Insights on Residency Training

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.

In 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.