern now and my idea of a good relationship with a patient is getting them to answer my questions about their chief complaint, both of us being pleasant to each other, them not changing their story for the attending and the whole thing being wrapped up in the 25 minutes I've got before my next patient visit. Out of the 200-400 patient's I've seen so far, maybe two have even acknowledged that we helped them. Most have been rather 'brassy' about the care they deserved and how nothing we (myself or the team) did was good enough.....

yeah, I'm jaded right now. The point is - your perspective will change with time, pressure, burnout, real physician responsibility and real physician-patient interaction.....

I'm doing the most that I can for the most people...I'll help all of them to some degree and my satisfaction comes with that....

 

[DDX2k]

Interesting -- there's a study that's been done that shows if you sit down at the patient's eye level, talk in a soothing tone, listen until they shut up (usually about a minute) and then inform them of your plan, they'll love you and think you spent 25 minutes with them.

I realize I'm making a generalization here -- the patient's I deal with have a laundry list of problems and social issues and no one to talk to -- I could get in and out of a room dealing with medical issues only in about 5 minutes and see my 25 patient's in a half day....it's the other 15 to 20 minutes of them talking about their social issues (which do have a place in medicine) and not answering the questions that takes so long.....

building a rapport with your patient's is fine but your job is not to be a life counselor, your job is to deal with their medical issues and you need a rapport that will facilitate that....too many patient's forget there's a waiting room full of people that feel exactly the same way they do in terms of demands on a physician's time and part of continuity is that we deal with all the problems, just not all RIGHT NOW....

With you not being in medicine, having the desire to build a rapport is understandable. I had the same thing. I'm an intern now and my idea of a good relationship with a patient is getting them to answer my questions about their chief complaint, both of us being pleasant to each other, them not changing their story for the attending and the whole thing being wrapped up in the 25 minutes I've got before my next patient visit. Out of the 200-400 patient's I've seen so far, maybe two have even acknowledged that we helped them. Most have been rather 'brassy' about the care they deserved and how nothing we (myself or the team) did was good enough.....

yeah, I'm jaded right now. The point is - your perspective will change with time, pressure, burnout, real physician responsibility and real physician-patient interaction.....

I'm doing the most that I can for the most people...I'll help all of them to some degree and my satisfaction comes with that....

You definitely bring up some good points there. I'd like to hear some more about the stress level associated with being an FP (as well as PMR and IM, if possible). Does anyone have anything to say about that? Or more viewpoints on patient-interaction time?

 

[JustPlainBill]

You definitely bring up some good points there. I'd like to hear some more about the stress level associated with being an FP (as well as PMR and IM, if possible). Does anyone have anything to say about that? Or more viewpoints on patient-interaction time?

So what type of stress do you want to discuss---

Medical Student Stress-- Can I make it through the material enough times to memorize/learn enough to pass AND have time to study for the exam immediately after that one to pass since I wasted all that freakin' time going to those lame lectures where Ph.D's/Clinicians read - in a drone like monotone - the powerpoints to me but my dean was anal retentive about class attendance and would stop the audio if the attendance went down -- type of stress

or

Intern Stress -- Oh, crap, I don't remember/didn't learn how to replete sodium in a hyponatremic patient and my attending is going to chew my ass rather than teach me as a way to make sure I learn to either A)ignore the problem and hope my senior fixes it B) ignore the problem until after rounds and then do it C)hate my program even more D)despise the hospital I work at and vow NEVER to refer anyone to them or their alumni or E) wake up even earlier, be more sleep deprived and hopefully don't kill anyone because of dumb mistakes type of stress

or

FP Intern stress -- Oh, God, I have to remember OB/Gyn, Peds, Psych, Pharm, IM, Surgery (for small procedures), Renal, GI, Cardio, Pulmonary, neonatal, MFM, ortho, and S/W to be able to do my job and learn it all in 3 years -- type stress....

Take your pick...

 

[MedicineDoc]

I don't know how true a representation that intern scenario is at least from the perspective of the training we get at our program. One Intern is paired with one 3rd yr for a month long hospital service rotation. The 3rd yr delegates out things to the 1rst yr in return for teaching the intern and answering any questions they might have. The better and faster you can teach your intern the more they can help you take care of the service and the less work you have to shoulder. Typically the 3rd yr writes the orders and the intern does the h and p. Ultimately the 3rd yr is responsible for helping the intern and running the service. The Intern calls the attending with the h and p and orders are done as a team. Attendings cut slack for interns and aside from minor quirks which are quickly learned can be approached for advise. It's more of a process of knowledge acquisition than a struggle. It comes. Interns and the upper level function as a team and can typically handle most any thing thrown at them.

