What Medicine Is Really Like - Part 1

I didn't really know what medicine really was like until my clinical rotations in med school.  I generally thought all doctors were nice, that everyone respected doctors, and that everyone collaborated really well in the hospital.   I thought people who could get better got better, and I didn't know there were so many administrative things to do, and I didn't know insurance companies could be so hard to deal with.  I didn't know I could nearly vomit from anxiety in certain situations as a doctor.

The Work Environment

So everyone is overworked.  Pleasant people become sarcastic and cynical.  The rare few who aren't have fantastic coping mechanisms.  Consult teams are paged all the time and are juggling so many patients that they might brush you off or be rude to you.  You'll have to page a second time and then get yelled at on the phone or talked to in a condescending way.  A superior will make an intern call a consult that isn't exactly medically indicated but is being called as part of a defensive medicine move, causing friction between the primary team and the consult team.

Different specialties talk bad about other services, and everyone has their own idea of how the hospital should be run.  You'll hear stories about patient mismanagement and then see it yourself the longer you are in medicine.

Medicine says surgery is dumping patients on them, surgery thinks their surgical patient is more of a medical patient.  Nurses get frustrated that the July intern doesn't know everything and the intern is frustrated that he doesn't get the patient updates going to the upper level or fellow.  Ancillary staff will give you a lot of grief and won't hesitate to disrespect you for minor things that don't even matter.  Disrespect from techs is pretty unwelcome.  I know they're overworked and I often hear them complain about their job, but please, residents are learning and doing their best with unstable patients and every moment is critical.  They don't know exactly what it's like to be a resident.


Administrative Headaches
There's a lot of learning how to document in medicine that makes you feel like the administrative aspect overshadows patient care.  We have to check these boxes and prove to others that our central line in the ICU patient in shock is justified and checking boxes to show we reviewed medications on the patient who got admitted.  We have to document everything, down to our discussions with patients about bowel movements, or it never happened and we are held accountable.  I understand the impact medicine has on human lives, but we're micromamanged a lot and have to document everything little thing because of the medicolegal atmosphere.  You can verbally instruct a patient to do this or that but if you don't take the time to document that conversation in your busy backed up clinic with impatient patients and overworked staff, you're in trouble.  A lot of medicine is documentation to protect yourself. 

We spend more time doing computer related charting and administrative tasks than on actual patient care on a typical inpatient unit or outpatient clinic.  It makes you feel dissatisfied.

Patient Adherence

It used to be called compliance,but I guess that sounded too authoritative.  I've seen dozens of patients repeatedly get admitted to the hospital for exacerbations of chronic diseases because they just didn't want to take their medicine.  I've had patients with HIV tell me they stopped taking their anti retrovirals "because I felt fine and didn't feel like I needed them anymore."  Seeing a patient get admitted twice in the same month a week apart because they have terrible heart failure but chain smoke and follow a diet full of salt while not taking any medication is something that happens a lot despite how ever much counseling you do.  I can see why internists burn out.  The patient who eats healthy, runs, and takes all their medicine, and loses weight has been pretty rare in my experience.