Not enjoying medicine, wanting out

[GetMeOuttaThisMess]

To expand on TWR's statement, I have now had the opportunity to work with just about all the cross-sections of society with the hope that the answer was working with a specific subset of the population that I had yet to run across (too poor, too rich, not educated, too educated, etc.), or a different specialty setting.  Unfortunately, they all have their quirks and issues.  It has taken me all this time to come to the realization that you have so much more quickly.  I believe what delayed my realization was the dramatic change in the profession from the 70's/80's until present day and realizing that my old school training may not be enough to allow for a satisfactory comfort level in today's medicine (we didn't have a general surgery option in school for example), as well as coming to grips that old-school patient responsibility and a desire to better themselves just isn't necessarily the case any longer.  They want what they want, and they want it yesterday.  I feel that I have been living the medical profession version of the Book of Ecclesiastes from the Bible.

 

I wish I had the answer for you, and looking back, the comfort level of the known as opposed to the unknown and steady income coming in can be an awfully strong draw to keep you in a field that you just may not enjoy.  I think your observation that the medicine is interesting but not the one-on-one interaction is dead on.  I have yet to locate an opportunity that would somehow blend this unique combination.  Best of luck to you.

[Guest Paula]

^^^^^^  There is nothing new under the sun......all is vanity, vanity.

[GetMeOuttaThisMess]

^^^^ Tried this, tried that, and nothing gave me that personal, deep satisfaction with regard to work.  Short term?  Yes.  Long term?  No.  Referencing a prior thread regarding telemedicine, I wonder if this might be something that would be a nice segue until retirement time when I can drive the yellow ball cap NAPA Auto Parts pickup ;-)?

[EMEDPA]

I'll be honest---I do not like being a PA or healthcare in general most days. 

 

A little background: I'm in my early 30's, been practicing for a little over 2 years. First gig was in Ortho Spine---hated it---current gig is in Occ Med and disability evals. It's tolerable but in no way do I love it, and many days I hate it.

 

there is your answer. Occ med is probably the specialty with the most difficult pt demographic, many pts faking illness/injury to get money....as others in the thread have said, try working in a setting in which you are appreciated, like ANYTHING rural or underserved.

[BruceBanner]

...as well as coming to grips that old-school patient responsibility and a desire to better themselves just isn't necessarily the case any longer.  They want what they want, and they want it yesterday.  I feel that I have been living the medical profession version of the Book of Ecclesiastes from the Bible.

 

I wish I had the answer for you, and looking back, the comfort level of the known as opposed to the unknown and steady income coming in can be an awfully strong draw to keep you in a field that you just may not enjoy.  I think your observation that the medicine is interesting but not the one-on-one interaction is dead on.  I have yet to locate an opportunity that would somehow blend this unique combination.  Best of luck to you.

 

Thanks for your thoughts. I totally agree with the above. Granted, I am very green in terms of practicing, but I did expect people to take a lot more accountability in their own care. Perhaps they do more so in other specialties, but I feel like "drive-thru doctor" here.

 

I am going to take other's advice here and keep digging for a better fit. If it comes time for my first recert and I still hate it, then I'll feel more confident about getting out of medicine entirely. 

[FBIDoc]

I have struggled with this career choice for years...I still do to some extent, but have found a niche in IR...my average procedure is 30 mins of patient face time, I do a variety of spine, body, and vascular procedures, have some admin time, round on a couple of the cerebral aneurysms/SAHs...it's a M-F 8-5 gig, no nights/weekends/holidays, and the private practice group I work for is amazingly pro-PA.  PM me if you're interested as we may be hiring a second PA this year.

 

Oh, and it gives me time to work on opening my distillery!  Cheers. 

[Joelseff]

^^^^^^ There is nothing new under the sun......all is vanity, vanity.

Or "meaningless, meaningless..."

[GetMeOuttaThisMess]

I have struggled with this career choice for years...I still do to some extent, but have found a niche in IR...my average procedure is 30 mins of patient face time, I do a variety of spine, body, and vascular procedures, have some admin time, round on a couple of the cerebral aneurysms/SAHs...it's a M-F 8-5 gig, no nights/weekends/holidays, and the private practice group I work for is amazingly pro-PA.  PM me if you're interested as we may be hiring a second PA this year.

