This morning I saw what I expect to be my final consultation at CCHS, a very nice gentleman with multiorgan problems who probably benefited from a number of the interventions done in his behalf over many years. I had not seen a patient in about a week. It was hard to get motivated to get to the hospital, as much as I wanted to see him and as lost as I felt not having a census for the first time since my fellowship.
USA Today recently published an article on Physician Burnout which describes a lot of people that I know, sometimes me as well. I spent the last week resolving loose ends on charts, picking up dropped balls, staring at my box of charts with no enthusiasm at all. I cannot wait to get back into an exam room where I can interview patients and put puzzles together. For the last ten years I have quipped to whoever would listen that I am probably too innately intelligent to function as a physician in the 21st century. Clinical guidelines have replaced judgment, the lab results and faxed glucoses need to be followed-up with uncompensated phone calls, my chart bench has endless notifications from insurers reminding me to have patients get lab work that was already done, or at least ordered, an eye exam that was also already done or reminded, medication warnings on people who had successfully taken those medicines for a decade, Medicaid representatives who do not return calls, formulary overrides inhibited by people who know less than me and have no understanding of how medicine is supposed to be used. Medicine remains a challenge for me and the patient care gratifying but I understand why so many of my colleagues yearn for times past and opt out earlier than they had planned.