As to the original question, after awhile you should feel comfortable either speeding up or slowing down the patient encounter depending on time avaiable and time required. Learning to take control effectively of the patient encounter based on need and circumstances is your right as someone trying to take care of all the people that come that day and if done right will demonstrate your knowing what is important and what isn't to your patients. It's not your job to play patty cake with them if you don't have the time.

 

[DDX2k]

When I talk about stress, I'm talking stress within the practicing FP profession, not so much the residency, but some input there is always good too!

Thanks for all the responses, guys. MedicineDoc, its nice to know that you have some wiggle room to adjust your time with each patient.

 

[DDX2k]

In addition, what are your hours like? Do you feel that you have adequate time to spend with family and friends? What about any hobbies? I mean, obviously you can't do everything, but do you find that you have any time for other activities? Gym, martial arts, playing guitar, etc?

 

[JustPlainBill]

In addition, what are your hours like? Do you feel that you have adequate time to spend with family and friends? What about any hobbies? I mean, obviously you can't do everything, but do you find that you have any time for other activities? Gym, martial arts, playing guitar, etc?

In my experience, you get your 4 days off per month and sometimes get a golden weekend (two days in a row) -- otherwise you're working unless it's an easy rotation and that varies...most of the time, when you're on an off service rotation, the specialty residents get the weekends and you get the scut and long hours--crap they don't want to do...and no, there is no time for anything else....other than sleep....

As far as the Intern stress I mentioned above....I've got one upper level who even bothered to attempt to teach...most of the time we're sent to do the H&P, make an attempt and then get yelled at for doing it wrong, present to the attending and get corrected for the plan that wasn't yours in the first place...and forget learning how to put in orders...the upper levels do that almost exclusively......we get blamed for the mistakes and the only teaching comes in getting yelled at with the corrections.....

 

[MedicineDoc]

In our program interns don't work any holidays. 2nd and 3rd yrs work 1 holiday per yr. I have never worked Christmas as we have some Muslim residents who don't mind working it. I worked one memorial day and another one I forget which. If on fm hospital service (1rst and 3rd yrs do 2 months per yr), you are on call 2 weekends of the month long rotations and 2 weekdays ( mon through thurs) of the month. All call is from home. If you are not on fm hospital service and you are a 2nd or 3rd yr you do about 1 weekday (mon through thurs) per week,1 or 2 if you have to do a weekend which is about 1 per month. First yrs don't do call for fm if not on fm hospital service. Other rotations have no call for example out pt peds, cardiology, others have 1 weekend per month. Bottom line lots of weekends off. We also have in house moonlighting in our Er and urgent care centers which is optional but great for extra money and experience. We don't compete with internal medicine for good pts as we recieve pts or a parallel hospitalist service recieves ots depending who is up on the list. Fm is the only residency. We are a regional medical center with a 25 bed icu andf 400 beds. Many of our residents go into hospitalists, Er or private practice. Much better than a big university with other competing residents. Believe me I transferred out of a neuro residency IM prelim yr. That place and their IM residency sucked a@@.

 

[DDX2k]

In our program interns don't work any holidays. 2nd and 3rd yrs work 1 holiday per yr. I have never worked Christmas as we have some Muslim residents who don't mind working it. I worked one memorial day and another one I forget which. If on fm hospital service (1rst and 3rd yrs do 2 months per yr), you are on call 2 weekends of the month long rotations and 2 weekdays ( mon through thurs) of the month. All call is from home. If you are not on fm hospital service and you are a 2nd or 3rd yr you do about 1 weekday (mon through thurs) per week,1 or 2 if you have to do a weekend which is about 1 per month. First yrs don't do call for fm if not on fm hospital service. Other rotations have no call for example out pt peds, cardiology, others have 1 weekend per month. Bottom line lots of weekends off. We also have in house moonlighting in our Er and urgent care centers which is optional but great for extra money and experience. We don't compete with internal medicine for good pts as we recieve pts or a parallel hospitalist service recieves ots depending who is up on the list. Fm is the only residency. We are a regional medical center with a 25 bed icu andf 400 beds. Many of our residents go into hospitalists, Er or private practice. Much better than a big university with other competing residents. Believe me I transferred out of a neuro residency IM prelim yr. That place and their IM residency sucked a@@.

Hmm, that's interesting that you guys get so many weekends off. Do you think that is more the norm or the exception? Also, while I am quite interested in how busy residents and interns are, I'd also like to know how people that are practicing now are doing in terms of juggling hobbies, family, work, etc. Any insight into that from you all?