A few hours ago, I saw my last "office" patient for a few months, as I am now on an indefinite Medical Leave and looking in other directions for a while. This decision has been a time of reflection and although I do not feel 'burnt out', there is a bit of an exhaustion beyond just my health.
What I will miss the most is the special privledge of being with people on their journey. This has not changed for the past 30 years. I am just as humbled now as I was long ago. Medicine has given me rewards beyond any expectation: a wonderful opportunity to serve, a comfortable life for my family, intellectual challenges, association with some of the best people on earth, and exposure to a world I never imagined existed.
What I will not miss, is the evolution of primary care medicine into a gimmee gimmee experience, replete with greed, self-service, political correctness and manipulation. More and more patients seem to want something other than appropriate medical care: i.e. Vicodin, a written excuse to slack from work, Viagra for a lousy sex life, to stop their spouse from drinking, to get sedatives, more Vicodan, telephone Rx for antibiotics; after a while you start to feel like a well paid drug pusher. All too often, patients do not want your opinion, your concern, your medical expertise anymore than they want that from the corner drug dealer.
What perhaps is the more unpleasant gimme experience are the Insurance Companies and HMOs that seems to know better than me how to care for patients and routinely try to convince me and the patient that the cheaper drug is actually better treatment rather than the truth: that cheaper drugs mean bigger profits. Getting scans and care for my sick patients has deteriorated into a grovel and a plea on behalf of the patient. My ability to grovel seems more important than my ability to make medical decisions. I think the patient's fear that if they get a catastrophic illness, their HMO/INS company will abandon them, is a very realistic concern.
Perhaps that is why I gravitate toward senior and long-term care: these folks are the people of the greatest generation, who have nothing but gratitude. And because they have been neglected by insurance companies and the greedy medical predators, you rarely have to grovel, or make excuses, in order to provide outstanding care.
No-one particularly cares that none of my HIV patients in the last 10 years have died, that none of my arteriosclerotic or diabetic patients have been amuptated, that none of my hypertensive or diabetic patients have had to go on kidney dialysis, that all my transplant patients are alive and well - what seems to count more is my speed at Rxing the Vicodan or pulling strings to get 'em into the dermatologist for a brown spot or saving a few bucks for the HMO.
Do not get me wrong - I am extremely grateful for what has been my medical practice, but the constant 'demands' by insurance, HMOs and unhappy people eventually dulls your edge.
Hope a rest after 30 years of continuous medical practice infuses new energy. My personal philosophy is that of the Hard Rock Cafe: Love All - Serve All
Peace and Health...
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