Why I still practice medicine

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Much like online review sites, where only the unhappiest of customers take the time to write a comment, I often find myself writing about my latest frustration with the practice of medicine.

How I repeatedly mutter “I hate insurance companies,” how tedious it is to secure prior authorizations and how patients would rather believe the latest issue of the National Inquirer than their physicians. That isn’t what I signed up for when I became a physician.

But two very different recent patient encounters, oddly enough only tangentially related to my specialty of endocrinology, reminded me once again of the beauty and art that is the practice of medicine.

The other day, I saw a patient who I had inherited from another endocrinologist. His reputation of being a very anxious person preceded him. He doesn’t even allow us to check his blood pressure because he gets so worked up at doctors’ offices that his BP is often sky high.

In truth, he has very little need to see an endocrinologist. His thyroid issue resolved itself years ago, but he wants to keep an eye on it, so he still comes every few months. We reviewed his labs and were finished fairly quickly. I asked him if there was anything else he needed to discuss. He said, “I know this isn’t your area, but maybe you can help me. I hate flying, but my wife booked us a vacation in the Caribbean. I don’t even like the beach. I’m afraid I’m going to get on the plane and freak out.”

Well, he is correct. As a physician, this is not my area of expertise, but I am a frequent traveler. I am also someone with an irrational fear of heights. I told him that while my phobia is different than his, I understand what it’s like to intellectually know something is safe and yet still be deathly afraid of it.

We talked a little about the safety of flying and some coping mechanisms. He said his primary care physician had offered him a prescription for Xanax to ease his anxiety but that after talking to me, he already felt better about the whole thing.

On a sadder note, hours before I wrote this, I sat by the hospital bed of a patient who was recently diagnosed with pancreatic cancer.

He was a little cranky when I first walked in, probably because I woke him. He was annoyed that his glucose had gone too low the night before. He complained of the side effects of his chemotherapy.

He said, “They haven’t made any great strides in treating pancreatic cancer. I know I am going to die. Why are they making me take 15 pills? My family gets upset that I don’t want to take the pills because they make me sick. They say, ‘If you don’t take them, you’ll die.’ Well, I’m going to die, anyway.”

I got him some tissues, and I held his hand while he cried. It took all my strength not to cry with him.

After a time, I explained to him about palliative care and asked for permission to recommend a consult. I told him that giving him quality of life is most important right now.

And he’s right: Some things don’t matter. His glucose doesn’t need to be perfect. It’s OK for it to be a little high. He can eat what he’d like because he needs his strength.

He looked at me and told me I was the only one who came to visit every day. I was the only one who understood, and he appreciates that.

Physicians are often painted as pill pushers or smart but with no heart. There are times that our current healthcare system forces some physicians to behave that way.

I know darn well that taking the time to ease someone’s anxieties, whether it be about a plane ride or one’s mortality, doesn’t pay the big bucks. But you know what? This is exactly what I signed up for and why I still practice medicine.

Melissa Young, MD, FACE, FACP, is sole owner and solo practitioner at Mid Atlantic Diabetes and Endocrinology Associates, LLC. As such, she is both actively involved in patient care and practice management while also raising two kids and a dog in suburban New Jersey.