 

Oh, and it gives me time to work on opening my distillery!  Cheers. 

 

I am really kicking myself in the backside for not interviewing with our local medical school last summer for an IR position.  Had a local offer down the street that went belly up.  Love your patient exposure statement!  Darn!  I just realized that we're out of our "mash" after getting back from the islands this week.

[winterallsummer]

Other procedure heavy fields may be good for the OP as well.  For example there are some PA cath lab positions I have heard about.  Or if you like the OR (not my thing personally), there are positions with 70-90%+ OR time. If you really don't like dealing with patients (sick or well) then this is the way to go.

 

The other thing is you may have just been exposed to a very crappy patient population.  I have heard a lot of horror stories about ortho spine and occ med.  Personally I really don't like seeing back pain myself.  Often these people think every problem in their life is because of their back pain and have unrealistic expectations of what medicine will do for them.   Other times they are outright drug abusers.  Even the honest and nice ones who are realistic can be frustrating because you see they are in pain but can do very little for them. Their negativity is often transferrable and dealing with that day after day could suck the life out of anyone.  

 

I know you didn't have a favorite rotation but what was your general feel on other rotations?  When pts came to you with a more managable or fixable problem, did you enjoy helping them?  

[Derbingle]

I have noted that most of the people who are not enjoying the ride (myself included 1/3 of the time), are a compassionate bunch who really want to help people and do medicine. Unfortunately, business models for profit are prevailing and what medicine wants are money minded business people, not folks who really want to help. And with malingerers weighing on the system, compassionate people are forced to be uncompassionate (if thats a word) which sucks!

[physasst]

Other procedure heavy fields may be good for the OP as well.  For example there are some PA cath lab positions I have heard about.  Or if you like the OR (not my thing personally), there are positions with 70-90%+ OR time. If you really don't like dealing with patients (sick or well) then this is the way to go.

 

The other thing is you may have just been exposed to a very crappy patient population.  I have heard a lot of horror stories about ortho spine and occ med.  Personally I really don't like seeing back pain myself.  Often these people think every problem in their life is because of their back pain and have unrealistic expectations of what medicine will do for them.   Other times they are outright drug abusers.  Even the honest and nice ones who are realistic can be frustrating because you see they are in pain but can do very little for them. Their negativity is often transferrable and dealing with that day after day could suck the life out of anyone.  

 

I know you didn't have a favorite rotation but what was your general feel on other rotations?  When pts came to you with a more managable or fixable problem, did you enjoy helping them?  

Back pain is fun! Agree with the unrealistic expectations, but that's my role in Spine, to get them to understand that we have very little to offer them.

 

I even keep a magic wand in my desk. When I have a patient who just isn't "getting it" regarding their axial pain, I will occasionally pull it out (it's Disney, so it works you know) and offer to wave it over their back.

 

It often creates the "aha" moment.

 

I work in chronic pain, and manage complex spine patients from all over the world. I can count on both of my hands how many narcotics prescriptions I have written in the past 12 months. Cause the answer (in the absence of an acute radic, fracture, tumor, etc.) is simply no.

 

I write for a lot of therapy.

 

I love spine patients.

[winterallsummer]

Yes I agree not all back pain is bad.  Sometimes you can really improve QOL for these patients and it is very rewarding.  And then there are pts you can really make a huge change for.  But to deal with it day in, day out, I would imagine most (not all) would get frustrated.

[GetMeOuttaThisMess]

I always noticed that private pay/insured had faster recoveries and a greater likelihood for success compared to WC pts..

[Joelseff]

We used to have WC companies send us DVD's of pts dancing, washing their big ass SUVs, jumping on trampolines etc from private investigators hired by them to observe patients. They would even add statements like "PA Joelseff and Dr. So-and-so must have done a tremendous job because Patient So-and-so clearly has made a full recovery." These are the same patients who know what to say and do on exam to garner a schedule RX and request crap like a tempur-pedic mattress and additions to their home (I kid you not! )

 

I agree that spine was actually VERY interesting and I would even say I am the resident back guy at our practice since I do a more thorough exam and plan than my SP for spine issues but to do day in day out, was not MY cup of tea. Some ppl love it like Physasst does (love the magic wand bit by the way LOL, I'm copying that :D). You just have to get in where you fit in.

