It is a job, career, occupation. Whatever we call this ride on the hamster wheel, it is how we survive, put food on the table and a roof over our heads. If you are lucky, you may enjoy the job you have. I am a physician and, for the most part, I do enjoy my work. But to be honest, there are times when the goals of work are unclear.
To me, the most satisfying parts of the job are the ones where goals are clear and easily completed. Someone has a laceration and I sew it up. A bone is broken, I have it splinted and refer them to an orthopedist. A urinary tract infection is simply treated with antibiotics I prescribe, and problems are solved; very rewarding.
Now here is where it gets tricky. Someone with chronic back pain for three years is having more pain and wants a higher dosage of Norco® (hydrocodone), an addictive narcotic. Increasing a pain medication does not solve this chronic problem, and the patient will just build up a tolerance to the higher dosage, and be in just as much pain as they started. They lament that they have tried numerous other nonnarcotic medications and that Norco® is the only thing that helps. When I don’t prescribe a higher dosage, then come the screams of frustration. “I’m not a junkie! I’m tired of being treated like a drug addict! I’m in real pain!” This decision to not increase the dosage of a narcotic has nothing to do with whether I believe someone is in pain or not. It just would not solve the problem. It could even prove deadly, as our opioid crisis attests to.
Then there are those who want temporary disability or extended time off of work for various reasons. Of course there are such things that are obviously justifiable, such as post-op care for surgeries. Yet, there are many instances where no x-rays or lab tests or any objective evidence can be found for someone’s pain. Again, there is great indignation from the patient if they are not granted their requested paid time off. I cannot in good conscience grant everyone who simply wants to not work a formal disability, but can I in good conscience not give disability to those who are in disabling pain just because there is no tangible cause for it? I did not want this form of social policing dropped in my lap, but here it is.
Then there are the instances where patients simply want something that is not good for their health. Antibiotics for upper respiratory tract infections has long been an issue of contention. So many patients insist they need them when antibiotics simply do not treat viral infections and most upper respiratory infections, otherwise known as "colds," are caused by viruses. Antibiotics can wipe out normal, healthy bacteria in the body and cause fungal infections or gastrointestinal distress. Even more concerning is the over prescribing of antibiotics that only creates stronger, antibiotic resistant bacteria.
There are numerous examples of patients wanting surgeries or other medical prescriptions or treatment that are detrimental to their health. It usually boils down to the patient yelling at me that I work for them. Their insurance or their personal money is paying for my service and I need to give them what they are paying for. I find this very distressing. I hesitate in citing the Hippocratic Oath because it has been modified so greatly since its inception between the fifth and third centuries B.C., where it began with “I swear by Apollo…”. Yet universally, the oath contains the phrase “Do no harm”. It seems almost comical to most people. How difficult is it for a doctor to “Do no harm”? Turns out it can often be difficult. And, constantly reminding oneself of this mantra is useful. The cure may be worse than the disease.
A doctor friend of mine once told me that she tells her patients that she does not work for them. She works for their health. Their health is her patient. This simple mind shift brings me much clarity and some peace. In these times of discussions of moral injuries that accompany many professions, I welcome any peace.
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