Burnout

Something is wrong. 

When I ride my bike to work, I have to wend my way through the towering colossi of medical buildings along Francis Street in Boston’s Longwood Medical Area. The tower cranes are constructing new clinical spaces, bigger hospital wings, offices, outpatient clinics, all built in the name of better care for patients, but they also happen to boost the bottom line. In this town, maybe more than any other in the U.S., you can literally feel the thrum of the medical industrial complex. 

My first patient, I'll call her Amy, comes in late to her 15 minute appointment, partly because of the construction. She's had abdominal pain for two months, and she tells me about the letter she needs to excuse her from work. She doesn't make eye contact as I ask her about the pain, telling me she doesn't have time to talk about it because her son is double-parked. He's skipped his college classes to drive her, and since he doesn't have his license, a ticket would be devastating. 

It only takes ten seconds of silence before she starts weeping. 

By now, I know enough to keep my mouth shut at times like these. Her recurrent abdominal pain has defied investigation with CAT scans, endoscopy, biopsy, antibiotics, and all manner of pain medication, but I have a suspicion that it's about to make itself known. Between sobs, she tells me about the breakdown in her relationship with her daughter, the money that was lent and then squandered, the shame, guilt, and sadness, the lack of sleep, the trouble with work. And of course, the continued pain. 

How strange that this woman’s workup, spanning two months, five office visits, one specialty referral, and totaling at least $3,500, simply needed someone to shut up and listen? She is depressed. More curious still, consider the fact that the medical colossus, that her son is nervously navigating below, is built on that $3,500. And finally, despite the gleaming towers and efficient endoscopy suites, nowhere in this massive complex is there a therapist with whom I can connect her. In seconds I can order more of these colossus-building tests with the flick of my fingers, but to get her some actual relief it will take minutes of scampering around the back hallways trying to find one of the few social workers trained in mental health counseling.

Our 15 minute visit that started late has now run past a half hour. I start my scamper, and as I brush past the waiting room, I can feel the eyes hungering for my time. Ask not for whom the parking meter ticks -- it ticks for us all. I am burning out. 

I chose primary care because I love talking with patients. I love solving problems. I love taking all comers. I love helping the vulnerable in all forms- poor, traumatized, discriminated, frail. I love finding the true nature of someone's abdominal pain and connecting them with a treatment that can restore their family. How can it be that, in the midst of that sentiment, a voice in my head says, "I hate this."