[UGoLong]

There certainly are conflicts between the practice of medicine and the business of medicine. This is an especially big deal for docs in private practice in an era of decreasing reimbursements. I feel that pressure every day and have experimented with different ways of handling it. As PAs, we don’t have infinite flexibility from the work rules in our offices, but we can still choose how we will view the very next patient encounter. When the door closes, it’s just you and your patient.

 

I know, for example, that I have to keep moving to handle today’s schedule.   I also know that, if I need to slow down in order to solve a particular patient’s problem, I can choose to do that.  A battle will go on between my ears over the demands of the office and the needs of my patient.  I know that I can’t drag out every patient encounter, but I know that I personally need to spend time whenever I think that it is important to do so.

 

Realizing that I have this flexibility is something that took some time to develop.  My SP, who runs and owns his practice, is acutely aware of the pressures of time and money.  I am also aware that some of my pay is productivity-based.  Still, I did not become a PA to once again totally succumb to the lure of income.  I need to respect my beliefs too.

 

The one thing that separates my being a PA from all of the other jobs I’ve held is exactly this: every day there will be several moments when I know exactly why I am doing this job.  I need to stay present for those moments.  If I’m not, then my days are just meaningless efforts to eke out a living and nothing more.

[DJ Bunnell MSHS PA-C]

I have cared for children with congenital abnormalities and I have cared for the lady who faked a seizure multiple times per week after eating at a restaurant only to recover as we arrived in the ER and walk out of the ambulance.  I understand the spectrum.   Fair warning...I'm going to be hard on you but keep reading because I will back off at the end.

 

Life and people are messy.  Your "Don't Like" list is what life can be.  My interpretation is that you wish to care for people who have become sick or injured in a manner in which you approve.  I guarantee that this would be a bad opening for your essay if you were applying to get into PA school.  This business is not about us.  It is about people and all of their frailties.  We do silly, annoying, and stupid things.  Sometimes we complain of back or head pain when in reality we are so overwhelmed with our troubles that it is all we can think of saying.  However, sometimes we are complaining of back pain when it turns out we have metastatic prostate cancer that was undiagnosed. (An actual case that I have seen.)  Sometimes we complain of a sore throat when we actually have Ludwig's angina.  (Another case that I have seen.) 

 

However, I do applaud that you are expressing your messy and complicated feelings.  I am certain that you are not alone.  Our working life looks a lot like that of Physicians and they have an alarming rate of dissatisfaction, depression, and suicide.  Why should our ranks be different in that respect if everything else is starting to be more similar as time passes.  What do I know?  I don't work where you work nor do I live your life.  Maybe you are getting a steady diet of misery and I should be more sympathetic to your plight.  However, it is not your patients fault that you are currently in a job that is mismatched for your interests.  While you are figuring out what is right for you, try spending some time putting yourself in your patients' shoes.  If you label the back pain sufferer as a malingerer then you miss why they are coming to you to complain of the pain.  They may not be in pain, they may have a pain syndrome that science does't really understand yet, or they may have a big problem that has a common symptom.

 

All of that being said, if you are truly unhappy and a different perspective doesn't change your feelings then get out of this job quickly and find something you do love.  Forget about what it looks like on your CV.  Life is too short to be miserable every day.  You owe it to yourself and the people you love to work for peace of mind and to do great things.  Good luck and thank-you for sharing your story.    

[roman6163]

What I LIKE about medicine:

 

-Using my skills to help someone who TRULY needs it, i.e. injured or ill through no fault of their own.

-Diagnostics and decision-making

-The money

 

What I DON'T like about medicine:

 

-The patients: Malingerers, factitious pts, somatosizers, whiners, non-English speakers, drug seekers

-The chaos of a walk-in clinic

-Sick visits

-Mundane tasks like physicals, charting, etc

-Treating people who don't need or don't appreciate care

-Insurance dictating my scope of care

-The list goes on

 

 

 

Bruce, you said it exactly the way I feel.

 

I'm gonna start doing Locums beginning next year and do some travelling to some cool and exotic places and get away from some of these patients who excel in this"entitlement mentality"

 

Try to hopefully see some people who actually need the medical care and aren't out to just bilk the system, get their free medical care or get their endless supply of free pain meds.......

