Old Timer’s Disease

Today’s Jack Handy-like Deep Thoughts are brought to you because of a comment from one of my frequent blog readers. Thank you, Rob, for making me think. 

My work life is busy enough, yo? I see telepsychiatry consults from two to four days per week, and then I do a mental  health clinic another two or three days per week. I work an average of seventy hours per week. Yeah. Lots of reasons for that that go pretty deep too, but we won’t go there today.

Patient after patient, chief complaint after chief complaint, mental status after mental status. It is good work, intense work, fulfilling work, and it keeps me on my toes. Most of the time it gives me a sense of pride and accomplishment and makes me want to come back the next day to do it all again. Most days I do. Ad infinitum.

I find that one thing happens as time goes by and the sheer number of patients I see goes up by orders of magnitude. 

I have a hard time keeping all of them and their stories in my head. In my professional RAM, you might say. Easily accessible instantaneously, called up from the fastest part of my brain that holds information that I expect to be able to access at almost any time, quickly.

Now, my father could do this. The man’s capacity for information and stories was infinite. It awed me. There were lots of things I did not like about my father, but I wanted to be like him in this way. To be able to walk up to someone he had not seen in days, weeks, months, years even, and say hello, call them by name, and ask how their spouse and all their kids were, also by name. It blew me away how he could do that. 

He did not pass along that ability to me.

I used to be better at it than I am now. I used to be able to see a patient’s name on my schedule for the day, think for a split second, and pretty much recall the last visit with them, what I did, the reason for today’s follow up, and other pertinent details. Today, the sheer volume of patients and the severity of their illnesses and the desperation of their circumstances makes it very, very difficult for me to do that. Sometimes, I look at that name and cannot bring a picture of the patent into my head at will. I need more prompting. I need more clues. 

Where do these come from?

Nowadays it’s mostly from the Electronic Medical Record (EMR) or the Electronic Health Record (EHR) depending on where you practice. A record keeping system by any other name…

The volume of people who need our help as doctors is huge. The broader healthcare systems are overloaded. The information to be managed and recalled and manipulated is boundless. The treatment options are many, many more than we had even twenty or thirty years ago, in my practice lifetime. I sometimes feel, and I’m quite sure other doctors feel the same (but they don’t write about it, so here goes) that I am frantically treading water in a huge ocean of misery, red tape, government regulations and insurance company oversight that has completely taken away my ability to swim freely but has forced me to comply or drown.

Part of that manifests itself, at least to me personally, as disconnection from the object of my primary affection, my patients. 

If I cannot take the time to listen to you and your stories, to learn about you and take you into my brain and formulate my therapeutic responses and treatment plans that I think will help you, why am I practicing medicine? If I cannot keep your basic list of medications in my head, not on a server somewhere, if I cannot care enough about what our last visit entailed to make it a springboard to this one, without relying so heavily on an electronic record to drive my actions, then what were all those years of training for? 

If I see your name on my list of appointments today, and I cannot even remember who you are without all these external prompts, if I cannot even see your face, then how long will it be before I forget who I am as a doctor?

How long after I lose meaningful therapeutic contact with you will I completely lose myself?

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14 thoughts on “Old Timer’s Disease

  1. In the fire service, I often got confused when our daily training session featured pump physics and the relationship between Volume and Pressure (as volume increases, pressure decreases).
    If we extrapolate this to psychiatry and define pressure as “presence” I think we have the answer. But what’s the solution, Doc? I mean until cloning becomes more practical. Fire engines have changeover valves, whereby the engineer can adjust the pump configuration (series or parallel) to match the situation. A good rule of thumb was, start off in pressure so the first attack line has plenty of penetrating power, then switch to volume once you have more than three lines in operation—but no more! Modern fire engines have huge pumps, with much greater capacity, and I wouldn’t know where to begin today. Personally, I’d love to see you “dial it down” to teaching and writing, with a small private practice at first, and eventually just teaching and writing–you have the cred, and then some. Don’t go down in flames, please! Rob

  2. Dr. Greg, I believe you to be a very good doctor, and that’s the main thing your patients need. Yesterday in Urgent Care, I met a Dr. Greenbaum. He seems to be in his 80s. He didn’t know me, but he listened to me; he respected me. He ran a strep test on a patient that had a temp of 96-and no throat inflammation. He did list multiple causes for my sore throat, but he did this gently. Then he came rushing back, greatly surprised, saying that god creates some unique bodies and it’s the doctor’s job to learn how they work, I have hot strep, and I now have antibiotics. He said that he would contact my PCP-and mention my low temp, normal looking throat. I’ve had these strep-symptoms coming and going since mid-May. I’ve been tested twice to see if I was a strep carrier. I’m not.

    Which doctor practiced medicine and gave me comfort? the one that knew nothing about me, but listened, or the one that knows my son is a disabled vet, knows all of my allergies, but stopped listening for some reason? He’s normally a good doctor-but this time he failed me. I think that he was blinded by failed technology-it failed for me.

    As long as you listen, and practice med 101-and I believe that your 101 level is extremely high, your patients are winners in many ways. There is more to friendship than remembering the details of someone’s family life, it is liking the person, being there mentally. .

  3. I’ve somehow the feeling that, the more “technologized” our world is getting, the more overwhelmed by red tape and energy-consuming chores we are.
    Technology was supposed to help us and facilitates our lives, whereas it just enables to add more and more tasks to our everyday working lives.
    So many files about us, so many people big-brothering us, so few human relationships between us.
    My feeling is that, as long as you question your good-practice, as long as your question your core being as a psychiatrist, you’ll stay what you presently are: exceptional.
    Don’t change. Please. :)

  4. Meyati nailed it Doc (she usually does) and I’ll let you off the hook if you promise me you won’t forget where the relief valve (prevents catastrophic failure) is located on your pump panel. Deal?

  5. Oh heck, Greg, you’re human not a robot. Your patients don’t want a robot, I’m sure they’d far rather you have name and face and other gaps than be an automaton that can remember things that, in the end, really don’t count for much. You’re still helping people, yeah? That’s all that matters.

  6. Greg,

    I know that YOU know you are not alone.

    …”Treading water in an ocean of misery, red tape, government regulations & insurance coverage oversight which has completely taken away my ability to swim freely but has forced me to comply or drown.”

    Every healthcare professional I am in contact with struggles as you do. Some have retired early. Some are changing the scope of their practice. Some have actually made career changes. And some are fighting & struggling in their present positions, doing their best to keep from drowning, as you are doing. There is no easy answer. But I see you clinging to a profession with everything you have, because of a fiery passion that burns in your heart & soul. A passion for people who are hurting. A passion to do all you can to take away maybe just a piece of their pain. These patients of yours…the ones hurting to their core…they see this passion. They feel it. And they know you will do everything in your power to help them. So they keep coming back.

    THAT’S why you persevere through the red tape, government regulations, insurance companies, & insane volume of patients in that ocean of misery. You must get through all that crap to get through to your focused goal…your patient. You have a gift from God…namely that of compassion. You have a tremendous desire to use that gift, as God intended. And you will continue sharing your compassion, knowledge, skills, expertise, & experience with those who seek your assistance, until the time comes to move on.

    I tip my hat to you for fighting & persevering. I couldn’t handle the red tape & continued government control. So I got out. I loved the healthcare field but just wasn’t strong enough to persevere. You, on the other hand are, my friend. God supplies you with what you need & you run with it. But it’s not a sprint. It’s a marathon! So regroup, recharge & run like the wind! With perseverance, you win!

    We know that suffering produces perseverance; perseverance, character; and character, hope. Romans 5:3-4

    M

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