July 7th, 2011

The Price of Being a Doctor

Greg Bratton, MD

I saw a patient while I was moonlighting the other night that actually made me question whether or not it was worth it to be a doctor.

The patient was a 56-year-old gentleman who presented to the emergency room complaining of neck pain. When I went to talk with him and learn more about his complaint, he told me that he had a history of neck pain and felt as if it was about to start “rebounding again.” He had no previous or recent injury to his neck, never underwent radiographs, and had no neurological symptoms, but some physician somewhere had felt it was appropriate to give him hydrocodone, and he had been treating his pain “effectively” with this medication ever since. He was taking no anti-inflammatories, had never seen a physical therapist, and had taken no other conservative measures to manage his pain. In fact, he had no primary care physician at all.

As we talked, it became blatantly clear that his “rebounding pain” was running in direct correlation with his dwindling hydrocodone prescription. I readily admit that I believe we, as a whole, under treat pain (for fear of inducing potential addiction, tolerance, and side effects), which is a disservice to our patients and their quality of life. However, as a sports medicine physician, I see my fair share of chronic musculoskeletal pain and, therefore, am comfortable with my treatment algorithm and with who qualifies for narcotic medications.

This guy did not require narcotics.

hydrocodoneIn further discussing his condition and my medical opinion that he needed to treat the ailment rather than masking it with pain meds, he became agitated (as you could imagine) and demanded hydrocodone. “I need hydrocodone 10/325 and I need a quantity of 30,” he emphatically stated. “It is the only thing that works.”

At this point my patience was wearing thin. Not only was this patient misusing the medical system by arriving at an emergency department for what appeared to be a medication refill, he was now attempting to bully me into prescribing him medication I did not feel was medically necessary. To make a long story short, I told the patient that this was not a negotiation and that I was going to treat him no differently than I treat any of my other patients. I stayed true to my clinical criteria for prescribing narcotics, and he left with a script for Mobic.

I was later informed by my nurse that, as he was leaving, he turned to her and asked, “What night does that doctor not work?” as if he was plotting his next attack.

I went back to my desk, irritated, and reflected about how I spent 4 years of medical school, incurred a large amount of debt, trudged through residency, sacrificed family time to extend my training through moonlighting, paid big bucks to take a board exam — not to mention the cost of licensing, DEA, and DPS numbers — and how it was all just lost on this patient because I was expected to do what he wanted.

And to be quite honest, it pissed me off.

There are people in our communities that have capitalized on physicians’ fears of litigation and willingness to practice defensive medicine to get what they want. They feel entitled when they are seen by a doctor. They “know” what is medically best. They aren’t coming to their appointments to get evaluated and treated, but rather, they are using the doctors as suppliers. They are successful because they instill a sense of “if you don’t do what I want, I will report you for failure to treat my pain adequately.”

And if this is how practicing medicine is going to evolve (insert political commentary here), then is it still worth it to be a doctor??

I had this question answered for me on Easter Sunday. I was enjoying a nice Easter service with my family. I had just returned to my pew after communion when, from the back of the sanctuary, a hysterical mother called out, “Is there a doctor in the house!?!?” A silence fell over the congregation and everyone stood frozen in their place — except for me. I arose from my pew and made my way to the mother.

As I approached the woman, I found her 14-year-old daughter lying horizontal on the wooden pew, pale and diaphoretic, with a confused and scared look on her face. She had passed out and was just awakening when I arrived. With the help of some other providers, we tended to the young girl, comforted the mom, and handled the situation appropriately.

Thankfully, the mother’s call for help was for something minor, but, to me, it was a major boost to my failing sense of purpose. To have my “name” called in a moment of personal despair and to realize that, in a gathering of 300 or more people, I was the only physician, made me feel as if being a physician still was something special.

So, is it worth it??

Yes, it’s priceless.

47 Responses to “The Price of Being a Doctor”

  1. Patricio Torres-Lisboa,MD says:

    I also find priceless that Greg gave open testimony of his practical Faith, which is not just showing up in Church but to show that we are the hands and feet of Christ everywhere we go.

