I recently received a phone call from a potential patient. A physician colleague made the referral. Over the phone, the prospective patient, speaking in a fast and anxious pace, told me that her primary care doctor "broke down and cried" during a recent visit because of how worried she was about her patient's well-being. As I gently probed for more information, it was not at all clear that this patient felt stressed or distressed. Yet, it was clear that the primary care doctor was in a great deal of trouble. This raises a familiar question in medical consultation. Who, in fact, is the patient? The person calling or the clinician that referred them?
What does it mean when a physician breaks down and cries about a patient's situation?
It can sometimes happen that physicians express emotions about a patient in a way that can institute change, including a needed plea for engagement in psychotherapy. Physicians can't do it all, and the more savvy of them know when they need the help of a mental health professional to also look after a patient. Yet, in this instance, the patient was telling me that it was her physician that seemed overwhelmed. It was not clear that this patient wanted or needed therapy. I then wondered who was more stressed out, the patient calling or her referring physician.
Whether or not this story is accurate, doctors seem scared and stressed out these days. The fears can seem basic and financial. Fears about the always-impending Medicare SGR cuts are omnipresent. Now, the sequester cuts that took place on Friday, March 1 indicate even further cuts to Medicare reimbursement for physicians.
Beyond this immediate crisis, physicians do seem to be nervous these days; physicians are increasingly dissatisfied with medical practice. One by one, doctors I used to refer to are leaving traditional practice settings.
An added factor is that no one really knows how medical practice is going to shake out in 2014. Despite what we, the public, might think about The Patient Protection and Affordable Care Act, doctors are running scared. At times, the running is literal. Increasingly, physicians are getting out of the insurance game and trying to cajole patients into cash pay practices.
Physicians in traditional private practice worry about how they will pay their bills. Reimbursement decreases every year, while expenses increase. Will there be a model for private practice medicine in this country? No one really knows.
Medicine in general is undergoing an identity crisis. Doctors are less satisfied and financially compensated than ever before. The older generations of physicians are used to sending their kids to private school while still paying a mortgage. Increasingly, doctors are part of the regular middle-class and not the upper-middle-class. They simply cannot pay a mortgage and afford private school for their kids.
For those of us who do not work in medicine, this may seem to be overdue justice. Some doctors have over-billed and over-exaggerated their billing, and this has contributed to the health care crisis we are all faced with. Yet, I think about today's medical students, many who come out of medical school with more than $300,000 of debt, and I wonder if our outrage is fair. Physicians not only have an arduous education that most of us could not obtain (or afford), they are at the front lines of dealing with the trauma of medicine every day. It is mostly young people who find themselves in medical school. As students and residents, they see the entire spectrum of human misery and unfairness: brain injuries, random accidents, the people who do everything right and still end up with cancer. I could go on, but young doctors see things most of us don't.
When I think about medicine and medical reimbursement, I can get as worked up as anyone about the lack of good care and the high price I need to pay to find someone who pays attention to me. However, doctors are highly trained and experience more than their share of vicarious trauma in taking care of people who have bodies that don't work. They are also less compensated than any other generation in medicine. Maybe doctors should receive combat pay, in the ways that soldiers do. At least this would help to pay for sometimes needed psychotherapy. Physicians also need someone to listen and provide support.
Are doctors stressed? Yes. Even in the best-case scenario, they have to develop coping mechanisms to deal with medical trauma every day. This is a lot to ask of young people who aspire to take care of traumatized medical patients.
Practicing medicine now, in this day and age, may be another kind of traumatic stress, and one that is new to a younger generation of doctors. Imagine not knowing how you will get financed two years from now and if the government will cut your funding. A lot of us can relate.
We all want our doctors to be better. In fact, we all really want our doctors to be the omnipotent parents we wish we could have had. Doctors are people with the same job and personal stresses we all share. We are no different from them. We all need support regarding how traumatic illness is.
Maybe your doctor is just as stressed as you are.
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