"What do you do with the rest of your day? I mean if you only see 12 people a day, you must play a lot of golf." So asked one of my esteemed colleagues after I had completed a lecture on the Ideal Medical Practices concept. His question, dripping with the sarcasm of disbelief, took me by surprise. After all, I don't even play golf.
Docs get paid for quantity. The more patients seen in a day, the more money billed to insurances and the more collected. Perhaps because of this dysfunctional payment system or perhaps just because of some bizarre machismo drive, many docs take pride in the treadmill. I remember when I was a medical student and one chief resident passed the other and said, "See this face? This is a face that has slept 3 hours this week." It was a Thursday. In residency, the attendings would tell us how when they were residents, they worked 130 hours a week and fought over patients because they so wanted to learn. Intrinsic in these comments is that somehow those who sleep or have interests outside of medicine are somehow inferior or less committed. But I remember how terrible I felt after working 40 hours straight with no sleep. I know how poor the care was when I saw 63 patients in a single day at my previous practice. So when does the push for productivity become toxic?
I pondered this question again today as I took care of a patient dying of liver failure. She needs a transplant, but the next available appointment with the specialist at that hospital is in July. I looked to try and get her an appointment at a clinic closer to home, but even they are booked out over a month. How is it possible to not feel burned out if you know you are booked up for the next 5 months? How do you fit in the critically ill if your schedule is already full? If you do fit them in, how does that impact the other patients who you now cannot spend as much time with? When does the empathy wane and the apathy take over?
I have the breathing room in my office to try and coordinate the care of this unfortunate lady. I'm sure doing this will take hours and hours over the next few days and (hopefully) weeks. I will not collect any money doing this, but will have the satisfaction of knowing that I am doing what I can to help someone in need. I can only hope that I can find someone in the hospital system who also feels care should come before money and quality should come before quantity. Someone who can use their skills to assist this lady in ways I cannot. Unfortunately, with the system set up the way it is, the likelihood of finding that physician seems to be getting slimmer. Some days I wish I would have taken up golf...
John Brady MD
Newport News, VA