  2. Thomas Willke, MD says:

    Hey!! Best get used to this up and down yo-yo for the next 40+ years…..Haning been doing this now for 35 years, It gives me great pleasure when a pt says thanks…but more and more, you will everyone questioning your every move….and to make it worse, those with not nearly as much education as you have will have the power to make decisions of care that are at your level, or even higher, depending on what state you live in…You will be governed by so many rules andf regs and overseeers that your head will spin..UC and Family NP clinics in Grocery stores will assume care that once was given by us “PCP’s” as a continuum of care to pts…no longer..Hospitallists swill see your pts in a hospital, yet will never tell you what they were there for… Your cohorts in mMedicine will think of it as a job…EMR will take all the fun out of Med simply by how they work..and all the data that will be collected on YOU!…It’s still the best business to be in though, since that THANK YOU you receive occasionally is really worth more than all the hate you get from people seeking what they KNOW they need…stick with it….with Christ in your hip pocket, it’ll all work out well…JUST STICK TO YOUR PRINCIPLES…

  3. John Menchaca, MD says:

    I used to teach at the hospital where where Dr. Bratton is doing his residency and I am proud of him for his being a true professional.

  4. Linda Ross says:

    Thank you for being a doctor. Patients appreciate good caring physicians. Having been diagnosed with carcinoid cancer, I pray every night to thank my doctor for extending my life to enjoy my family and my new grandchildren. I enjoy every minute and hope that they will grow up with values and learn how to say THANK YOU to those who work so hard to help their fellow mankind!!

  5. Sometimes it can be hard to distinguish among addiction,Munchausen’s or in Pediatrics,Munchausen’s by proxy.It can happen to anyone of us,especially in the earlier years of residency or practice.

  6. Couca Zakzak says:

    Thanks for sharing this story. My question is how is it possible these days that highly educated people (physicians, lawyers, scientists, etc…) still believe in the writings of the Bible, Quran, Torah, etc…?
    I’m not referring to those who seek meditation in houses of God but I’m referring to those who actually believe in the literal writings of these books (e.g., heaven and hell, adam and eve, creation of the world in 7 days, how the Quran was not written by people but was actually passed down from heaven, etc…) I’m having a hard time accepting the one person could be a scientist and at the same time believe in these things. Could these beliefs truly exist in the mind of a true science person these days? This is confusing to me.

    • Robert Massey PA-C says:

      It is our Lord who gave us the abilities we have… evolution is not a proven theory and the bible has been proven many times… Also many men died for what you consider not to be the truth…It is actually very easy for a person w/giftings from God to do many things – I am truly sorry you believe otherwise…You may eventually learn how wrong you are. I have a Masters Degree, am a Physician Assistant, and believe in God and the bible. It is in His giftings that I am able to help all who come to me in a compassinate way.

      • Jennifer D.O. says:

        You’ve got to be kidding….. Why have people been so brainwashed by superstition? The evidence of the first human (homo sapien) dates back BEFORE the bible. People worship out of fear that if they don’t, they might go to Hell. They worship Gods because it’s what they were taught to do growing up – No Free Thought at all. Take a look at our founding fathers – most were free masons who believed in free thought, not one God. Science makes sense and has evidence based on the laws of physics. One of my biggest gripes is that you see so many people who claim to be devout Christians, yet, all too often you see them gossip, talk ill of others, are selfish, exhibit greed and are not genuine….. “My Country is the World, and My Religion is to do Good.” (Thomas Paine quote) – this is the motto I live by. Do good to others, live a moralistic life and be open to the vast possibilities out there and all of the fascinating science yet to be discovered.

  7. Sondhi says:

    Can’t agree more…There are lots of occasions where we are expected to just fulfill the demands of patients, even though one may feel those demands to be medically incorrect and unscientific. Though on most occasions one may not listen to what the patient and their kins are saying but by the time the “ordeal” ends, it leaves so high and dry as if you have been sitting in grocery store and arguing for some casual household item while what is actually at stake is someones life. These are really the times when you question your decision to take medical profession.

  8. Norman M. Canter, M.D. says:

    There are few people who have the privilege of saving or extending the lives, or of alleviating the pain of their fellow men/women. The fire-fighter extracts people from burning buildings, policemen protect citizens from crime, but the physician in treating acute surgical and medical emergencies is the prime example of acting as “the hand of God” in cases of appendicitis, G.I. bleeding, acute heart attack, asthma, stroke and a variety of near fatal traumatic problems from head injury, to pneumothorax, to hemorrhage. Additionally, he has the knowledge to advise about diet and life style. His reward must come from a self-recognition of his accomplishments. Fortunately, society rewards him monetarily so as to be able to provide for himself and family and educate his children. Whether on an intimate level or in Public Health, there is no higher calling nor greater satisfaction than in the practice of Medicine.

