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Medicine will steal your life

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  • Zaphod Zaphod 
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    Earnest refinancing bonus

    ok then everybody goes to the ED.

     

    forced or willing? so the person is sick enough to be admitted to the hospital, but they don’t need to be seen by a doctor?

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    Agree there will always be edge cases where it matters and a physician will add a lot of value. However most of the time its totally going to be fine to have midlevels answer calls and hospitalist/midlevels admit non emergent cases to be seen in the am, etc…this is already done in a lot of places. There are plenty, actually most things are not that emergent but might require hospitalization.There are those that require the eventual treating physician to be there immediately, but much rarer. Of course they wont only be assessed by midlevels, many are assuming ED and hospitalists as well have seen people.

    Nurses could easily field the majority of phone calls and escalate to dr if beyond their scope. Many calls come in later about the most mundane stuff, usually after pt is awake and bored and simply wants someone to talk to.

    #213851 Reply
    Liked by Eye3md
    Avatar hightower 
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    I think my original point has been turned into more of a burnout focus. Whether you like medicine or not, controlling your hours as you would like takes an active effort. Medicine is a 24/7 thing and will try to make you be that way too. If you want to give a whole lot of time to your work, that’s great. Go for it. Medicine sure will take it if you let it. However, I would prefer to give a whole lot of time to my family and my personal endeavors.

    My original post is just saying that Medicine will steal my time from all other areas if I let it. You have to be pro-active in drawing your line in the sand on your time.

    You only get one life to live. Live it wisely.

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    Sure, but the problem is that many docs these days (perhaps most?) are unable to draw any sort of line in the sand because their group doesn’t allow it or it would cause their partners to resent them or they would lose benefits or they can’t afford to cut back for any number of reasons, etc.  Job security is often a big concern when you go to part time in a group practice.  You’re seen as less vital to the practice if you’re not willing to do a full time work load.

    If I had a private practice and could run it as I see fit, then sure, I could only be open for business Tues-Thurs 10-4 or something awesome like that…my only consequence to cutting back would be a decrease in revenue, which I could deal with as long as the practice was on solid ground from a business perspective.  This isn’t possible for docs in primary care who have to be available 24/7 either directly or through their partners covering for them and who are also responsible for such enormous patient loads.  It’s also not possible for hospital based practices who have patients admitted to them in the hospital setting.

    It’s much easier to control your work/life balance in a privately owned practice and especially if you’re a consultant only

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    huh? when is a primary care physician ever contacted in the middle of the night? vast majority of primary care people don’t even round in the hospital anymore and if they do it’s like a cursory thing and the hospitalist runs the show….

    I have literally no idea what you’re talking about. so your patient gets admitted to hospital and they call you and tell you at 2 am (which never happens IMO), do you rush in there and see them? come on.

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    I was referring to the fact that doctor-patient responsibility is a 24/7 job. If you are the attending, you own that patient 24 hours a day.  Your partners cover for you while you’re gone or a hospitalist covers for you while they are admitted.  You need an answering service during off hours, etc.  When you’re off, you’re not really off, there’s just someone covering your responsibilities for you.  I’m not saying that you’re working 24 hours a day.  Maybe this is the first time you’ve thought about this?

    This is why so many people avoid primary care in the first place.  If you’re a consultant, your responsibilities are only for the patient’s you’re currently following and when you sign off, your responsibilities end.  When you go home at night, the patients aren’t yours, they’re someone else’s.  You’re only on duty during the hours you choose to be on duty.  You also only have to focus on one small area of their problems.

    #214199 Reply
    Liked by Zaphod, Tim
    Zaphod Zaphod 
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    Click to expand…

    I was referring to the fact that doctor-patient responsibility is a 24/7 job. If you are the attending, you own that patient 24 hours a day.  Your partners cover for you while you’re gone or a hospitalist covers for you while they are admitted.  You need an answering service during off hours, etc.  When you’re off, you’re not really off, there’s just someone covering your responsibilities for you.  I’m not saying that you’re working 24 hours a day.  Maybe this is the first time you’ve thought about this?

