A real reminder

December 17, 2010

Burnout threatens sometimes when the frank reality of what you have to do overtakes the feeling of altruism that led you to do it in the first place.

When we sign up to be good doctors, we aim to help people and make a difference. We look to M*A*S*H*'s mischievous Dr. Hawkeye Pierce and Dr. B.J. Hunnicut in the face of the Korean War, the selflessness of Dr. Doug Ross detoxing a heroin-addicted baby in ER's County General despite hospital policy, and the courage of Dr. Andy Brown trading in his neurosurgeon's scalpel for a rural family practice in Everwood.

No, I certainly hadn't been bamboozled by the visions of television screenwriters over the years, but I had believed that the medical profession was about medicine. Instead, we cope with endless charting, painstaking billing issues, increasing pay-for-performance demands, temperamental insurance companies, and forms galore-all of this too frequently crammed into hours too early or too late to allow for a balanced personal life.

I needed a serious sit-down with myself to get back to basics with my goals, rejuvenate, and refocus. I couldn't let my demoralization threaten my medical practice or impair my interactions with patients. As it stood, the tension began to show at the office, occasionally in rigid body language or a terse word.

Then Ryan came through the door.

A VISIT FROM THE PAST

At this stage in my career, the majority of my workday evolved around acute care visits. I essentially took overflow for my partner while I slowly built my own practice. Thirsting for continuity, I always relished the words "new patient" on my schedule.

"Hi. It's so nice to see you again!" a dark-haired man beamed at me.

"Hi. Welcome to our practice," I responded.

He looked so familiar, and clearly, he knew who I was. Was he a former patient of mine? Or the parent of a patient I had just seen? In medical school? In residency? Last week? I harbored an inner embarrassment for not remembering, but there was something in his accent and mannerisms that pulled at me.

"Thanks. Maria has been doing so well. She's grown so much. I was going to bring pictures of her for you, but I forgot them at home. Mary has a physical scheduled with you a few weeks from now. I will have her bring some of those pictures in for you."

By the sparkle in his eye, I assumed that Mary was his wife and that Maria was his daughter (all names in this article have been changed). Then it came to me. Intern year, my second in-patient pediatric rotation. The 1 case I had tried to forget.