  9. Denise King, RN, OHN says:

    Thank you for posting this story. It has blessed me more than you know. Thank God for you using the gifts that He has blessed you with. We know that situations and circumstances may come from time to time but God will continue to bless and keep you. Continue to be the man that God has made you!

  10. William DeMedio says:

    Thicken your skin. This gent does not deserve the time he is wasting in your brain. Next time someone like him comes in, kindly state that hydrocodone is a schedule 3 narcotic opioid and is the number one cause of prescription abuse in the U.S. He has not had the appropriate tests to prescribe it. He had no injury to warrant it. You do not know him. He is not getting it from you. Pass the information on to the facility director so no one gets in trouble. Don’t let this bug you, in family med, emergency med, and urgent care, these manipulators are a dime a dozen.

  11. Having just celebrated my 20th year since graduating from medical school, and being the head of a large family, I have noticed two things in common between patients and my children. In both cases, unless I give in to their wishes, I am considered a lousy doctor/father. It helps to put it into perspective that people really don’t change as they grow up.

    Like you, most of the cries for help that I get in public are in church, and most of the emergencies are people passing out. God bless.

  12. js kindleburry says:

    there is no god

  13. Andrea Lyman says:

    I understand your emotional reaction, but don’t think you are stepping back to consider the nature of addiction as a disease. It is not about you.

  14. Loma, I says:

    There surely is a God. I am a doctor and believe in the Bible. Many times throug training I saw how He helped me go through horrible calls, have the strength to give comfort to patients, and saw patients heal in ways and time medically not possible. I also work patients dealing with paon and upfront I telll them that I will avoid opiods as much as possible, some are okay and some hate me. I am okay with that, since I stand up for what I believe…God and do no harm first

  15. Leila Hagshenas, MD says:

    Demanding patients can be extremely trying, and I commend you for not caving. You were probably correct in assuming that this patient has an addiction. I do hope, however, that you don’t lose sight of the fact that addiction is a disease, that it makes people act in ways that aren’t nice or logical, and this is part of their illness and should be treated as such. It’s so easy to be “pissed off” at someone with an addiction, but that’s why we study psych in family medicine residencies and learn about things like countertransference!! and you will encounter numerous people in your career who won’t like you, even if you’re the most likeable person in the world. It’s not you! You can’t take any of it personally!

  16. DRVJG says:

    Working in school health for several years now, I feel that the children still see the doctors with an ‘awe’. Going by sayings in the Lord Krishna’s Geeta one should believe in “Karm Karo Phal Ki Ichcha Na Karo” means: Do your duty forget the fruits of it. I have found that creating health awareness and guiding the children on path of healthy lifestyle is an extremely rewarding activity to be done being a doctor. One should always feel pride in his medical education and responsibility bestowed on him based on it. One should not come down to the level of negative people/patient trying to bully because we are class apart. They can’t see what the mind doesnot know.

  17. Ben Avrunin, M.D. says:

    It is interesting that people are trying to make a religious issue out of this. The point is that there are times when it really is satisfying to be a doctor, although it is becoming harder. There are too many obstacles now a days. Lawyers waiting in the wings, overhead expenses getting worse, demanding patients and families. Lowering reimbursements. The future of medicine is looking more like big business. See more patients, spend less time with families. More time on forms, insurance coding,etc. I feel sorry for the students I see in my practice, who tell me they can’t afford to go into primary care as they are already in tremendous debt. Medicine will become more like a business in the future. Let’s just hope we can attract the caring and good students.

  18. Becky says:

    Thanks for sharing your story! Think about going on a medical mission where you practice medicine without the politics or paperwork. Becky, FNP

  19. Bohdan A Oryshkevich, MD, MPH says:

    It is very telling and sad that it was an event outside the actual practice of medicine that brought some relief to Dr. Bratton.

    The need and the challenge is to make the workplace itself rewarding.

  20. QUALICUMBOB says:

    Oh yes he did need narcotics and unfortunately he will just become another statistic. I guarantee another one of your peers will indeed enable him with his drug of choice. Rather than just sloughing him off as a crock maybe a frank discussion about his addiction would be appropriate. Hopefully your God will help him in an area that you are unwilling to.

  21. Steve Sanders says:

    It is frustrating to me that you seem to extend your feelings about one drug addicted patient to patients in general. You are the one who went to medical school, how dare they question your authority, how dare they bring their own perspectives, how dare they expect to be a co-participant in determining their course of treatment. This kind of attitude is what is driving patients in droves to naturopaths, homeopaths and accupuncturists – quacks who don’t have science on their side, but who are running circles around the medical community in terms of listening and empathy.