    This is why so many people avoid primary care in the first place.  If you’re a consultant, your responsibilities are only for the patient’s you’re currently following and when you sign off, your responsibilities end.  When you go home at night, the patients aren’t yours, they’re someone else’s.  You’re only on duty during the hours you choose to be on duty.  You also only have to focus on one small area of their problems.

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    Makes sense, but what is meant by consultant? I imagine very few specialties have so little patient loads and are peripheral enough to be really free at any time. I would doubt this reality nuance is a reason people avoid primary care.

    Even for something many people would think is pretty edge and easy like plastics it just doesnt take much work to have a potential call at any time, even without considering ER type call. Even just the cosmetic side if you get busy you’re going to get calls, sure theyre usually basic in nature, but it can get busy.

    Was talking to friends about this yesterday and everyone seems to be getting more and more reluctant to give advice over the phone, and have started telling people if they have any concerns, to go to clinic/ER. Seems such a waste of resources, but I absolutely understand from a medicolegal standpoint.

    #214200 Reply
    Liked by aCMD
    Avatar Eye3md 
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    ok then everybody goes to the ED.

     

    forced or willing? so the person is sick enough to be admitted to the hospital, but they don’t need to be seen by a doctor?

    Click to expand…

    Agree there will always be edge cases where it matters and a physician will add a lot of value. However most of the time its totally going to be fine to have midlevels answer calls and hospitalist/midlevels admit non emergent cases to be seen in the am, etc…this is already done in a lot of places. There are plenty, actually most things are not that emergent but might require hospitalization.There are those that require the eventual treating physician to be there immediately, but much rarer. Of course they wont only be assessed by midlevels, many are assuming ED and hospitalists as well have seen people.

    Nurses could easily field the majority of phone calls and escalate to dr if beyond their scope. Many calls come in later about the most mundane stuff, usually after pt is awake and bored and simply wants someone to talk to.

    Click to expand…

    Yeah, I agree with this. N my practice, we don’t have nurses but we do have ophthalmic technicians.  During the day, patients call with questions or concerns. My technicians take the note, run it by me, and then call the patient back. Some of the techs have been with me for years, and could handle a large majority of these calls without my input. These same type of calls come in after hours, when on call as well. 99% are not emergent and could be handled by a technician. Sometimes, I think patients believe there’s a central office where doctors are sitting around 24/7 waiting for any and all calls about anything, because patients call with silly stuff at odd hours.

     

     

    #214201 Reply
    Liked by MaxPower, Zaphod
    Avatar hightower 
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    Click to expand…

    I was referring to the fact that doctor-patient responsibility is a 24/7 job. If you are the attending, you own that patient 24 hours a day.  Your partners cover for you while you’re gone or a hospitalist covers for you while they are admitted.  You need an answering service during off hours, etc.  When you’re off, you’re not really off, there’s just someone covering your responsibilities for you.  I’m not saying that you’re working 24 hours a day.  Maybe this is the first time you’ve thought about this?

    This is why so many people avoid primary care in the first place.  If you’re a consultant, your responsibilities are only for the patient’s you’re currently following and when you sign off, your responsibilities end.  When you go home at night, the patients aren’t yours, they’re someone else’s.  You’re only on duty during the hours you choose to be on duty.  You also only have to focus on one small area of their problems.

    Click to expand…

    Makes sense, but what is meant by consultant? I imagine very few specialties have so little patient loads and are peripheral enough to be really free at any time. I would doubt this reality nuance is a reason people avoid primary care.

    Even for something many people would think is pretty edge and easy like plastics it just doesnt take much work to have a potential call at any time, even without considering ER type call. Even just the cosmetic side if you get busy you’re going to get calls, sure theyre usually basic in nature, but it can get busy.

    Was talking to friends about this yesterday and everyone seems to be getting more and more reluctant to give advice over the phone, and have started telling people if they have any concerns, to go to clinic/ER. Seems such a waste of resources, but I absolutely understand from a medicolegal standpoint.

    Click to expand…

    Perhaps this is a “grass is always greener” issue for me in that perhaps my views of consultant life are not as accurate as I thought.

    #214640 Reply
    q-school q-school 
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    Joined: 05/07/2017

    You’re only on duty during the hours you choose to be on duty.  You also only have to focus on one small area of their problems.

