Three More Hours

I am sitting in a salon chair finally getting my hair done. It desperately needs some help and this was the only time I could fit it in. I 

work this afternoon and then I am off for almost three weeks. 

Three weeks! 

Three more hours of patient visits to go. 

Three more hours of lab reports, consults and prescription renewals. 

Three more hours of dealing with other people’s problems. 

Yesterday I started to worry that I was getting depressed again. I suddenly just felt … I don’t know, I felt off. I felt like I just didn’t care about any of it anymore. I didn’t want to go home and face the chaos of trying to clean and pack and deal with the kids. 

But then I got home and amongst the chaos and dirty faces and piles of laundry to fold, I felt immensely better.  I was happy to be home. I can’t begin to describe how reassuring that was to feel. Despite the state of emergency that my house is currently in, I was happy to be home and in the middle of it. 

I don’t need a break from my family, house or kids. I need a break from work. 

Only three more hours to go. 

The “F” word.

Now, now… get your minds outta the gutter.

The “F” word I am referring to is Fibromyalgia.

It’s plagued my office work over the last few weeks.  It’s a diagnosis I hate. It’s difficult to tell a patient they meet the criteria for diagnosis. It’s difficult to manage and impossible to treat (for the most part).

Fibromyalgia (fibromyositis, myositis):Fibromyalgia is a common syndrome in which a person has long-term, body-wide pain and tenderness in the joints, muscles, tendons, and other soft tissues.   Fibromyalgia has also been linked to fatigue, sleep problems, headaches, depression, and anxiety. (Source: PubMed Health)

It’s hard enough treating chronic pain, but treating widespread chronic pain, in mostly women, with our without other psychological issues is a whole entire other matter.  It’s not surprising to me that the recommended treatments include medications which also have some mood stabilizing qualities.  But how to explain that to a patient?  “Hi, you have FM.  I’m going to suggest a medication that has been used in the depressed population.”  Um … say again?  “I’m not depressed, I’m in pain.”  Most patients refuse.  Those that don’t often recognize that there is some element of mental health issue that could be playing a role.  Others are adamant that those medications are not for them and insist on being seen by yet another Rheumatologist, or Neurologist, or “pain specialist”.  These patients often have had every test imaginable – x-rays, EMG, MRI, CT.  And for the most part, the results are normal.  I can understand the patient’s frustration – but imagine what it’s like from my perspective???  I have cost the health care system money in diagnosing that there is no pathological cause of their pain.  Yet, they are still in pain.

What does one do?

Some doctors would just start the narcotics, but that’s a slippery slope and never ends well.

Conservative treatment suggests exercise, healthy diet and OTC analgesics (like Tylenol or Advil).  How does one exercise when they’re in pain?  How do you explain to these patients that their pain will get better with mild-moderate exercise?

The thing that gets me the most with Fibromyalgia is the first thing on the list as possible causes (see also: Mayo Clinic) — physical or emotional stress.   There rarely is an individual whom I’ve seen diagnosed with Fibromyalgia who doesn’t have some emotional/psychological trauma in their past. I believe it’s their subconscious way of coping.  It’s somehow easier to describe (and therefore sometimes treat) physical pain rather than emotional/psychological pain.

I am at a loss most times with how to deal with these patients.  I know they are in pain but my options are limited.  I am already beginning to resent the select few who threaten harm to themselves “if you can’t help me”.  What they fail to realize is that I am trying to help them and that sometimes, thoughts of them keep me  up at night.

The Road to Burnout?

I’m experiencing a bit of writer’s block.  I’ve spent most of the past week thinking about what to write and decided that maybe if I just start writing I’ll think of something.

I’ve been following quite a few blogs and recently read a great post about a new mom, a physician, going back to work and she talked about Compassion Fatigue.

After a quick google search, I realized that I suffer from this at least once a month.  Sometimes I just can’t muster up the compassion a patient is seeking.  Sometimes I just don’t care.  Does that make me a bad doctor?  Sometimes, I think it does.

I have some patients who don’t cope.  With anything.  Traumatic childhoods lead to traumatic adolescence which inevitably lead to traumatic adulthood.  These patients learn to rely on others to fix their lives, most commonly their doctor.  Finding support for these individuals is difficult.  While they may present as depressed or anxious, or with chronic back pain, not only are they seeking the golden answer to solving their pain, they often come to the office expecting it.  As if they are somehow entitled to it.

  • “What do you mean I can’t get my physiotherapy covered?”
  • “How am I supposed to pay for that if I can’t work because my back pain is so bad?”
  • “Why can’t I see a psychiatrist once a week?”
  • “Why won’t you help me?”

I’m fairly lucky that I have only a few of these kinds of patients in my practice.  Yet, somehow I always seem to see them in the same week.  Is it the cycle of the moon?  I’m not sure, but I do know that at the end of such a week (this was last week), I am tired.  Mentally tired and emotionally drained.  I can see how dealing with these “chronics” can lead to a physician’s burnout.  I can see how it can lead to my burnout.

So how does one avoid burnout?  In particular, how does a physician avoid burnout when dealing with these kinds of patients?  A colleague of mine gave me some great advice a few years ago.  He told me something really simple.  “You can’t fix these people.  Don’t even try. Support them as much as you can, but don’t expect to save them.  You’re going to lose one or two and it’s not your fault.  Remember that and you’ll be fine.”

I’ll pose the question to my readers, physician or not …

What do you do to avoid burnout?