Feet First

“It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.” - Sir William Osler

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    Wednesday, March 31, 2004
    So Tired

    I've taken on extra shifts in the evening urgent care clinic and for night call to try to get this home renovation thingy paid for. I'm working Thursday, Friday and Saturday shifts this week; wasn't scheduled to work tonight, but the doc who was called in sick and I took his shift. This means I've been seeing patients for, oh, eleven hours or so. It feels like I'm back in the ER.

    I'm not afraid of work. I used to have a part-time job in the Northridge Hospital ER back when I was working in the Valley (more about that tomorrow) and the weekend shifts there were twelve hours - that's standard in most ERs. One Memorial Day weekend I set myself a goal: to see one hundred patients in three days (Saturday, Sunday and Monday). I almost made it: we saw 97. They closed down the Fast Track early Monday evening because people stopped coming in and sent us home to save money. I was pissed, not grateful: I wanted those last three patients.

    The indoctrination starts early in medical training. Don't complain, suck it up, the more you can do the better you are. I'm not writing this to grouse, I'm grateful to have the work and the extra money, but sometimes I sit back and wonder about the insanity of a professional mindset that encourages us to push everything else (families, our health, hobbies) to the wall and put our patients first.

    The system as it exists now is coming to an end, not imminently, but within the next ten to twenty years. The docs coming out of residency now are shooting for specialties that allow them to spend more time with their families, like Derm: no one wants to do primary care anymore, or if they do, they want nine-to-five hours and no night call. Specialties like hospitalist care and emergency medicine are becoming more popular because they have set hours. With dropping reimbursements, there simply is no financial incentive any more to take on the backbreaking work of primary care. My prediction: in 25 years most people will be getting their primary care from nurse practitioners or physicians' assistants. I don't think that's intrinsically wrong, but it won't be the same level of care. I know a lot of very competent NP's and PA's, but to claim their training is comparable to an internist's four years of medical school and three years of residency is simply not so.

    Sometimes I think that when I retire, I'll be put in a glass case with a plaque that says:




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