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A Doctor’s Personal Graveyard

By March 30, 2017September 13th, 20195 Comments

My first week of internship was frightening!

That first night of call is forever engraved in my memory. I was little more than a month out from graduation and running a code on telemetry. I really had no business running that code, but if I didn’t, then who would?

I read voraciously and tried to learn as much as I could out of fear that I might screw up and harm someone. It was trial by fire and I was determined to survive without killing anyone.

Fear was a great motivating factor in those days and served me well in my maturation into a full-fledged physician.

I survived that first month in the MICU and moved on to a month of Trauma Surgery. Call was brutal and it was not uncommon to work 120-hour workweeks. My immediate supervisor was another emergency medicine resident in his third year.

He was a nice guy and we got along well. For the purposes of this article, let’s call him John. John did everything he could to teach me and look out for me on the rotation. It was a level I trauma center so there was no shortage of patients.

One day, one of his patients in the SICU coded and John was called to his beside. The patient was intubated with an intracranial pressure monitor, arterial lines, central lines, and all kinds of medicines running through his veins. John started CPR and called for backup.

But nobody came.

Our attending physician was in the operating room on a long case that he wouldn’t be free from for hours. So John frantically plugged away doing everything he could.

There were fluids, and pressors, and CVP and ICP readings. The patient would regain his pulse for a while just to have it go away again. This went on for some time and John threw the kitchen sink at him, but nothing worked. He called the attending again just to be rebuffed anew.

That didn’t stop John. He called down to the ER and asked if that attending would help him. He couldn’t abandon the patients in the ER, but sent the fourth year resident up in his place.

Despite their best efforts it was futile.

It was a lot for my intern brain to absorb, but I could see the anguish that John endured trying to save this patient’s life.

When all was said and done and the trauma surgery attending showed up, he didn’t commend John for a job well done or offer a single word of encouragement. Instead, he said:

All doctors have their own personal graveyard – A place in which patients go as a direct result of their doctor’s mistakes and miscalculations. Yours will be bigger than most.

You could have heard a pin drop when he said it, but the silence didn’t last long. John lost it and was reduced to tears. The emotion of the day coupled with sleep deprivation and callous words proved to be too much.

While the breadth and depth of my knowledge at that time was limited, I didn’t need a medical degree to know a jerk when I saw one. That attending was out of line and John left immediately. In fact, John never finished that month of trauma surgery. He simply quit.

As the years have gone by, I sometimes think back to that distant memory. After having practiced medicine for almost two decades I haven’t changed my opinion on the abusiveness of that trauma surgeon and his piercing condemnation.

Having said that, I now realize that there was some truth in those words. Every doctor does have those cases that they wished they had handled differently. Maybe it’s a blatant error of commission that haunts them on a daily basis. Others live with more subtle errors of omission in which they wonder if an outcome would have been different had they just acted sooner or taken another path.

I know I have a couple of cases too. The lingering doubt and what if scenarios never really go away and just become something you have to learn to live with.

The reality is that being a doctor is hard.

However, the privilege of taking care of patients and making a real difference in their lives has always outweighed those hardships. At least that’s what it used to be like.

Unfortunately, medicine has changed.

Somewhere along the line, medicine was hijacked by third-party payers backed by government regulators demanding a new focus away from patient care and toward cost containment.

This morass of new regulation has overrun medicine, putting dollars ahead of patient care. That is incongruent with our calling and is leading to physician discontent. Just as John quit so many years ago, many of us are fed up and quitting today.

This is medicine’s new graveyard? filled with doctors and their careers.

Take for example the study published in the December 2015 issue of Mayo Clinic Proceedings that concluded that:

Burnout and satisfaction with work-life balance in US physicians worsened from 2011 to 2014. More than half of US physicians are now experiencing professional burnout.

That’s no typo; physician dissatisfaction is currently at epidemic proportions with 54% experiencing burnout. Additionally, suicide rates among doctors rank among the highest of any profession; hovering around twice that of the general public. It’s not surprising that the overwhelming majority of doctors wouldn’t recommend the profession to others.

While the cause of their dismay is multifactorial, doctors consistently attribute the massive documentation burden from the electronic medical record as their greatest frustration. Technology should enhance the doctor’s ability to care for their patients, not hinder it. And yet, doctors find themselves spending more time entering data into an error-prone computer system than on actually seeing patients.

In fact, a 2016 study in the Annals of Internal Medicine found that for every hour a doctor spends on patient care, they spend an additional two hours on documentation requirements. Two-thirds of our days are spent complying with government-mandated check boxes and navigating insurance company landmines.

Is it any wonder why burnout rates and depression amongst doctors is at an all time high? Shackling doctors to meaningless busy work takes them away from direct patient care. It’s wasteful and it’s demoralizing.

In many ways, medicine has become unrecognizable. Unless we tame the bloated bureaucratic nonsense coming from government regulators, health care administrators, and insurance company executives we will continue to see a growing graveyard rooted in physician discontent.

 

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Dennis Bethel

Dennis Bethel

After 18 years of working in the trenches of a broken health care system, Dennis Bethel, M.D. extricated himself from medicine utilizing the power of passive income from real estate. Now he helps others conquer their number one financial fear, cut their biggest expense, and tame the greatest threat to their careers.

5 Comments

  • Dr. Jack says:

    Age: 66. In the past, docs in my specialty would work until they were 80. I’m happy to be sliding out because of the morass of insurance and government regulations.

    • Dennis Bethel says:

      Hello Dr. Jack, I’m glad to hear that you are able to get yourself out of the mess that has been created. I’ve done the same. I had mixed feelings as the patients need us. However, the third parties have inserted themselves so far into the doctor-patient relationship that it has become incredibly hard to actually care for them. I spent more of my days complying with meaningless mandates than caring for patients. It’s sad!

  • Edward j. Floyd says:

    I agree 100% with everything said in the article. I wish all will read it

  • Dave Buckman says:

    100% correct on all points! I practiced 30 years before most of this bureaucratic nonsense became front and center. Is it any wonder that we have a hard time encouraging young people to go into medicine. I loved what I did and still keep in touch with some of my patients. Lawyers and politicians are the fly in the ointment. God bless those who still provide great care in a fractured system and I pray that my grandchildren and great grandchildren will be able to find competent , caring physicians in the future. Thanks to Dr. Bethel for this article because it is time we wake up and deal with this impending disaster.

  • Philip Monroe says:

    When I retired last year after 40 years practicing Primary Care, I was concerned about leaving the patient interaction and problem solving. However, because of the hassle of EMRs, Medicare, and especially insurance company mandates and denials, I don’t miss any of it! I haven’t noticed that any of these mandates have improved outcomes, but they have certainly chilled the doctor-patient relationship.

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