* * Anonymous Doc

Wednesday, October 21, 2009

A good doctor would never actually leave. There's always more to do, there's always labs to check on, there's always tests to run, there's always follow-up. When I look at my watch and see it's time to sign out to the night float, I'm genuinely excited to leave. I race to finish up what needs to finish up, and I leave. And then as I walk to my car I remember eight more things I should have done, calls to make, results to check on. And I feel like I'm not giving my patients enough, that if I was a good doctor, I'd still be there.

That's the problem with this profession. The problems are never all solved. There's always another patient, there's always another illness. Everyone will die of something, no matter what we do. We will never reach the end of the stack. It's like being a public defender, I guess. There are always more criminals. So what's the point? I mean, of course there's a point. There are the ones you can help, the ones you can save. But there are so many more. My work doesn't make a dent. Even for these specific patients I'm not sure my work makes a dent. But in the overall scheme of things it certainly doesn't.

The solution, if there is one? People say this stuff is why they're drawn to research. They want to be involved in the bigger questions, they want to make an impact. Well, okay... but then you look at the research actually being done, and the vast majority of it is pointless. Maybe not pointless, but at least very specific. Even in the best journals-- I went to the JAMA website. We've got "Implications of Hypertrophic Cardiomyopathy Transmitted by Sperm Donation," "Laser Photocoagulation and Intravitreal Injection of Triamcinolone for Retinal Vein Occlusions," "Computed Tomographic Colonography for Detecting Advanced Neoplasia." These may well be important and useful studies, but they're relevant for such a tiny percentage of the population. And this is a *good* journal. There are all sorts of less-good journals. And unpublished papers. And research that finds nothing. This isn't a knock on research. We need good research. Research helps us. But doing research doesn't actually sound that interesting, especially not at the level I'm at. Helping a professor collect data, input data, sort data. Calling a list of folks who've broken a hip to ask them about the fall precautions they've taken in their homes. This is one step above telemarketing.

A good doctor would leave. A good doctor can't do everything. A good doctor shouldn't feel guilty for passing things off to night float. That's what night float is there for. That's the job. We can't care about everyone and everything. We can't get personally invested in every patient, in every test result. We couldn't do our jobs if we did. There aren't enough hours in the day. A good doctor should leave. A good doctor should sleep. A good doctor should leave.


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