For the six and a half years that I spent practicing full scope family medicine for UCSD, I’m not sure I ever really had a day off. True, the work rules which protect nurses and medical assistants from abuse would temporarily halt the influx of patient messages and refill requests from 5 pm on Friday until 8 am on Monday. But not once during that time did I ever say to myself “I’m done. I no longer need to think about work until tomorrow morning.” Well, the cycle of perpetual responsibility for patient lives has finally ended. And it is amazing!
Our kids were sick last week. Just a cold that they probably picked up while traveling, nothing serious. But significant enough that our baby sitter couldn’t take them. And, it also happened to be a day when my wife had an important work meeting which she couldn’t cancel. If such a circumstance had ever arisen while I was a practicing clinician, staying home with the sick children would have involved canceling patients at the last minute, double booking them at a later time, triaging those who needed to be seen sooner to another provider and so on and so forth. And my lack of physical presence in the office would have no bearing whatsoever on the quantity of work flowing in. Patient calls, patient emails and refill requests would not abate in the slightest. Oh, how jealous I was of those hourly workers who are off when they are off and who get paid when they are not off. It would seem to be such an intuitively fair system. But in clinical medicine, even if you’re not getting paid to be at work, the work keeps coming. Just because your shift has ended or just because you have finished seeing the last patient of the day doesn’t mean that your professional obligation has ended.
“But,” you may protest, “Why can’t a colleague (who is not taking the day off) cover my inbox the same way a medical assistant might for one of her colleagues?” They can…to a degree. But, there are major barriers. For, doctors don’t simply follow protocol. They get paid the big bucks to make big decisions. They get paid to accept the responsibility for any bad outcomes their decisions might produce. And a doctor who has had the benefit of spending an entire visit with a patient has already gone through that decision-making process. So, for that doctor, the calls that come in later can be answered quickly. A colleague covering for me needs to open the chart and figure out what the heck is going on before they can determine whether that methadone refill is appropriate. The nature of current medical practice is a huge barrier as well. The idea that having a single primary care physician to act as your advocate and to be the director of a team-based approach to care has been shown to be both cost effective and to yield better outcomes. But, it results in a culture that rewards doctors who give up their personal time in order to help their patients and stigmatizes doctors who try (and mostly fail) to approach their job with an “on the clock/off the clock” type of attitude. I am, and have always been, decidedly of the later mindset. I believe in hard work and I believe that life is most rewarding when one performs to the best of one’s ability. I would always strive for excellence in clinical practice as I now strive for excellence in utilization management. But work does not equal life. There is so much more than work that we need in order to be fulfilled spiritually, physically and emotionally. Work has its place. That place is a box. A box with unbreakable sides and a hermetically sealed top. It must be kept in its box.
Hence, the day off that I had last week was kind of a novel experience. Every 30-40 minutes my brain would reflexively turn my body towards the nearest internet capable device in order to log into…wait. There’s nothing happening today that requires my personal attention. The work will all get done. I’m not getting paid to work today, dammit – why am I thinking about work? 17% of my brain cells which had previously spent their entire lives worrying about whether I had killed anyone that week suddenly had nothing to do! It was as if I could I could hear the song Celebration playing somewhere in my head.
On a particularly contentious peer to peer discussion I had today, a doctor said to me, “I’m sorry medicine didn’t work out for you.” The only thing I could think to say at the time was, “Buddy, you have no idea how inaccurate that statement is.” I didn’t say that. I bit my tongue, allowing him to finish his temper tantrum. After all, I was in that doctor’s shoes not long ago. And it sucked. And I’m so much happier now, because medicine has worked out for me better than I ever thought it could.