[UGoLong]

Honestly, non-English speakers are on your list?

 

1. Would our ancestors have survived to the point where we would have been born without a healthcare provider helping them at some point? Thank God someone took care of my immigrant grandparents!

 

2. Don't you have access to translators? It still makes for a slightly longer patient visit, but it's better than pantomime.

 

While a fair amount of what happens to people's health is in their hands, all of it isn't. While some frustration goes with the job (and other jobs as well), if one finds themselves constantly judging the motives of their patients, then they are in the wrong place. And if how a patient looks or talks or got to the US is an issue that interferes with the job, then another profession might be in order.

[Guest JMPA]

• Don't even get me started on these "non-english" speakers. Don't you just love it when they demand a translator, absorb all your time for trivial nonsense, and then speak fluent english when they feel they ae done? Yeah, i feel your frustration. To assume the OP as a bad person wis wrong. All patients should be judged on their motives, looks, talks, and sometimes "got to the US" status. Thats how a good clinician provides adequate care. Whats next, we should not ask family history or social history because it is deemed judging the motives of others?

[physasst]

but I did expect people to take a lot more accountability in their own care. Perhaps they do more so in other specialties, but I feel like "drive-thru doctor" here.

 

They don't. Reminds me of an axial, mechanical back pain patient I saw recently who was obese, and had advanced lower lumbar facet arthropathy. I see a lot of these patients, late 40's through 90's. My usual approach is therapy first, with interventions such as facet joint injections, or MBB w rhizotomy as a second line treatment. Meds are third line. I also set expectations immediately. I tell ALL of my chronic axial patients that we will NEVER, EVER make them pain free. That is not a realistic expectation. I tell them, that if I can get them 60-70% better? That's a win....that's a BIG win.

 

When I explained that I would not recommend injections as first line therapy as they are only temporary, and therapy will provide longer lasting benefit with lower risks, and that, because of that, I would like to exhaust the therapy option first. She seemed disappointed....now, MOST patients here, will nod, and say, "Yeah, that makes sense"...and will go and try the therapy.

 

She told me.."Well, just so you know, I'm not really disciplined" It took every bit of self control to not nod and say 'you don't say' given her obesity. But, I listened, and she expanded "I'm probably not going to do the therapy, cause that sounds like too much work, I don't understand why I can't just have the injection".

 

My reply? "Ma'am, my back doesn't hurt.....YOUR back hurts. I will wake up tomorrow morning and feel fine. YOU need to take ownership of this, and YOU need to participate in your care".......One of my physiatry colleagues was walking by, and he had to stop himself from laughing.

 

She needed a wake up.....

 

Two weeks later...guess what.....she called in to complain (not that I was surprised) and asked to see a "real" doctor. I scheduled her with my Spine Center Director, and he's already reviewed it, and said she's going to hear the same answers from him.

 

See, I used to dread chronic pain patients, I used to shudder seeing back pain on a presenting complaint, but I actually enjoy the confrontation now. I enjoy the discussion, because, when you hit a home run.....and you do..not all the time, but you do...you can dramatically change someones life.

[GetMeOuttaThisMess]

^^^.  Man, am I getting t'd off again just reading this.  It's been 26+ years since I heard this on a regular basis and it still gets to me.  No wonder that I feel the way that I do about these folks.  The best are those that alternate between the lumbar spine and the cervical spine every other year and end up with surgeries to both.  Looking back, I really don't recall a high, long-term success rate with our rhizotomies, even though the patient did great with the block.  That was another thing that drove me nuts.  You spell out for the patient the timeline with regard to the anesthetic effect and then the potential steroid benefit.  They come back in the office in a couple of weeks and you ask how the block did?  Their response was "it didn't work".  Then you inquire as to short-term benefit from the anesthetic and they tell you that they were great for several hours initially, then better again over the next several days, but today, while in the office, it's horrible again.  DUH!  For each and every one of these folks, as punishment, they should receive a discogram to an unhealthy disc (for those who aren't familiar with discography, while the procedure is not painless, it is much more uncomfortable to those with unhealthy discs).  Yes, I'm mean this morning...

