Saturday, May 30, 2015

Why doctors quit

I was reminded of this exchange upon receiving my med-school class’s 40th-reunion report and reading some of the entries. In general, my classmates felt fulfilled by family, friends and the considerable achievements of their professional lives. But there was an undercurrent of deep disappointment, almost demoralization, with what medical practice had become.

The complaint was not financial but vocational — an incessant interference with their work, a deep erosion of their autonomy and authority, a transformation from physician to “provider.”

As one of them wrote, “My colleagues who have already left practice all say they still love patient care, being a doctor. They just couldn’t stand everything else.” By which he meant “a never-ending attack on the profession from government, insurance companies, and lawyers . . . progressively intrusive and usually unproductive rules and regulations,” topped by an electronic health records (EHR) mandate that produces nothing more than “billing and legal documents” — and degraded medicine.

Courtesy of a colleague

1 comment:

  1. I have always had a pretty vivid imagination and come up with some pretty crazy ideas; and I would argue this is a central part of creativity. During this time, however, I began to ask questions in my private internal dialogue such as, "Were I writing a novel, how could a character carry out the perfect suicide, making it appear an accident?" For some time it was just a game, but then as I slipped more deeply into despair, I began to imagine myself in these scenarios.

    There would be advantages, after all. My family would be spared the crushing blow of deliberate abandonment, and life insurance would secure the family finances. My wife (whom my medical school classmates described as my "only redeeming quality") was a marvelous woman and would have no trouble finding another soul mate. There would be a funeral, with mourning and recounting my virtues (that would take about 30 seconds) and a gracious overlooking of my innumerable failings. Then life would go on and everyone else would be fine.

    The sorrow hung like a millstone around my neck, but I laid it aside to care for the others because that's what you do as a physician. Yet, when I was alone, the sense of hopelessness was becoming insufferable...

    I called a friend in psychiatry who saw me the next day. When asked to summarize why life was so painful, I didn't have to even think. "All I do is disappoint people. No matter what I am doing, there is always someone angry or disappointed that I am not doing what I should for them."

    The answer to my prayers came in a way I did not expect, in the form of a caring, kind and well-trained psychiatrist who prescribed an antidepressant. My response to the medication was rapid. Within two weeks I felt as though someone had turned on a light in a very dark room. It wasn't until I felt normal that I realized how dark my thoughts had become...

    The sense of freedom and joy that has followed has restored my enjoyment of life and those I love. As a result, I am more attentive to my own health and try to listen to those who love me.

    One of the most curious ironies in reflecting upon my story was the fact that although I had helped numerous young distressed physicians get help and cared for innumerable patients struggling with depression, I was unable to see it clearly in my own life. And this is something that I think is easy for many physicians to experience.