    • Steve Sanders says:

      I should add – I don’t disagree with your assessment of this patient who wanted narcotics. But perhaps you should consider that it was another white coat with a medical school degree who got him addicted in the first place.

      • daniela says:

        “But perhaps you should consider that it was another white coat with a medical school degree who got him addicted in the first place.”

        Yes. A little compassion for your annoying patients will go a long way in reducing your frustration.

        You are going to face this situation many, many, many times in your career. Stick to your principles, but just BE NICE. You’d be surprised how helpful it is to say to someone, “I’m sorry. I hear how upset you are about this.”

    • Glen Cadence says:

      Steve you are an idiot!!!! Who gives you the authority to call anyone quack? If you think medicine and its pseudoscience made up by the big Pharma companies is science, think again you Moron!!!!

  22. Ana Pfitscher, M.D. says:

    Sometimes is good to remember on the deep of my heart why I am a doctor and your text made me feel in this way.

    I´m from Brazil and this kind of thing, sure, also happens here. It´s not only because of “defensive medicine” – only some specialities have this problem here (plastic surgery, obstetrics…), nor because of the money the patient is paying (here most of the health assistance is provided by Brazilian government for free).
    I think that maybe people don´t respect doctor as it used to be. Free and open information (as internet provides us) is great, but sometimes give the false impression of that you REALLY know a subject, and that you don´t need a professional assistance.

    But, anyway it´s a good experience that you shared with us.

  23. AR Kinge, MD says:

    It is Good to stay on your principles. As a physician you should respond to patient needs putting in mind that you “do no harm”. If he doesn’t get the narcotics from you, he will get it somewhere else; as he was already doing. I would say give him what he needs cause you can not treat the addiction by one refusal, start counseling and get family members to help pave the way for rehabilitation.

  24. John GolbergM.D. says:

    Thirty years on , I have those feelings still, almost very week, especially when some insurance clerk tells me how to practice medicine.
    I noticed a clinic the other day where paramedics seem to be the new qualified providers.
    Search every day for the incidents that ‘make a difference”… there will be many,and the rest is best ignored or dealt with in some political forum.

  25. Brian says:

    Great article regarding the mental trials and tribulations of a medical professional that are very difficult to “teach” or even convey. Real world stories contain a wealth of knowledge that have left an impression on the writer and therefore represent the unique challenges of a role as seen through their eyes. Being confident in yourself while allowing inputs from others when necessary is always a challenge. I commend you for having the conviction required to stick to the care plan/procedure you have established. Although open mindedness, flexibility and preparedness all help keep us from diagnosing a overabundance of some biased and “forced-to-fit” illness, it is very critical that we remain confident and true to our beliefs. I believe you did exactly that.

    Thanks for sharing!

  26. Brandon Young says:

    Physicians aren’t the only ones who suffer from this sort of behavior. As a pharmacist I have four years of pharmacy school resulting in a Doctorate of Pharmacy under my belt with comparable student debt. Trust me, it’s no walk in the park. When we run into drug seekers they give us even less respect, and we are not empowered to really do anything to stop them. The last thing a physician who was bullied into a hydrocodone prescription wants is the pharmacist calling with fears of drug seeking. And don’t forget we see them far more frequently when they stop in for refills, advances, pleading for a few pills “just this one time”, or blatant robbery.

    Compound that with a certain lack of respect from other health professionals and we have some very unrewarding days.

    I like the positive ending to this entry, and I will follow suit. I chose to go into health care and subsequently pharmacy and, although there are ‘those days’, I don’t regret it.

  27. Steve says:

    Who was in more need of a physician’s healing expertise? The girl who fainted in the pew or the unfortunate drug seeker who is desperately acting out in response to his addiction? For those of you who do believe in God – they are BOTH God’s children. After 25 years of practice, many of the most difficult and challenging patients, when approached with compassion and understanding, prove to be the most satisfying enconters in the long run. Next time you feel that frustration, ask yourself what it is in you that makes you react that way. Then you will be sure to grow as a physician and person.

  28. Monica T says:

    Dr. Bratton,

    Thank you for sharing your experiences. You know that with this patient you made the correct decisions both professionally and morally. You treated his pain as appropriately as you knew from his history, and you did not prescribe narcotics liberally – especially since he was a first-time patient.

    If he really did have pain that requires narcotics, he needs to re-evaluate his long-term pain goals. Does he really want to be on narcotics for the rest of his life? It seems as though he was not even willing to consider other therapeutic options.

