Inspiring residency graduation speech

When I read this I had a few reactions
Like  oh come on are you kidding me?
 She probably thinks we should hug  patients too.
Doesn't this woman understand??
Health care  is a mess  Patients won't trust us  despite our years of toil and education We  carry tremendous responsibility working long hours carrying delayed gratification for years- who is this young person, what does   she know about  the real business of staying afloat? Malpractice is a nightmare, there are global codes to deal with  and tugs from the practice manager and the staff who want raises and my kid who needs me at a soccer game. I have to run faster and  buy more gadgets to keep  my income. Of course we care about patients. This young woman will soon hit   a wall of  harsh reality .
Washington needs to fix alot of things. Flowers in the waiting room won'to help.
Patients do not remember anything I say . If only they would follow directions. Naivete is good , I thought ,but this young doctor is going to hit a wall

Then I remembered what I did yesterday.
I too am a family doc
I used to think patient centered care meant hugs  and fresh muffins in the waiting room. Yuck.
  Yesterday i saw S whose first husband beat her  and whose her current husband was the love of her life but now  weighs 400 lbs and cannot leave the house and  she  feels guilty so cares for a mentally ill sister who hits her  and had S arrested last week after  she picked a fight with S . I dx'd S with  cancer of the vulva a few days ago .She has no car to get to the oncologist  2 hrs away. She is  poor, a diabetic and has severe  pain.
Then G came in. G's husband was getting  joint injecions for pain .But wasn't xray'd  Had a  metastatic lesion.Many weeks, pain, and tests later he got the egd that found the primary. G got ascending cholangitis while she was visiting him .Both in the hospital at the same time. He is now in hospice and she says I will take him home the first second I am strong enough!
ANd i sawC who had  a egd for a Schaitzi's ring .And was ruptured But I had a perfect  record this 91 yr old said to me yesterday. Lived alone  with Mulligan her dog and took no meds. Drove. So after the esophageal rupture she was in Icu, the floor, ICu, then two intermediate facilties a few times .Yesterday she went home- home.
 I remembered I see everyone the day they call for  at least 30min and i am on call 24/7 for 4 yrs now even on my one vacation to Mexico. but  I cannot save for retirement. Specialists seem to be impatient with me .
But now i see that   patients don;t trust becasue no one listens to them
Patient centered care is about sharing my skills and education with a person who has some   questions and symptoms, and coming to a place where the dx and treatment make sense for them
 I am deeply seething angry most days that I  both have the honor to  work as a doc  but cannot pay  my bills  and have patients  i cannot get transportation for to see a critical doctor   who may not communicate well but will be so burnt out he  will scream "but I am trying" without  knowing anymore what trying could mean . I cannot change others but I can  keep talking to my colleagues one at a time and I can stand behind my patietns and use every colleague i know  every program i can get my hands on, every skill I have to get people  what they need 
I wish this young doctor well -she IS up agianst alot .I understand. MAy there  be more like her.

Comments

[A Davis, MD]

Get rid of insurance. Extend your office visit length. Insist on full payment at the time of service. It won't solve all the social problems, but it will at least give you a chance to fix some of them instead of just treating the symptoms and rushing on.