“In my lifetime I want to see the culture of medicine driven more by relationship than by revenue.”
Nice to be back, friends!
This post is a bit different from my usual format and style. It’s maybe more raw and blunt.
Please bear with me and keep an open mind?
I know posting this may be risky. It started out as just jotting down ideas for a longer, more detailed future post. I had to get the ideas and thoughts out so I could focus on work. And then the ‘jotting’ somehow evolved into what I imagine a poetry slam might look like. So I decided to post as is.
My long term objective is to stimulate generous thought and respectful discussion between patients and physicians. I wish to prod us out of our default complaint modes and reorient all of us to the idea that we are all on the same team, but our connections are under siege by outside forces. The system harms and oppresses us, physicians and patients, the end users, and the ones with the real power. Together, we are the sleeping (sedated?) giant that must rise up and reclaim the system for ourselves. This post is an attempt to spark the flame that draws us together, by pointing directly to the spikes that drive us apart.
Disclaimer: What follows is my own expression and does not represent or reflect the opinion or position of any colleague, institution, or professional society with whom I associate or to which I belong.
I hear my colleagues say: Get rid of the patient portal!
It’s too much!
Limiting characters does not work, they just send multiple messages
Charging for messages just makes more work
“They abuse the system”
“We give an inch, they take a mile”
Keep them away!
Us vs. Them mentality.
Antithetical to mission of medicine: To meet patients where they need us, and help them.
Because we are too busy.
Every. F*ing. Thing.
Rx prior authorizations
Endless documentation, infinite clicks
Rx refills with no information on follow up or patient status
Filling slots to meet RVU goals
Prescribing more meds to meet “quality” goals
Keeping up with the latest evidence for every disease, test, treatment, guideline, diet fad
Rushing to the next patient so that the patient we’re with does not have time to even think of their questions, must less ask them
Patients walk away from visits with their true needs unmet.
So they use the resources available to them to ask for what they need.
And this ‘adds’ to our work
And we feel busier and more frustrated, exhausted, frayed, irritable
We feel Overwhelmed.
Patients also feel it
They feel unseen, unheard, dismissed, discarded
And they don’t understand or relate to where it comes from
They get angry
So they send more messages: to us, about us; criticizing us, lashing out
Making us feel bad about ourselves
Which manifests as defensiveness first, then even more frustration, exhaustion, irritability
But we don’t disengage.
We remember our calling.
We forge on in smoldering resentment, pride, bitterness, duty, guilt, shame, and occasional fulfillment
And then abstractions to reconcile the cognitive dissonance
All they do is take take take
They don’t understand that I’m Doing My Best to help them
Why don’t they appreciate me
They are so entitled these days
They want everything now now now
They think I’m at their beck and call
Like I’m not working every minute of every day
Like I don’t have a family and a life also
Like I live only to serve them
Patients are the enemy
Oh and it happens on both sides
All they do is type away at that blasted computer
They don’t even look up, see me, or hear me
They don’t understand what I need
They just want to see more patients
Make more money
I’m just a number to them
A cog on a conveyor belt
They’re all in the pockets of Big Pharma and Insurance
They withhold the help I need
They hoard it
They don’t care about me
They Don’t Care About Patients
All they care about is making the next buck
Doctors are the enemy
There is no substitute for the Time and Energy
Required to cultivate Healthy, mutually Respectful, mutually Fulfilling, mutually Beneficial relationships
It is always a two-way street
Our relationships kill us or save us. Always.
Doctors and patients must find ways to reconnect
Find one another through the thick morass
And Hold Tight
Learn, Train and Practice Together
Our Communication, Empathy, Compassion, and Collaboration skills
Defend against the forces that drive us apart
Advocate for one another and for our Sacred Contract
So we may once again
Heal Through Connection