“In my lifetime I want to see the culture of medicine driven more by relationship than by revenue.”
–me
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.
WHY?
Because we are too busy.
DOING WHAT?
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
Patients suck
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
Really?
Oh and it happens on both sides
Doctors suck
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
Really?
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
In Solidarity
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
Healing Through Connection 
Catherine, thank you for this. I recently moved & had to start over with a new GP & psychiatrist. It’s daunting, but I was determined to start creating relationships with them both—to patiently answer questions I’ve had to answer 100 times before, to calmly present my learned experience, to thank them for caring about my obesity/intolerance to drugs/etc.
I will not give up this time. I will not get mad/silent/offended. I will keep looking for the person and the professional while I hold my boundaries and self-respect.
Thank you for the important work you do.
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Sandy Sue!
Thank you for continuing to follow this blog!
Hope you are settling in and finding more peace each day in your new home.
I have faith that your new doctors will resonate with your authentic presentation of hope and connection. May you hold one another up in this morass of our healthcare system, serve each other as partners, and lead by shining example for the rest of us, physicians and patients alike. ❤️
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The idea that we are all on the same team seems so elemental; why is it so darn difficult? It feels like there is something in certain systems—not just in medicine, but education, civil discourse, even religion—that benefits if we cannot come together. With regard to health care, I can blame insurance, and undoubtedly a lot of blame lies there, but there’s something more that I can’t wrap my head around. It sometimes seems that from the moment we come into the world, we are encouraged to look for differences and to jockey for the top position. I love this post, Cathy, and I’m so glad to see you back in the blogosphere. Keep asking the hard questions—and living them—until one day, as Rilke predicts, we will “live along some distant day into the answer.”
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Thank you, Donna!
I agree, and every day I learn about yet another layer of divergent self-interest looking to take a piece of the pie. Some days I get positively despondent. Thankfully, that never lasts long. We must hold tight and push through. When you fall down I will pick you up and vice versa. It’s the only way.
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OMG, Cathy, you just slammed one of my hot bottons–with so much force it’s now stuck.
One day I will share my thoughts in more detail. To me, the root of most of our primary care woes lies within three f….ing letters: R..V..U.
“You get what you pay for”. Most docs, especially primary care in the NM system are paid by how many RVU’S they generate. True caring, relating, healing cannot be measured in RVU’S.
Most docs I know want to do “the right thing” but what exactly is “right”. When our worth to the system is defined by how many RVU’S we generate (as it is now) our future, in my opinion, is bleak.
By the way, I LOVE MY JOB. I strongly encourage my patients to use the patient portal. In the exam room I usually have the computer positioned so my patient can see what I am entering, AND my AVS actually consists of my advice to the patient. I have been fortunate to usually work with an MA who knows how to help me with the pre-auth nonsense. Oh, and I am salaried–though management still closely monitors my RVU production.
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Of course you are right, Larry! Quantifying the art and science of medicine and caring for our fellow humans in ‘work units’ is total and complete bullshit. And still, here we are. While we still feel this work is more meaningful than stressful, we have a chance at saving it, if only we can grow the inner light of true connection and belonging to one another.
But more and more I learn that the oppositional, adversarial attitude and approach is likely counterproductive. It feels Righteous and powerful in the moment, and ultimately undermines the objective—strength in connection and shared goals. And I’m thinking of more than just medicine now—just look at political discourse around the world, not just here.
*sigh*
So I guess I’m not a total cynic just yet. Some days, though…. 🤨
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