We went into medicine to help people, and now we struggle with feelings of betrayal.
We sacrificed so much. While our cohort in college went on to graduate and earn an income and start families, we continued with medical school, an all-in venture financially and personally, demanding all our time, efforts, and attention. Then we trained. And trained some more. And then, finally, we went to work. We took our rightful place, as doctors, after a grueling 12-plus years plus of education and training for which many of us went into significant debt.
I think it is safe to say that becoming a physician was rife with proud moments and a tremendous sense of accomplishment. We survived a grueling process and, as a result, can offer earned expertise and excellent care.
The sacrifice is critical; it plays a big role in the unwritten rules of engagement. I worked hard to get here, at a significant cost to myself and my family, so that I could take care of you, my patient.
So when a patient is argumentative, hostile, or uncooperative, there is much more at stake than just an unpleasant exchange. We feel betrayed.
While many patients neither read, nor agreed to, our implicit rules, we have certainly been betrayed by our keepers, the corporations with which we have signed contracts to do our work. That work, to date, has been so all-consuming that we have worn blinders. We have agreed to work harder for increasingly less compensation, accommodating increasingly difficult circumstances, tolerating consistently eroded satisfaction, so that we could keep taking care of our patients.
And we risked our lives, all of us, collectively, over the last year and a half. Many lauded us as heroes, and we were heroic. On the other hand, many buried their heads to the reality, preferring to believe elaborate fantasies instead.
Again the work of gaining our expertise was betrayed, this time by deniers of a lethal pandemic, both politically and within an increasingly untrusting and hostile patient population. And all of this with inadequate protective equipment.
Truth: We can be heroic, as any human can, but we are not heroes. We are a diverse group of individuals with varying beliefs, values, and character flaws who generally work hard. Some feel trapped by finances. Some carry significant debt. Some feel trapped by expectations or the simple failure to have ever considered doing anything else. And some will tolerate any circumstances just for the privilege of being a physician and caring for patients.
The inherent rewards are great. It is indescribably satisfying to help others in such a concretely beneficial way. You feel sick, want to have a baby, need chronic care to avoid illness, are suffering, and in pain — and I am here. This is a sacred relationship.
But the terms of commitment have changed and are beyond simple reframing as a solution. Our paradigms are shifting with tectonic force.
We struggle to find our way in a morass of influence outside of our control. An industry increasingly determines how we deliver care, denies our orders and recommendations, eats up our precious time, frustrates our efforts — despite the sacrifices we made, despite the expertise we gained.
And that industry rarely offers a decision-maker appropriately educated to call those shots. Increasingly, non-physicians are making physician care decisions. This is not an attitude problem on our part. These are the realities we practice in even as we are being replaced by providers who did not go through the rigorous education and training demanded of medicine.
This is a bitter reality to come to terms with. So what do we do?
Many physicians express a deep, only partly understood, anger; many go part-time or leave medicine altogether. Some find or make favorable circumstances in which to practice. All is not lost. We are all watching and wondering where the state of our practices will evolve. We are unsettled.
I think it is safe to say our blinders are off, and we know we need to become politically involved to protect our investment, our ability to practice without so much interference. We need to gather, unite, and cooperate towards a common goal.
The terms are simple: I am a doctor, and in exchange for caring for your health, I make a good living and have time for my family, interests outside of medicine, and myself.
Can we make this happen? Or do we continue down the destructive path we have been led to before we took the blinders off?
Maire Daugharty, MD, is an anesthesiologist.
This post appeared on KevinMD.