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Monday, June 13, 2005

Medicine IS awesome and I miss it but many docs can't wait to retire

Medical Madhouse recently commented that at least some of what is done by doctors is "F**king awesome" and added that in the heat of the moment we do not appreciate the awesomeness of the activity. (having made that attribution I can't find that comment on his blog site).He is right.

Further to that, when you retire from medicine the fact is that very little you routinely do is even in the same neighborhood as awesome. The intensity of the awe generating activities for most physicians may peak out in the house officer years, at least I believe that is true for internsts. For example, as a first year resident ( now called a second year resident) I treated 14 cases of DKA in coma.They all seemed to occur at night and in those days the first year resident ran the show. All recovered-one was apneic in the ER.In many years of practice I saw no DKA with coma, and in general the awesome incidence was much lower. Lower, but not absent.There was also more low key awe. Longer term relationships with patients, small victories and the occasional burst of awe.There is the satisfaction of doing things in keeping with current thinking in a given application and explaining to a patient why this or that approach might be best and having the patient actually do what you suggest and subsequently seeing that particular approach actually work. There is a bit of awe there. It is clearly awesome to treat an acute asthmatic patient and see their dyspnea lessened fairly quickly and to see the shortness of breath markedly improve in minutes with treatment of acute pulmonary edema. I thought it awesome to have several members of a law firm call for check up appointments because you had diagnosed atrial septal defect in their 46 year old female partner who claimed she couldn't have that because she had had 30 exams in her life and none had said anything, but she had it and she was operated. But....

I have recently been at my 1965 medical school class reunion. Many had retired and none of the retirees would admit they missed anything. No one talked about the awe of medicine.
(admittedly this sample is likely biased i.e. limited to those who retired and who go to reunions, while some or maybe all of the reunion non-goers may be euphoric or at least content at their continuing practice) But at least for a sizeable number of my class they could not wait to retire and miss nothing of it according to their accounts. Those who retired could only speak of the multiple negative effects of managed care and concern about malpractice. Many had been retired for 4 or 5 years having retired before age 60. The alumni organization had arranged lectures on various aspects of current medical education and those who spoke radiated enthusiasm and described exciting medical advances and I left that meeting supported by their energy.

 The 1965 class dinner, though filled with handshakes and hugs and a few shared memories and seemingly sincere laughter, projected the picture of a group of people who were glad to quit and sad that the profession that seemed to offer so much a few decades ago offered them now no pleasure and little satisfaction and more than a little bitterness. I hope that the docs who don't go to med school reunions represent a different mindset.


Anonymous said...

I found your comments very interesting. I'm interested in examples of people who seek non-monetary compensation, i.e., psychic and reputational rewards, the ego rush of "saving" a life over just cash.

Of course, no man is an island, and doctors don't really save lives. The enormous industrial-scientific project, which belongs to society as a whole, does.

Nonetheless, it is certainly true that as medicine has become corporatized, doctor's autonomy--and with it a good bit of the psychic rewards--has been diminished with the increasing power of HMOs and insurance companies. (though as a statistical matter, average inflation-adjusted income as increased--particularly if increasing starting salaries are counted over a career) Perhaps, income has remained constant--just the coin has changed.

Should we, as a society, be worried about that? The supply of people wanting to be doctors is still high. There're plenty of Indians and Philipinos who want to move here and practice. Do patients suffer if their doctors don't feel like masters-of-the-universe? No evidence of that. Do other professions love what they do? Hmmm. Law school reunions I suspect are equally glum.

There is another way to look at this. As knowledge/technology improves, medicine should become more routine and boring. That's a good thing.

james gaulte said...

Thanks for the comments.Very interesting thoughts.

Anonymous said...

"I have recently been at my 1965 medical school class reunion. Many had retired and none of the retirees would admit they missed anything."

I retired from medicine at age 46 and don't miss it one bit. I'm just one data point but getting out of medicine was the best thing I ever did for myself and my family.

Maurice Bernstein, M.D. said...

As in my case, being retired but also teaching clinical medicine to medical students gives me the best of both worlds: more personal choice of what I do with my time and still the awe of interacting with patients and their diseases but not having the patient responsibility. ..Maurice.

Anonymous said...

I hope to be able to do some clinical teaching as well with IM residents starting next year.

Moi said...

I do get the feeling that many of the doctors I've been to were burned out or would rather have been retired.

I'd like to have a doctor with your mindset!
I have multiple food intolerances that I have formed antibodies to, according to RAST test results. I also have confirmed gluten intolerance, intestinal inflammation (endoscopy), and a host of menstrual problems, including a ruptured cyst found with ultrasound...
I have been to SO many doctors trying to find a reason for why I developed all of these digestive problems and other issues in my early twenties.
I was always made to feel like, if they couldn't find a pill that would fix it or a definitive diagnosis, it was all in my head.
I even went to a shrink to find out if I was unconsciously making it all up (no).

Am I the pet peeve of doctors? I get the feeling that they would much rather see someone with diabetes, a stroke, cancer, heart attack, etc.
Every doctor I saw reffered me to another one ane the new one would refer me to another one...
Now, I don't go to the doctor at all.
I feel like I'm doing them a service by not stepping in their office.
What do you do when you have a patient that has unexplainable symptoms and abnormal test results but cannot be diagnosed? You seem like one of the good ones!

Anonymous said...

To the lady who commented just above,

You're right, it can be frustrating.

Like any professional doctors are most useful when the problem you have is something they can fix. When there is a mismatch, you are likely to be frustrated because your problem isn't going away, and he is likely to be frustrated because he is unable to help you, something he probably subconciously feels he has to do because his profession trained him that way.

Sometimes a suggestion that a patient see a psychiatrist is borne of frustration. Usually its because there is genuine concern that psychological issues are causing, contributing to, or aggravating the disorder. This is often a correct supposition because psychological problems are so common - they are probably the most common cause of illness in developed countries aside from some common infections like the cold.

Certainly from your very frank blog, you have stressors in your life, it doesnt seem unreasonable to suggest seeing a mental health professional - learning coping strategies can help.