    From a pharmacy standpoint, I get tired of patients who ask for specifically the “Watson 349″ Vicodin or that say they are allergic to “the speckled ones” (Norco). These people know which tablets and strengths are recognized on the street and get the most money for them. FYI, these patients often have UDS positive for cocaine. The physicians I work with don’t write narcotic pain meds for patients with positive drug screens.

    Patients have to be willing to help themselves. There is only so much you can do when they destroy their own bodies.

    Best of luck with the rest of your career. I’m glad the positive experiences make it all worth it to you.

    “Whatever you do, work at it with all your heart, as working for the Lord, not for men, since you know that you will receive an inheritance from the Lord as a reward. It is the Lord Christ you are serving.”
    Colossians 3:22-24 (NIV)

  29. Don S. says:

    One’s disappointments in life are directly proportional to his/her expectations. The simple fact is that we cannot control patients, or anyone else for that matter, including even our own family members. We have the opportunity and obligation to attempt to influence their behavior, but we do not have control over the outcome. It is a potentially devastating experience to condition one’s happiness on the decisions they make and the behaviors they choose. I often remark that human behavior is the last frontier. Think about it. We cannot cure most lung cancer, but we know how to prevent about 85% of it–simply by not smoking. Yet lung cancer remains the #1 cancer killer of both men and women, having surpassed breast cancer mortality many years ago. Go figure. Yet many thousands–possibly million–of people have been influenced not to smoke. But the decision to not smoke, or to quit, was theirs alone. Human behavior is the last frontier. It is a rare practitioner who does not see self-defeating behavior, not only in patients but also in our colleagues, on a daily basis. Get used to it. And you won’t escape it by changing professions.

  30. Dr. Nan says:

    Hi Greg!
    After fourteen years in primary care, I still struggle–Is what I’m doing worth it? WHy do we struggle? Because it is HARD! We don’t do nosejobs and eyelifts-we don’t do chemical peels. We treat sick people–and sick people have flaws, some that are compensatory for being sick, and some that show physical illness as a compensation for more psychological illness!Some days I feel more like a pill pusher than an expert in the diagnosis and treatment of serious diseases. I have reconciled myself in that–I am here to treat sick people–they do not always behave as I think they should, but they probably do the best they can. I’m not saying I prescribe a bunch of narcs–I would have done the same as you–but that patient needed someone to say “No”. Maybe he will figure it out–maybe not! But your mission, or passion should not be weakened by one ill and weak patient. I get jazzed about the small things as well. There is no dramatic save to most of what we do. There’s no glory in preventing a heart attack (over thirty years, working on someone’s cholesterol). Most of the appreciation I receive from my patients (and is thus my positive reinforcement) comes from very small actions on my part (or no actions). There are things that may not seem clinically significant to me, yet are important to the patient (perception is everything). You can only be the best physician you can be–stick to your morals, and do not expect appreciation from every patient–much of what patients need–they do not like!!!

  31. chew boon how says:

    Many patients don’t know what they really need, it is the same as many people don’t really know or appreciate salvation grace in Christ.

    However, that is exactly what it means to provide patient-centred care: a process of coming to understand each others (and significant others eg. family members or carers of the patient) and shared decision making with the patient if possible. The process has to be valued and comfortable to the patient. If it does not go well with the doctor, then an informed-referral can be arranged. This may be a more fulfilling doctor-patient relationship.

  32. George Kent says:

    Such experiences are not limited to the practice of medicine. Almost any job will encounter obnoxious, manipulative jerks.

  33. Rafi Ahmad Masoodi says:

    I have innumerable reasons not to love India and just two to love it.One of the two reasons is the angelic attitude and behaviour of an Indian Doctor.When it comes to the WORTH of a doctor what matters more is how you treat,esteem and evaluate your patient and not the other way round. The PATIENT could not coerce you into something not befitting a doctor makes you “THE DOCTOR”.

  34. William Schuler M.D. says:

    I have had many similar situations in the past 30 years, some of them barely a few minutes apart. My wife tells me, “behind every upset there is an unmet expectation.” The longer I live, the fewer expectations I have. I think it really helps to read authors who have a better and wider appreciation of the human spectrum than your typical medical author. Professor Einstein once said that he got more out of Dostoevsky then out of the stuff written by his colleagues. I would also recommend Walker Percy and Flannery O’Connor–they seem pessimistic to the world but they are far more charitable than strict materialists; some of whom have made the typical intolerant remarks that we have come to expect from what passes for discourse at the present time.

