My Rant: It is not Malpractice to be Tired

kidsfightingFair warning: I am on a rant. Skip this one is you don’t want to hear me whine.

In the last few days I have seen doctors in the media picked on because they fell asleep (“Doc, there are patients who need to be seen!”), because they were burnt out, and because they didn’t smile, explain things thoroughly, and ask about the patient’s home life while checking for an ear infection. Doctors fought back with comments about their long hours, intense work schedules, and exhaustion.

It didn’t work. The comments just changed to: “Well, fight for better hours!” Or: “Be willing to make less money!” (umm, I did go into pediatrics…) One person was actually so narrow minded and idiotic as to tell us we were harming patients by working too hard, and that it was sheer laziness that kept us from improving our schedules. That we “were keeping our heads buried in the sand” so that we did not see the important issue: that the business of medicine was as important as the practice of medicine. That what we were doing was “not good enough,” and that doctors never fight for anything. How that person knitted all those ideas together in one head is beyond me, and I don’t believe that I, or any other doctor, deserved it.

First, no one was harmed in any of the situations. The sleeping doc got up and went back to work, probably better for the quick power nap. The child whose doc did not smile and ask about their home life nevertheless fit that child into her already full schedule and took excellent care of her. I have in thirty years never harmed a child because I was exhausted. I did once tell a mother that I was too tired to care for her child and would find them another doc, after which I walked back to the office, sat down, passed out and had a seizure. Doctoring is a different sort of job.

Second, doctors have been fighting far longer than I have been one. We fight with insurance companies every day. Through the AAP we fight in the legislature for pediatric issues. We fight for universal vaccination. We fight for neglected kids, for abused kids, for healthy foods in schools…

Last, our heads are about as far out of the sand as they can get, as we care for children whose parents have poured boiling water over them, for teenage girls gang raped at parties, for gay children who are thinking of slashing their wrists…

There are a limited number of hours in the day, and every single time the kids matter more than how overworked we are.

The one thing that I am never willing to compromise is the care of my patients. Jumping from “doctors are overworked and stressed” to “doctors are harming patients because they are overworked and stressed” is a leap. The data actually proves otherwise.

Presuming we can simply work less and everything will be fine is naïve.

One of the biggest problems right now is that there are simply not enough docs, and fewer of them are going into and staying in primary care. Those of us in the trenches cannot do less when there is no one to take up the slack. Legislation can not fix this problem, and the fact that we are judged and condemned at every turn just puts another nail in the coffin of primary care. The doc above fit an extra patient into her day, took care of the acute problem, and was spat upon because she didn’t smile and answer questions that weren’t even asked. If burnout is a concern, then stringing us up for target practice just because we are doing our jobs is a problem.

So here is my fight for the day, because I do not want to be accused again of not fighting enough: please appreciate the 11 or more years we spent in school and worked for free, accumulating debt while you were already earning a paycheck. Please appreciate the fact that when you call at 2AM, we answer. Please appreciate the times we miss important events in our children’s lives because we are helping someone else’s child. Please appreciate the fact that we carry the responsibility inherent in our jobs on our backs every minute of every day.

A simple “Thank-you for fitting my child into your busy day,” will go much further toward keeping doctors in primary care than any change in our work hours or income. We are not the enemy; we became doctors because we wanted to help people. Please let us do our jobs, and don’t snipe at us because we are tired. The fact that we are tired and overworked is not a good enough reason to fault us. We do not deserve it, and we have earned at least that much respect.

Whether or not the insurance company pays that $35.00 is always going to be at the bottom of my priority list, as it should be. The business of medicine will never and can never be as important as helping that little boy in room 2 to breath better.