One of the biggest conundrums of the COVID-19 pandemic has been the simultaneous panic-hiring of medical professionals in hot spots and significant downsizing of staff across the country.
The future of the doctor’s visit is the topic of innumerable conference lectures, policy forecasts, and venture capital meetings. Will we all go to community clinics under single-payer health care? Will doctors’ offices shut down as on-demand house calls prosper? Will IBM Watson figure out what that pink mole is?
1. She has slept for 3 hours in the last 48.
2. On his first day of residency, a vindictive doctor sent him on
an errand to a nonexistent department just to watch him suffer.
On many days after, the same doctor called him an idiot in the operating room.
3. He had to pronounce three people dead in a week; the
gentleman with the poker tricks, the stillborn baby, the 17-year- old with alcoholic liver failure who wrote poetry. There was no counseling afterward and no place to process his grief. Later, he learns that his supervising doctor will not write him a letter of recommendation for fellowship because he was “slow”, meaning he spent too much time talking to dying patients.
4. She does not have time to call her family, pay bills, go to the
grocery store, change a tampon, get an annual physical, get a haircut, or study, even though she is supposed to study every day.
She feels guilty for urinating while on call because her pager is ringing.
5. The last home-cooked meal he had was three weeks ago.
After the cafeteria closes, his meals consist of graham crackers and Doritos until sunup. He has gained 30 pounds from stress and bad food. Women do not even look at him anymore; his youth is slipping away while his finance and law friends send photos of their new homes and children.
6. He was called “weak” for hesitating while being pummeled
with medical minutiae questions about his patient while he was exhausted and sicker than the actual patient. This is called “pimping”. Before he knew it, he was required to repeat a year of residency, ensuring he would lose a year of income-earning potential as a doctor and saving the hospital tens of thousands on a nurse practitioner.
7. She had a family emergency and called out for an on-call
shift. Her chief resident told the whole hospital that she just skipped out, and ruined her reputation. The chief puts her on call for more weekends than anyone else as a yearlong punishment.
8. He went to the hospital psychiatrist for help, only to learn
that the visit was placed in his “file” and his every move is being watched.
9. She miscarried while on duty in the ER and her co-resident
would not come in to take over, nor would her attending see patients, letting her writhe in pain for hours as she ordered morphine for the ER patients.
10. Her psychiatry patients adore her but she knows that
disclosing her anxiety will brand her as “weak” in the hospital, so she does not go to therapist appointments and drinks vodka every day after work instead.
11. His girlfriend of five years broke up with him over text for
“never being around”.
12. Her attending physician in family medicine failed her on a
rotation for “lack of clinical skills” after she refused his sexual advances.
13. He was a resident bullied by a racist doctor and made
mistakes from stress; now he’s unemployed with $600,000 in debt and every regular job tells him he’s “overqualified” for retail, but not qualified enough to get a job as a doctor.
400 doctors kill themselves every year. Who will be next
American medical trainees dog-paddle every day and night through a swamp filled with bullying, sexism, racism, fatigue, tiny computer screen checkboxes, loneliness, hunger, penury, and unmet spiritual and emotional needs. At the other end, their patients wait for them, dismayed as the residents’ and students’ faces fall from excited to fearful, as they run back to their computers and call rooms instead of spending that extra time at the bedside. Sometimes, the patients receive the wrong medicine. Sometimes, the wrong leg gets amputated. Sometimes, a residency program mysteriously advertises an “unexpected opening”, and the patient in Room 109 asks, “Where is that nice young doctor who has been seeing me?”
Their supervisors, scarred from being forced to stay up for hours on end themselves, crow that no medical training can be complete without work shifts that tear one’s circadian rhythms apart and that there is no such thing as a good doctor who was not bullied. But a system that produces one of the highest professional suicide rates in the nation cannot remain; we are lying too far to the right of the bell curve. There are other options. Whether this includes improving handoff procedures in the hospital, quickly firing the racist attending doctor or the lecherous surgeon, lengthening residencies to reduce weekly work hours, adding more residents to help with the patient loads (and facilitate actual taking of breaks and naps), or requiring teaching hospitals to provide free and unbiased counseling along with a morning off to actually use it, programs that purport teaching and education should follow the lead of those already working to face the problem of young physician suicide head-on.
For patients worrying about their safety under the care of depressed doctors on little sleep, supporting lawmakers like Rep. Kathy Castor (D-Fla.), who has presented bills in favor of expanding funding to increase residency positions, is a start. At the hospital level, speaking to the residency and medical student rotation leaders about the trainees seeming overworked or overwhelmed can be a start to a healthier training program, giving a voice to the voiceless. Demanding happy doctors may be exactly how to save a life.
Support the upcoming film ‘Do No Harm” http://www.donoharmfilm.com and raise awareness of physician suicide.
Could we lose hundreds, perhaps thousands, of physicians to bad software?
I’ve written about doctors’ frustrations with software before, but recent studies have now linked electronic health records (EHR) to physician burnout. That means the software that runs billing and medical records and occupies doctors’ hands and eyes for much of the work day is a direct contributor to feelings of apathy toward patients and medicine, depressed or angry mood, cynicism and lack of feelings of accomplishment.
The Indian party was in full swing. The ladies gossiped in the kitchen and rolled dough, and the men smoked and sipped whiskey in the den. One of our ‘uncles’ popped a second gulab jamun sweet in his mouth, prompting a raised eyebrow from one of the doctors in attendance.
Not everyone can treat patients legally, and not everyone can hold a person’s life and future in their hands. That’s why we have medical schools and licensure fees and exams and state medical boards-to keep quacks and charlatans from hanging out a shingle. In America, though, we permit just about anyone to accumulate lethal weapons–like the AR-15 assault rifle responsible for so many mass shootings–with the power to end many people’s lives.
Medicine is going through growing and shrinking pains at the same time. Conferences like MedX illuminate where we are falling short with our patients and where opportunities for change exist.