[physasst]

^^^.  Man, am I getting t'd off again just reading this.  It's been 26+ years since I heard this on a regular basis and it still gets to me.  No wonder that I feel the way that I do about these folks.  The best are those that alternate between the lumbar spine and the cervical spine every other year and end up with surgeries to both.  Looking back, I really don't recall a high, long-term success rate with our rhizotomies, even though the patient did great with the block.  That was another thing that drove me nuts.  You spell out for the patient the timeline with regard to the anesthetic effect and then the potential steroid benefit.  They come back in the office in a couple of weeks and you ask how the block did?  Their response was "it didn't work".  Then you inquire as to short-term benefit from the anesthetic and they tell you that they were great for several hours initially, then better again over the next several days, but today, while in the office, it's horrible again.  DUH!  For each and every one of these folks, as punishment, they should receive a discogram to an unhealthy disc (for those who aren't familiar with discography, while the procedure is not painless, it is much more uncomfortable to those with unhealthy discs).  Yes, I'm mean this morning...

See I love them, because often, my job is to tell them that there isn't much left that we can do, and that cognitive behavioral therapy and learning to live with it is the best treatment I have.

 

It's also the best treatment for ANY chronic pain, and I've seen homeruns with our pain rehab, but patients are often frustrated with that. I don't mind that...

 

Remember....Law #4. The patient is the one with the disease...

 

Mike

[cinntsp]

Honestly, non-English speakers are on your list?

 

1. Would our ancestors have survived to the point where we would have been born without a healthcare provider helping them at some point? Thank God someone took care of my immigrant grandparents!

 

2. Don't you have access to translators? It still makes for a slightly longer patient visit, but it's better than pantomime.

 

While a fair amount of what happens to people's health is in their hands, all of it isn't. While some frustration goes with the job (and other jobs as well), if one finds themselves constantly judging the motives of their patients, then they are in the wrong place. And if how a patient looks or talks or got to the US is an issue that interferes with the job, then another profession might be in order.

 

I don't think this is fair to the OP.  I am doing my clinicals in a city where my patient population is nearing 90% Hispanic and a large portion of them do not speak English.  It gets tiring sometimes to have to go find a nurse, who is already busy doing their own thing, to translate.  Family members are sometimes there but don't always understand medical jargon enough to be helpful.  When someone translates for you, you aren't sure if what you are asking or if what the patient is saying is truly coming across the way you need it to in order to practice good medicine.  Hospitals offer translation services, but who has time to pass a phone back and forth with the patient?  Patients get upset when you tell them you don't speak Spanish and to hold on a moment until someone who does can see them.  Doing a thorough H&P requires a good command of the language.  All of this makes for a huge time sink and can leave you frustrated and unsure about your decision-making process.  It can be taxing when it's like this day in and day out.  

 

So, I doubt the OP has a dislike for the actual patients that don't speak English, but rather a dislike of the aggravation and hassle that often comes with it.  I can empathize. 

[GetMeOuttaThisMess]

See I love them, because often, my job is to tell them that there isn't much left that we can do, and that cognitive behavioral therapy and learning to live with it is the best treatment I have.

 

It's also the best treatment for ANY chronic pain, and I've seen homeruns with our pain rehab, but patients are often frustrated with that. I don't mind that...

 

Remember....Law #4. The patient is the one with the disease...

 

Mike

 

Oh, trust me, I did my best to shed the light upon the darkness.  I always told these folks pre-op that if their goal was to come out of a surgical procedure pain-free then they had an unrealistic expectation.  The goal of the surgery was to provide improvement in the pain complaints as well as the level of daily function.  It always seemed to fall upon deaf ears, as long as the check kept appearing in the mail each week.  It goes back to what I have posted previously in other threads.  My personality is that of a "fixer".  If someone has a problem and they mention it to me then my expectation is that they want it fixed.  When they don't make an effort to help themselves (losing the spare tire around their waist and yet they continue to complain) then I have found that frustrating.  I have found it easier over the years to appreciate your stated rule, which I now strongly subscribe to.  How dead on that book was, in all it's darkest humor.

[GetMeOuttaThisMess]

As a separate note to this thread, I found this article, re-posted by USAToday, to be positive and reassuring as to why some of us continue to make the attempt to help those who come before us for assistance.

 

http://www.cincinnati.com/longform/news/2014/06/16/pancreas-transplant-organ-donation/10591867/