The mental break is needed. I know it won’t be a particularly restful vacation – how is it possible with 3 children, the youngest of whom enjoys waking up at the crack of dawn? But it will be a break from the daily grindhouse, of that I am sure.
It also means a small break from my half-marathon training. Yes, that is going quite well, but the long runs will take a small backseat over the next two weeks or so. I will aim to run 3-4 times a week regardless, they just won’t be more than 10k. I worry about losing momentum but I think I have developed a good base which should carry me through.
I hope to return from the lake with a rested mind. My patients need it. I need it.
This summer marked 12 years since I became a family physician. I have had my family practice, whereby I am primary care physician for close to a thousand patients, for the past 10 years. I have learned a tremendous amount this past decade but over the past couple of years I have come to realize that I cannot be everything to everyone.
Let me state that again.
I cannot be everything to everyone.
In the early days of practice, I used to believe that if I couldn’t help a patient that must mean I failed them in some way. After one patient yelled at me because I wasn’t helping them enough, I nearly broke down. I was just back from my first maternity leave and struggling with my own post-partum depression. To be yelled at in my own office and basically told that I was a shitty doctor, well it was the first time I came to tears while seeing a patient. I had to excuse myself and take a breath. Thank goodness for my colleagues present in the office that day. After I composed myself and debriefed with one of them, I walked back into the exam room. I listened to his concerns and formulated a plan for him. The appointment ended.
I learned a valuable lesson that day. I can’t fix people’s lives and while I believe that many patients don’t really expect me to, there is often an unspoken expectation that because I am a physician, I somehow have the answer to all that ails them.
Let me be perfectly clear on this…. I do not.
I can’t fix your life.
I can provide you advice, counsel and recommend options to you – all this in about 15 minutes, sometimes half an hour. I just can’t delve into your life and pick the up the pieces for you. I can’t do that for one patient, let alone close to a thousand patients.
Having said that, I still do sometimes want to be able to be present for and participate in all aspects of a patient’s care – to be there when their baby is born; to be there when the breast cancer is surgically removed; to be there when the chemotherapy is administered; to hold their hand as they take their last breath.
I want to do it all. I want to be that all-encompassing physician who does it all.
Do I vote yes and be complicit in accepting a 4 year agreement that knowingly under funds health care and continues to reduce my income; or do I say no and be subject to further unknown unilateral fee cuts for the foreseeable future.
Not so easy a choice is it?
Better to be screwed facing your attacker? Or better to be blindsided from behind?
Because that’s essentially what the physicians in my province are facing.
Damned if we do. Damned if we don’t.
I am not political. Never have been and really, never want to be. But I just can’t stay quiet on this any longer.
I am being asked to trust a government that has grossly mismanaged health care for years now and wastes taxpayers money on scandal after scandal.
I am being asked to help manage utilization of health care resources. What does that mean? Do I tell a patient that they can’t have that ultrasound because we have exceeded the budget for that month? Do I close my office one day a week because I am exceeding the budget for that month? Do I tell my staff to take an unpaid vacation day once a week because I can no longer afford to pay them for 40 hours of work anymore?
Waiting in the ER as a family member is boring and nerve-wracking. Waiting as a family member and a physician, watching your parent wince in pain is excruciating.
When I arrived he was seated in a wheelchair in the “Green Zone”, where the sprains and strains are waiting. He looked pale and sweaty and his heartrate was about 110. (Normal is 60-80). I found the nurse, explained who I was (daughter, not doctor) told her in medical terms what I had found when I saw him. She did an ECG (normal except for the fast rate) and moved him into the main ER. And two hours later we are still waiting to see a doctor. He is triaged as “back pain” and so we wait.
I finally couldn’t take it anymore watching him wince in pain and asked a nurse if we could get him something for pain and moved to a bed. About twenty minutes later the doctor shows up and my dad is lying down in a bed. He’s still sweaty and in pain. He also says he’s a bit winded and has a bit of chest discomfort.
The squeaky wheel gets the grease.
Percocet on board and labs drawn.
And the worst of it? I was supposed to be with my daughter and Aunt watching a live production of Cinderella.
December is not a good month to be a family doctor, or any doctor for that matter. I have lost count the number of bad diagnoses I have had to give before Christmas. What an incredibly shitty way to end a year.
“I’m so sorry to have to tell you this, but that lump in your groin is lymphoma.”
“The biopsy has confirmed it’s malignant melanoma.
“Unfortunately, your baby stopped growing around 9 weeks of pregnancy.”
“The lump in your breast is suspicious for cancer.”
January is sometimes even worse. Who wants to start a new year with bad news?
Every year I feel like I’m back here lamenting the fact that it’s supposed to be a magical time of year, these “holidays”, and I’m forced to give more people more bad news. Can’t I just have one year where everyone is healthy? Is that really too much to ask for?
I’m really trying very hard not to feel like a complete idiot right now.
I attended another appointment with my parents today. It was a follow up with the physician that made a diagnosis last year of minimal cognitive impairment (MCI). Since we were seen there last year there’s been some worsening of his memory and behavior and we were assessed by a different neurologist to rule out a structural brain disease called Normal Pressure Hydrocephalus. It was at that appointment a few weeks ago that the diagnosis of Alzheimer’s dementia was made.
At today’s appointment I sensed a bit of push back from the geriatrician as to why we were seen at a different clinic. After explaining, I then asked her a few questions about disease progression and whether starting medication last year might have helped. I didn’t think I was being critical but when the physician turned to me and asked, “Well, you’ve read the literature, right?” I felt like she went on the defensive. I said I had, (and I had read about minimal cognitive impairment last year!) she asked me what I remembered.
Um, excuse me? This wasn’t a teaching moment. I’m not her resident. I’m asking as a daughter, not a physician. I couldn’t believe she was treating me that way, and in front of my parents. I don’t care if she was pissed off that we went to another hospital and got a diagnosis, she had no right to treat me like that.
I was honest and said I couldn’t recall. She then answered my question. 10-15% of patients with MCI progress. Sadly my father is one of them. And starting medication earlier would not have been indicated. In fact it could have made things worse. As she related the information to me it started to come back. Still, I felt stupid for not remembering it and even more stupid for asking the questions. All I can see is my dad and his diagnosis. I should have the intellectual capacity to look clinically at the literature and apply it to my dad but you know, I can’t.
I’m just his daughter today.
I debriefed with my colleagues today and they agreed that it really wasn’t appropriate the way the specialist treated me. I have to get over my anger because this is the person who will be caring for my dad. I have to find a way to put it behind me. But right now, I can’t.
I was up at the crack of dawn this morning (what else is new?) but this time to take my dad to a specialist appointment. We are the first ones here, even before the receptionist!
Since I have taken over this role of being present at most of my parents’ various specialist appointments, I have come to enjoy watching another physician do a physical examination. It’s a great refresher for me, especially the neurological exam. This was my nemesis in medical school. It is probably the most complex sequence of tests and observations I have ever had to learn and I still feel like I never mastered it.
Today I witnessed a skilled clinical fellow perform a thorough neurological examination on my dad.
I knew everything she was doing and why. There were tests I had forgotten about, ones that are very specific and others more general. At the end of the 3 hour appointment, we had some answers and now a few hours later, I have nothing but questions.
I need time to process. I know the road ahead of us. I’ve seen patients and their families go through it. It’s not what I wanted for my parents, least of all my father.
But this is life. It is hard. It is ugly. It is rewarding. It is love.