Thursday, June 21, 2012

My Employees Care

     "Dr. C.!  You have to do these charts!  We can't let them pile up!  These patients need your help!"
     One of the front office personnel was hovering over my desk, looking down at me with a stern expression.
     Office hours had just ended. It was 8 pm and the she had just locked the door behind the last patient. She must have thought I was going to leave the charts until the next day and, in truth, the idea had crossed my mind.  Taking time off had made me realize just how different doctoring is from other jobs.  At least solo-doctoring.
     I had been away for a few days.  It's true, there were more than the usual number of charts with telephone messages, faxes, home health agency reports, reports from consultants, and office notes to review, answer and sign.  But I still felt the pull of the normal world, the lure of a nine-to-five job.  It seemed so healthy to get off work before dark, to stop at the grocery store, to take a walk or talk with a friend, and relax.
     Solo doctors don't know the meaning of the word, relax.  The commitment entailed in doing a doctor's work, caring about patients, laboring over them, wondering whether we've made the right diagnosis or said the right words to them, added to the long hours and administrative problems associated with running a small business makes relaxing a foreign word.  Or maybe we are constitutionally unable to relax, and choose this line of work because it suits our personalities.
     "Hey Doc, you'd better get to these x-rays before they get out of hand.  Let me organize them for you--you can't go home without reading them."  The x-ray tech was right;  there were three fractures, one kidney stone, and two pneumonias hidden in that pile and if I hadn't read the x-rays the patients would have had to suffer waiting for treatment.
     Last night I stayed at work until midnight.  I wasn't completely finished with the charts, but I was finished.  Before I cut back on office hours I would work until midnight or later about three days a week. Back then the clinic was open from 6 am to 10 pm seven days a week, we had two shifts of employees, and the waiting room was usually brimming with patients.  When my children were young they would loiter in the break room eating sandwiches, doing homework, coloring, blowing up condoms (which, by the way, make great water balloons) and importuning me, "Mom, when are you going to be finished?  Can we go now?"  These were the Fridays when I would take them to the beach for the weekend while other providers covered the office.  We'd leave at midnight, get to the beach at 2 am, and be able to wake up to the ocean. "Mom, how much longer is it going to be?"
     Now grown,  not one of my children  wants to go to medical school.  "Too hard," they say.  "I don't want to work that hard."
     And there's the matter of the raid, the investigation, the government's desire to repay its national debt by staging coups on doctors' offices, taking advantage of doctors' sensitivity, hoping for a "settlement" instead of an expensive, time-consuming, all-out court-battle.  The settlements add up.  The government claims it has "re-collected" hundreds of millions of dollars in its attacks on doctors, who mostly settle because trials are expensive and their sensitive natures--indispensable for the process of making medical diagnoses--are not able to withstand the negative publicity and pugnacious proceedings of court.
     Why would my children want to enter this world?  It doesn't matter how rewarding it is to care for patients, develop relationships with them, heal them, one by one.  No one wants to be attacked for nothing.
     Not me.  Which is why I think constantly about how to get out of this profession.  But it's part of my being.  I want to leave, but I don't know if I can.  I like the patients too much.  I like my employees.
     My employees care about me.  They care about patients.  They like their jobs.  The medical profession attracts people with strong feeling connections to the world.  This is true of my employees:  their sensitivity is their genius.  Without them I would not be able to do my job and the patients wouldn't respond to my treatments.  The entire office is the healing organism, the treatment. 
     It's 9:20 pm.  I have ten more charts to review and answer.  The nurse practitioner is laboring away at her desk, wearing her headphones, finishing her own stack of charts.  Soon I'll read the microscope slides from the week:  sputum gram stains to identify the organisms causing infection, vaginal wet preps for STD's, nasal smears for allergy-associated eosinophils.  Then I'll answer questions from insurance companies:  Why did you do an EKG on this patient?  What was the reason for the cortisone hip injection?  We won't pay unless we hear from you within 30 days.  We still might not pay, because we think you do too much.  We won't pay because we think we can get away with it. We won't have to pay because we know you're too busy to respond in the format and timeframe we require.  Ha, ha, ha, ha, ha.
     Okay, the insurance companies can laugh.  They can refuse to pay.  But the last laugh is ours, because we--my employees and I--have a special quality of life.  We have people on our side.  Our patients love us, and we love them back.  When we go home at night, however late, we can say to ourselves:  We did something good today. It was worth it.  It was worth every minute.


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