How do you deal with the weight of being a medical provider

[SavingMyself98]

Although it might sound unconventional, my career aspirations have evolved significantly over time. Initially drawn to forensic psychology, I pursued my bachelor's degree in the field. However, upon realizing the extensive time and financial commitment required for a PhD, I opted to explore my second passion: medicine. I've always been intrigued by the practice of medicine, and I am now actively pursuing admission to Physician Assistant (PA) programs.

As I progress in this journey, I find myself grappling with the weight of the profession. The thought of being legally and morally responsible for the well-being of others is daunting, especially considering my predisposition to anxiety. I wonder: Does this sense of responsibility lessen with experience? Are there alternative career paths within the PA field, such as research or education, where this burden is less pronounced? Or does my hesitation suggest that this profession may not be the right fit for me?

I welcome insights and perspectives from current or former practicing PAs. Thank you for your time and input.

[SedRate]

10 hours ago, SavingMyself98 said:

Does this sense of responsibility lessen with experience?

Yes and no. As you gain experience, you become more comfortable with being uncomfortable. You'll learn that it's impossible to know everything, and you'll be much better at figuring things out and get the patient the care they need. 

[ohiovolffemtp]

I often tell patients that I'll help them feel "less bad" - because feeling well will take time and may not happen completely.

I also came to learn that it's pointless to care more about a patient's health than they do themselves.

After ~11 years of practice I came to learn that I have only some control in any situation: we're always part of a team, with nurses, techs, consultants, and the patient themselves.    Most of our "mistakes" have only minor effects anyway.  You'll become knowledgeable and skillful enough to avoid the big mistakes.

However, as I listen to other providers: physicians, PA's, NP's, I still occasionally hear stories that make me glad I didn't have certain patients.

[UGoLong]

After 18 years, I think that being a PA has taught me to be diligent, to "start low and go slow" with med changes, to research approaches, and to talk to other providers.

In an emergency, I revert to the EMS model that I worked under for more than 30 years: "You have whatever resources you have and the team you happen to be on today. You are the decision-maker: take a deep breath and then take your best shot."

[rev ronin]

It was midnight, and I was sitting in another Intel Employee's cubicle copying off all of his devices for the FBI. I was looking at the wedding photos of the (currently suspended) employee, wondering about the moral impact of what my actions were doing to him.

The next day, I shared my disquiet with my office partner, a former police officer now a corporate security investigator also involved in cleaning up the mess, and he pointed out that I hadn't taken the actions that drew the FBI's ire, the suspended employee had. All I was doing was what the feds had asked us to do for them rather than them seizing a ton of corporate computers that they ended up not needing to make their case anyways. That insight helped.

In much the same way, we are substantially not responsible for patient outcomes. Our job is to do the right thing by the patient in front of us. In almost every case, the circumstances that brought the patient to you are not your doing: their own choices, someone else's choices, or just the natural chaos that pervades the universe led to their circumstances. All you are responsible for doing is what you can do. In the medical system, this often involves referrals that are blocked by insurance, drugs that are denied by insurance, or care of whatever kind that is unreasonably delayed by circumstances beyond you or your patient's control. You're not responsible for that, either, even though it really sucks to not be able to care for the patient because you are not given the tools to do so. Every clinician needs a way of dealing with the moral injury of not being able to provide good end-to-end care due to issues we have no control over.

[SedRate]

5 hours ago, rev ronin said:

It was midnight, and I was sitting in another Intel Employee's cubicle copying off all of his devices for the FBI. I was looking at the wedding photos of the (currently suspended) employee, wondering about the moral impact of what my actions were doing to him.

The next day, I shared my disquiet with my office partner, a former police officer now a corporate security investigator also involved in cleaning up the mess, and he pointed out that I hadn't taken the actions that drew the FBI's ire, the suspended employee had. All I was doing was what the feds had asked us to do for them rather than them seizing a ton of corporate computers that they ended up not needing to make their case anyways. That insight helped.

In much the same way, we are substantially not responsible for patient outcomes. Our job is to do the right thing by the patient in front of us. In almost every case, the circumstances that brought the patient to you are not your doing: their own choices, someone else's choices, or just the natural chaos that pervades the universe led to their circumstances. All you are responsible for doing is what you can do. In the medical system, this often involves referrals that are blocked by insurance, drugs that are denied by insurance, or care of whatever kind that is unreasonably delayed by circumstances beyond you or your patient's control. You're not responsible for that, either, even though it really sucks to not be able to care for the patient because you are not given the tools to do so. Every clinician needs a way of dealing with the moral injury of not being able to provide good end-to-end care due to issues we have no control over.

Well said.

5 hours ago, rev ronin said:

All you are responsible for doing is what you can do

This statement has really helped me and my patients. 

[EMEDPA]

On 3/19/2024 at 4:57 PM, UGoLong said:

 

In an emergency, I revert to the EMS model that I worked under for more than 30 years: "You have whatever resources you have and the team you happen to be on today. You are the decision-maker: take a deep breath and then take your best shot."

Love this. Kinda like " slow is smooth and smooth is fast". Had an EM doc tell me that once when I was rushing an intubation and I have never forgotten it. 

[SedRate]

2 hours ago, EMEDPA said:

" slow is smooth and smooth is fast". Had an EM doc tell me that once when I was rushing an intubation and I have never forgotten it. 

Yes! I love this.