Category Archives: the dichotomies of doctoring

49% Wouldn’t Do It Again

I was shocked quite frankly.

I suppose I shouldn’t be – after all, in every profession there are dissatisfied folks, those who discover that its not everything they imagined it might be. And I’ve certainly heard from docs who were indeed very unhappy.

According to a recent study in 2015, only 51% of physicians surveyed would still choose medicine as a career, down from 62% just four years earlier. Granted, this study was looking at one sub-set of medicine. But still…

51

Some would say its the fault of the current government. Or ever-declining reimbursements. Some would point at the ‘big business’ of medicine and decry how it has eclipsed any attempt at real service as the soul-destroying grind becomes overwhelming.

I remember about a decade ago when I hesitantly mentioned to a few doctor-friends that I was thinking of pursuing medicine, they all took great pains to tell me all the downsides. “Go into nursing, or become a PA”, they said. “Be a therapist if you want to heal people; become a scientist if you love studying Biology or the human body. Medicine is nothing like it used to be and I’d never do it again if I had the choice.”

I was curious, so I did a little snooping around.

A recent survey of over 95,000 nurses concluded that there was an alarming degree of job dissatisfaction and burnout in the profession.

MetLife’s annual teacher survey shows an “alarming” trend downward with only 39% of teachers satisfied with their jobs.

In fact, according to a job satisfaction survey that has been conducted annually for the last 30+ years, only 48% of Americans are satisfied with their jobs.

I suppose there are many different takeaways possible from this. Having lived as many decades as I have, I say, Bah Humbug to all the grousing about how unhappy any particular profession is – including medicine. The grass is no greener in any other job. The grind, unending documentation, onerous government regulations, stressful working conditions and limited autonomy – its everywhere!

And for all those who say they’d never go into medicine (or whatever profession) again… guess what? Its not the job! Its not the profession.

Teachers want to be doctors. Doctors want to be pilots. Cashiers wish they’d gone into Psychology and salespeople dream of finishing their MBA so they can have the corner office and make higher salaries. Those who never had the chance to get a higher education are certain they’d be happy if only they had, and those with multiple letters after their names fantasize about giving it all up and living on an island.

Just stop. We are more than our titles, bigger than the parts of us defined by who signs our paychecks. I’ve decided to completely ignore those who try to discourage someone’s dream based on their own “job dissatisfaction”.

Repeat after me:

I am strong. I am talented in these ways. I enjoy these parts of what I do, don’t enjoy these other parts, and can make peace with that. If I can’t make peace, I will make a change.

All that to say this: Yes, I’m aware that many of my colleagues had (or are having) highly stressful and even profoundly negative experiences during their medical education. I hear stories nearly every day from physicians who are deeply unhappy. Yet I remain convinced that its not the profession. PEOPLE are unhappy. In every profession.

I just happen to be overwhelmingly thrilled with every tiny speck of this journey I’ve embarked on. Every sleep-deprived study marathon. Each boring or hard to understand lecturer. Even meeting fellow professionals who seem rude or condescending or who don’t practice medicine the way I would. And including the not-at-all glamorous parts like ‘having to’ learn mounds of minutia that will be mostly obsolete by the time I’m in residency.

As long as we’re human, we get to take ourselves along into any profession.

Who I am is so much more.

 

The Pendulum Swings

I’m daily reminded of the gaping chasm between academic medicine and actual medical practice. I don’t have a solution (yet), but I notice it. Mostly on days when I’m in clinic or making housecalls or working in the ER with my clinical mentor.

I went into this grand adventure hearing for at least the last decade how more than half the information I learn in medical school would be obsolete by the time I graduated. That’s a theoretical and interesting fact until one is experiencing the whiplash going back and forth between clinical experience and memorizing seemingly endless facts.

Things like: if the evidence is incontrovertible that antibiotics simply don’t benefit patients with acute bronchitis, why are we taught to prescribe it?

If evidence indicates no net benefit for Tamiflu, why are we taught to use it?

Why are we taught to use thrombolytics for acute ischemic stroke when evidence shows they don’t help a single patient?

If there’s no advantage to using PSA to screen for prostate cancer

Well, you get the picture.

I spend hours every day learning, memorizing, absorbing all the details of development, anatomy and physiology of different body systems, what can go wrong, and how to treat it when that ‘wrong’ becomes reality. I enjoy (truly) every moment of this learning experience. But then there’s the whiplash of seeing patients with bronchitis, grossly enlarged prostate, or pharyngitis and watching docs cite the latest research and say something like, “The evidence shows that we could actually cause more harm than good by treating this with antibiotics …. With very few exceptions, your body really will take care of the infection.”

What’s even worse is watching docs prescribe treatments that they know have no benefit, because their employer has published the protocol, or because they’re afraid of litigation.

Holding both treat, or don’t treat, in my head at the same time sometimes makes me a little twitchy. I’ll admit, as a baby-boomer I’m thoroughly immersed in the belief that there’s a pill for just about everything, and its been tough to let that go. So in some ways, I’m much more comfortable memorizing lists of medications to treat various disease states. Yet I keep coming back to what I experience out there in the real world of patient care, learning from docs who are providing the very best care possible to their patients.

Perhaps by the time I’m a practicing physician, the pendulum will have swung back the other way. But I find myself hoping not. I dream of being part of a medical profession that intervenes rarely, that prescribes only when the evidence is incontrovertible that the benefits outweigh the risks, and that truly has the overall best interests of the patient in mind at every moment. I’m idealistic enough to believe I can help make that happen.