    I am pleased that the Journal Watch directed me to this site. In spite of “church” being mentioned. Will wonders never cease?

  35. Anonymous says:

    The breadth of the reactions here is quite striking. It amazes me the different perspectives from which the responses come. The article, in my opinion, is right on the money. Some responses are, indeed, quite difficult to take.

  36. Alejandro says:

    Ours is a difficult profession. Sometimes really hard, specially when our patient is not improving and we do not really know what is happening. Sometimes, I suppose we all think that better if we were lawyers or something like that. But I feel proud of being a physician and I try to do it the best I can.

    Besides, maybe I am lucky because I believe in God.

  37. Naveen kansal says:

    In India, after the consumer protection act (CPA) was extended to be applied, during last 2 decades, number of students desirous to be doctors has decreased dramatically (this is according to a recent survey in the leading newspaper ‘Hindustan Times’). Medicine is considered as toughest, and longest to be a professional, still less paying & less satisfying than others like engineering or management. Moreover, we study for 8-10 years to become a specialist, but may be taken by patient as a new doctor (i.e. doctor with less knowledge. Still, if a patient says ‘thank you’, it gives satisfaction but now it’s much less than older times!!! However, I think it’s priceless to be a doctor.

  38. Raman, MD says:

    Recently in a formal discussion with my senior residents, I was told that these pain medication issue is very recent (2 decades) to american society. To increase the sales of Oxycontin / Oxycodone heavy marketing strategies were followed to educate the physicians regarding appropriate pain control and at the same time too many commercials to ask for pain medications kind of changed the culture of over treating the pain. I noticed that younger physicians (<6-8 yr of graduation from residency) has high threshold to treat the pain with high doses of opiods. Please comment: Do you think physician community need re education about pain management??

  39. W.L. (MBBS) says:

    Preventing the Misuse of National Healthcare Resources
    i) National guidelines wrt analgesia must be developed and circulated both nationally and institutionally.

    ii) A national medical records system (public hosp) needs to be developed so the attending physician can immediately view the pt’s electronic med Hx and document current care clearly to prevent healthcare$ wastage/ abuse.

    iii) If the pt’s condition is complex and warrants specialist attention then such consultations should be documented in his/ her electronic med records. Any Jr Dr seeing pt for urgent drug refill/ treatment may give Rx X 3/7 at most or other such reasonable duration until until the pt next sees his specialist.

    iv) The specialist concerned should publish within the pt’s electronic folder his current management wrt pt’s condition and a brief summary wrt EVERY specialist visit so emergency care physicians can understand the patients true condition.

    This would certainly go towards improving the patient/ physician healthcare experience as well as prevent misuse/ abuse of health care systems.

  40. MARIA BECERRA says:

    I am a Colombian doctor,i have just finished my pediatric residency and sometimes i wonder the same…
    , is it worth it to be a doctor??
    and i think the same as you…
    Yes, it’s priceless!!!
    We study this because we feel it deep in our hearts…is our life mision….hope you understand my english =) bye

  41. George says:

    You had it coming. It is not worth it to be a doctor. You are just a slave to the system. Think about it, the board of directors of your hospital is made of doctors? oh wait… IT ISN’T! It is made of well rounded business people who are not bookworms.

    There you go. Live with it. You wasted your time and effort for the “dream” portrayed in Grey’s Anatomy; Foolish Foolish. Now you have to live with it, what a loser you are.

    • Shroomduke says:

      Yikes, a little harsh there buuuuudy!

      Yes doctors love to have their egos stroked and I guess this is one place they get it. and I like your honesty but next time try humor instead of sarcasm and vitriol.

      I know it’s impossible for some doctors to imigine what it’s like to have an addiction or living in the real world… A doctor whineing about a paitent, that’s new, try unloading trucks of gravel all day with a shovel when you have a bad back because you can’t make $250/hr being a doctor, then have some smart ass doctor who’s only known you for 3 minutes tell you whats gonna help..

      Welcom to the real world doc!

Leave a Reply

Note: This is a moderated forum. By clicking on the "Submit Comment" button below, you agree to abide by the NEJM Journal Watch Terms of Use.

Our physician bloggers cannot respond to requests for personal medical advice, and recommend patients discuss health issues with their individual physicians.

Resident Blogger

Priya Umapathi, M.D.

Resident Blogger

NEJM Journal Watch General Medicine

Learn more about Insights on Residency Training.