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.
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.
47 Responses to “The Price of Being a Doctor”
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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.
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…
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.
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!!
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.
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.
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.
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.
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.
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.
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!
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.
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.
there is no god
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.
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
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!
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.
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.
Thanks for sharing your story! Think about going on a medical mission where you practice medicine without the politics or paperwork. Becky, FNP
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.
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.