    Click to expand…

    i find this a fascinating comment from the hospitalist arena.  this is not a criticism and is not a comment directed at hightower, just continuing the conversation in general.

    more than almost any other specialty, i think the comment about hours is true for the specialties of hospitalist, ED, maybe ICU, maybe psych?  way less so for most specialties.

    i think it’s hard to generalize for consultants, since the breadth and intensity of practice and patient acuity can vary so much from specialist to specialist.

    if you are a very specialized surgeon, you are likely to be on call every 3rd night or something.  while the frequency of calls may be less, it is no bargain to be at risk of interrupted sleep at any time every third night and carrying a full schedule the following day.  many also cover their own patients at night, even when not on call.

    if you are a hospitalist, although you deal with the whole body, some of the responsibilities are shared while they are inpatient with the consultants, but the responsibilities generally end at the point of discharge.  for many of the consultants, the responsibilities continue in longitudinal relationships.  while focused on one organ system or body part, the visits and phone calls keep coming.  it’s not better or worse, but just different.

    i think all specialists appreciate the hospitalists for the work they do (they may not say it).  medicine couldn’t run the way it currently does in the old system where there would be holding orders and you would admit patients in the morning and do some surgery and then show up in clinic without the hospitalists.  patient expectations are different.  liability different.  documentation requirements.  hospital requirements.  family meetings.  we can’t even get hand washing right anymore.  gross, but proven fact.  etc etc etc.

    i disagree with my esteemed colleague zaphod one one point.  i do think many avoided primary care because during training they hated clinic.  They couldn’t see themselves doing it 5 days per week.  these days EMR maintenance is an even bigger nightmare for primary care than for basically any other specialty IMO.  it’s a HUGE deal.  It’s actually even worse than the part where you see 25 patients per day in 20 min blocks all day long.   hospitalists (respectfully) don’t have to deal with all the BS from outpatient EMR, and I wouldn’t classify hospitalists as primary care for purposes of discussions of primary care (generalist?)/specialist more for this reason than any other.

    ymmv

    jmo

     

    #214646 Reply
    Liked by hightower, Zaphod
    Avatar Antares 
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    Status: Physician
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    Joined: 01/20/2016

    This thread is fascinating to me especially from a historical perspective.

    I’m thinking about the starting point of the thread: those age 60+ docs criticizing the work ethic of younger docs. I’m 60, and my father was a pulmonologist, recently deceased at 85. He rounded every day in the hospital, and made frequent middle of the night trips to see new patients in the burn unit. I saw the burnout first hand (no pun intended) – he especially hated the administrative frustrations, and ended up leaving medicine by his early 50’s after retraining in another profession, and yet he loved patient care. To the end of his days he identified professionally as a doctor first and foremost, and in his retirement years, he regretted not having the stimulation of professional activities.

    So when I went to med school my friends and I already saw the Golden Age of Medicine as past. We were in a new era, one that would destroy you if you weren’t careful. Our mantra quite literally was get through training without too much damage, keep your perspective,  so you could still be an intact human being. Everyone wanted medicine to be a calling, but we were well aware that there was more to life than work. We had trouble taking seriously the older docs who rued a bygone era of more hours and more commitment.

    Maybe those 60+ docs have forgotten, or maybe it was squeezed out of them in training. Because surely even then, you needed to protect yourself from overwork and burnout. This is not new.

    So I pledged not to become my father. And for that reason, as well as a litany of others including personal interest and seeking long term close relationships with patients, I became a psychiatrist. And here I am, another psychiatrist on this thread reporting that I am not burned out, that I feel it is a privilege to do the work I do, that I am in my own practice, that I work 4 days a week, that I have no EMR, that I am theoretically on call 24/7 but rarely get called, etc. Not that there aren’t downsides and trade offs; there are. But all the above do contribute to a sense of some control, autonomy, answering to no one else. I don’t know what else to say by way of advice, other than to agree that self-employment has many rewards, and to shake my head at the erosion of medicine since the end of the Golden Age. Only I think the Golden Age ended somewhere in the early to mid 1970s!

    Echoing Anne’s comment, something about the circle of life….

    #214797 Reply

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