Why it seems like your doctor doesn’t care about you

There’s a clear disconnect between what most patients value in health care and what hospital systems and insurance companies want


Shirlene Obuobi for The Washington Post

I was on the 10th hour of a 28-hour shift in the intensive care unit when I noticed the message. I had missed a call from one of my primary care patients, an older woman who was complaining of a headache.

This round in the intensive care unit has been particularly scarring. My team is nicknamed “Team D for Doom” because of what appears to be our bad luck: We have admitted a disproportionately high number of sick patients. Our days are spent alternating between emergencies and end-of-life conversations.

I have not yet learned detachment, and I’m not handling the secondary trauma with the straight-backed indifference that is expected of physicians. I spend a lot of time crying in bathrooms and not enough time checking my inbox.

I call my patient, an apology on the tip of my tongue.

My patient isn’t willing to hear it. She is creative with her insults, and so loud that my co-residents can hear her expletive-ridden admonishments through the receiver from feet away. “You don’t give a … ,” she continues, using an expletive. “None of you doctors do.” She hangs up, but not before firing me.

It’s the first time a patient has accused me of not caring about them, but it won’t be the last.

It happens again when I inform an underinsured patient that the cardiac scan they need can’t be done during their hospital stay, leading to a delay of six weeks or more in appropriate therapy.

And when I inform a woman who is struggling with homelessness and recurrent infections that the surgery she needs has to be done at the county hospital to which she has no reliable transportation. An older woman with newly diagnosed cancer cries when I am an hour-and-a-half late to her clinic appointment, making her miss her ride home.

It is hard to hear every time. I wish I could tell all of these patients that I do care; that I, like so many physicians before and after me, entered the medical field out of a desire to help others.

But many patients define caring as taking the time to listen and thoroughly investigate their complaints, following up promptly on test results and advocating for them.
This kind of caring takes time and resources that many practicing physicians are not given.

There’s a clear disconnect between what most patients value in health care and what hospital systems and insurance companies want. The American medical system rewards procedures, imaging, tests and other diagnostics that generate revenue and have high reimbursement rates. This is reflected in the disparity in salaries for procedural and non-procedural specialties. For example, endocrinologists, who manage common conditions such as diabetes and osteoporosis, are paid about half as much as gastroenterologists, whose practice includes procedures such as colonoscopies, despite similar lengths of training.

Because they don’t generate revenue from procedures, non-procedural specialists are pressured to increase their patient volume and are often given appointment slots as short as 10 minutes.

It is quite literally impossible for a primary care physician to provide appropriate, guideline-recommended counseling to an average-size patient panel in one clinic day. A recent study estimated that to do so would take a 27-hour day. Despite this, the prevailing expectations from patients and institutions alike is that physicians provide thorough, holistic and compassionate care that generates high satisfaction scores.

Over the course of my training, I’ve found that leaning into my patients’ humanity has personal and professional consequences. Thoroughly investigating one patient’s complaint means running behind in clinic and upsetting patients with later appointment slots.

Taking the time to attend to multiple patients’ concerns before rounds means not finishing discharge paperwork in time and being labeled as inefficient. Calling back my primary care patients to answer questions about their test results means sacrificing three hours on my day off and upsetting my loved ones, who already feel low-priority during my training.

On the other hand, minimizing or dismissing symptoms generally lacks consequences. Physicians who adopt a more brusque and paternalistic approach seem to be more efficient.

Many physicians, however, can’t stomach the moral injury that stems from knowingly providing incomplete care. The result often is burnout, which has led

Нужно, войти или зарегистрироваться для просмотра скрытого текста.

to consider leaving medicine altogether.

For me, art has been a coping mechanism. I started drawing and sharing comics to chronicle my experiences as a medical trainee and to cope with the unexpected impact of moral injury.

I chose cardiology, which requires additional training, in part, because its procedural and diagnostic components would allow me to narrow my scope and, I hope, negotiate a work-life balance that will help me to remain an empathetic physician.

One of my mentors, a primary care physician who has been in practice for 25 years, recounted locking heads with her supervisors over her request for 40-minute appointment slots for new patients. They were concerned that she wouldn’t be able to generate enough revenue to justify her employment. She compromised by stretching out the length of her clinic day by three hours. Now she works until 8 p.m. It means that she doesn’t make it home for dinner with her husband, that she will be up late writing notes and that she will be up early in the morning to do it all over again. But for her, the extra work hours are worth it. Her patients don’t feel rushed, and she feels fulfilled in her work again. I admire her sacrifice, but the fact that it’s necessary makes me uneasy.

A week after I’m let go by my irate patient, I am running late again in clinic. I burst through the door of my final patient of the day. I’m flustered, but he greets me with a laugh. He tells me not to worry, that he appreciates that I take my time with him and figures I must be doing the same with everyone else.

It’s not much, but his reassurance reinforces that I’m doing the right thing, that I’m in the right place, and that the mission that drew me to my profession in the first place is valued by someone.

Shirlene Obuobi is a second-year cardiology fellow at University of Chicago medical center. Her comics about navigating health care appear on her Instagram @ShirlywhirlMD. She is the author of “On Rotation,” a novel about a Ghanaian-American medical student.

Нужно, войти или зарегистрироваться для просмотра скрытого текста.