Doctor’s Fantasy: leave psychiatry to sell Tupperware

Tupperware

Dear Pamela:

I can’t tell if I’m burned out or just don’t like being a doctor. My own medical school experience was so abusive. I wonder how other students like me fare when they enter abusive residency programs. I supposedly work at a place that values patients above all else, but it feels like everyone is exhausted and miserable and that the needs of our administration come first. And anyone who tries to say anything about it gets called lazy.

I hope the new generation of physicians will demand better treatment, but even this week I could sense how much young doctors just crave compassionate mentorship. They’re so grateful to be told simple things like: “It’s okay. I’ve been there too. I’ve stumbled in my career path ten thousand times. I know what it’s like to be lonely here, to feel like an imposter who can’t do things right. You don’t have to make up answers to insolvable problems. Patients just want you to be a human being, living and breathing with them, and respecting their voices.”

Medicine attracts perfectionists, and our training sharpens that quality into a dagger. The worst part—we become so diminished in our own self-worth that we no longer appreciate or even offer the healing that is the true legacy of doctoring.

I’m finishing my final year of psychiatry residency (thank god) and I’m just so tired. I used to think that things would improve after residency, but now I realize there’s no guarantee.

In my profession there’s an immense pressure to maintain “boundaries,” and they scoff at anything which is close to poorly defined. Many psychiatrists seem obsessed with proving that our field is “real” medicine, so they break patients into algorithms and charts, refer them to highly structured, easily quantifiable courses of psychotherapy that don’t allow deviation from “the treatment plan.” They measure illnesses with checkboxes and screeners rather than actually listening to any individual’s story.

But I doubt any medical specialty can actually heal patients this way, even for the most easily definable problems! How does a fool-proof algorithm for blood pressure control help if patients cannot get their prescriptions, or hate taking medicine, or can’t remember to take it, or quit due to side effects that they’re afraid to disclose, or any of the other millions of reasons that get in the way of good patient outcomes?! And those are things that you can never discuss in a ten-minute appointment.

Anyway, I’m glad that there are so many physicians who feel this same way, and even some who are brave enough to talk about it openly!!! How did we get so brainwashed that we actually believed that advocating for ourselves and for our patients meant we were lazy or inadequate? It’s so crazy. Nobody needed to oppress me by the time I graduated med school: I was the taskmaster and the criticizer.

When I talk about changing things, people says it’s not possible and we’re all doomed to misery and blah blah . . . Sometimes I say, “Well if that’s the case then I just won’t do it. I’ll pay off my loans and then go find something else.” My colleagues always look so shocked—as if they don’t have the same secret thoughts!!!

I’m about to have my last “performance review” with my abusive boss. My friends outside of medicine don’t believe me when I share the abuse I’ve experienced during my training. Lots of doctors try to pretend it’s normal, but it’s not. I go back and forth between trying to stand up for myself and thinking I should just put my head down and not cause myself any more problems. Most of the time I spend fantasizing about doing any other job—selling Tupperware, painting, working at a library—something normal, where nobody swears at me or treats me like I’m lazy after a 16-hour day. But really what I’d like to do is treat people with respect and provide therapy and run groups and teach mindfulness meditation. I just don’t know how to get from here to there.

I would write more but I have to fill out about 600 pointless electronic evaluations of my colleagues, in order for us to better wound each other anonymously. Yay!

Xoxoxo

Janelle

This letter was received and edited for clarity by Pamela Wible, M.D., a family physician and pioneer in the ideal medical care movement. Dr. Wible helps medical students and physicians recover from abuse and trains doctors to open ideal medical clinics at her biannual physician retreats. Photo by GeVe.

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I love old people, but I will not accept Medicare

Medicare

I love caring for patients—young and old. And though I may not accept your insurance, I will always accept you. I’m still happy to care for Medicare patients even though I opted out of Medicare in 2006. Why don’t I accept Medicare? Let me fill you in.

I do not accept Medicare because:

Medicare treats physicians as criminals—guilty until proven innocent.

Medicare warns patients on their billing statements to turn their physicians in for suspected fraud.

Medicare demonstrates no transparency in the flow of taxpayer money through their program.

Medicare may reimburse physicians so little that we lose money with each appointment forcing doctors to go bankrupt (or run Medicare mills with ramped up volume and quickie visits to make ends meet).

Medicare claims are more complex than any other insurer with more billing codes and rules and regulations that require hiring a team of staff to remain compliant or else . . .

Medicare regulatory codes by which physicians must abide is 130,000 pages long! (US Tax code is only 75,000).

Medicare requires compliance with more unfunded mandates and administrative trivia than any other insurer.

Medicare penalizes physicians financially if we don’t use a Medicare-approved computer system and electronic health record.

Medicare penalizes physicians financially if we don’t electronically submit prescriptions the way Medicare demands.

Medicare threatens doctors every year with all sorts of financial penalties if we don’t do what they (non-physicians) think we should be doing.

Medicare audits may suddenly destroy a medical practice and a physician’s life as described by Dr. Karen Smith:

Medicare abuses and bullies doctors.

This is no way to treat people who have dedicated their lives to helping others.

Pamela Wible, M.D., is a family physician who pioneered the first medical clinic designed by patients. Watch her TEDx talk on ideal medical care. Photo by GeVe.

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I may not accept your insurance, but I will always accept you

Accept Insurance:YOU

Just for the record: I am happy to see you—irrespective of your insurance.

I accept most insurance plans. And if I don’t accept your insurance, I have a very good reason.

I will not sign a contract with a health insurer that:

Abuses and bullies me and/or my patients.

Denies all my first claims.

Reimburses me so little that I may go out of business.

Leverages a $50 penalty against me when my patients accidentally go to out-of-network labs.

Charges me hundreds of dollars of “membership fees” before I’m allowed to see their patients.

Offers me a contract that dictates my responsibility for THEIR legal fees if they determine I did something wrong.

Keeps me on hold and rotating through multiple phone lines while never addressing my concerns.

Treats me like a criminal.

Assigns me patients who have not selected me as their doctor.

Pays me through a complex formula that even a mathematical prodigy can’t understand.

Penalizes me financially if I don’t use the type of computer system that they think I should use.

Penalizes me financially if I don’t electronically submit my prescriptions the way they think I should.

Threatens me and my colleagues every year with all sorts of financial penalties if we don’t do what they (non-physicians) think we should be doing.

Insurance companies have done all of these things to me. My choice to end my relationships with abusive insurance companies will never impact the quality of medical care that you’ll receive from me. I will always care for you even if I do not care for your insurance company.

Just saying.

Pamela Wible, M.D., is a family physician who pioneered the first medical clinic designed by patients. Watch her TEDx talk on ideal medical care. Photo by GeVe.

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