To advocate is to publicly recommend or support. In terms of healthcare, it means speaking up for yourself and feeling more confident about the choices you make with your doctor. It means not letting someone else make all of your health care decisions without your input. It means being an active player in your health care team and helping drive your outcomes in a positive direction. It means asking questions when you don’t understand. It means keeping track of the course of your care. It means knowing your history and your family history and any other details pertinent to your health. It means following through with your doctor’s recommendations and taking your medications as directed. It means emphasizing an honest, team-oriented relationship with your physicians. It means being honest about your preferences or concerns. Let me clarify. This does not mean being rude or inappropriate or deliberately obstinate with your physician or constantly being on the lookout for a mistake that you can capitalize on. It is exactly the opposite. That kind of behavior really does nothing but insure a negative outcome.
You get the picture? Advocating for yourself requires action! You are representing you! You are the only one who knows you intimately and is with you 24 hours a day. This is something that you should never have to apologize for. For me personally, I love it when patients ask questions and get involved with their care. It shows me that they are actually interested in getting better. I have some colleagues that would strongly disagree. They hate it when they have to spend extra time answering questions. They view it as more of an act of belligerence or a personal attack, doubting their expertise. To me that is just a sign of their own insecurity in their recommendations. I say ask away and don’t leave the office until you feel comfortable.
Did you know that studies show that people who advocate for themselves are healthier and tend to live longer? Sounds like another bonus to speaking up if you ask me. Self advocacy is important because it helps you to be able to make your own decisions. It helps you gain self-respect and self-confidence. It helps you form an alliance with your physician. It helps you be a part of the doctor patient team relationship. It helps you learn to express yourself properly to attain the goals that you want. From what I can see, there really isn’t a down side so speak up why don’t ya?
Being a good doctor has been especially tough lately. It seems like there are so many obstacles to being able to provide quality care without completely sacrificing your own mental and physical health. Fortunately for me, I consider myself to be very strong of mind and body and my love for my patients and my job still far outweighs all the negative impact of the obstacles. I am very grateful for that, but, some are not so lucky.
You ask yourself, what kind of obstacles could doctors really have? Don’t they have it made? I mean, don’t they just make a ton of money off of the rest of us and live these amazing extravagant lives? Don’t they just get to direct us like sheep with all of their recommendations, procedures, and prescriptions etc? I hate to burst your bubble, but it is not like that at all, at least not for me.
Did you know that the rate of physician burnout is set to hit and all time high this year? The final numbers are not in yet, but it doesn’t look good. On top of that, Ob Gyn as a specialty has the fourth highest rate of burnout among all the specialties. 46% of Ob Gyn physicians report feeling burnout. So, what is burnout anyway? Physician burnout is classified as a psychological syndrome that is a prolonged response to chronic occupational stressors. Heh? What? It means that the stresses of the job potentially get so overwhelming and so stressful that you kind of break down and just don’t want to do it anymore. Yikes! Sounds awful doesn’t it? I mean anything with the word burn in it can’t be good right?
So, what are the symptoms of burnout? 1) Feeling tired and drained all the time is one of them. 2) Fatigue that does not budge no matter how much sleep you get is another. 3) Feeling sick all the time is yet another. 4) Changes in appetite or sleeping habits 5) Drop in libido or sexual desire 6) frequent back pain, muscle aches, headaches with no other apparent cause.
What do physicians have to be so stressed out about you ask? There are a ton of potential stressors. Let’s start off with the fact that your incredibly high medical school loans offset by the lower average salaries for most physicians means that your debt is not paid off until you are nearing 50. How about the fact that reimbursements for physicians, particularly in my specialty continue to drop, regardless of manhours spent or level of difficulty to the point that I find myself wondering if I am going to be the one paying to do procedures on patients instead of the patients…lol. Let’s think about the hours for a minute. For me, a solo practicing obgyn, I am essentially on call 24 hours a day and 7 days a week. My ability to do anything with my family completely depends on what is happening with patients. I find myself getting coverage if I decide to go to the bathroom in a town that’s greater than 30 miles away, much less if I am going on an actual vacation. I just can’t risk missing a call. For those of you with 9 to 5 jobs, most of you get to be done when you go home. I am never really done. I am always responsible for my patients. I am not complaining. I chose this life and this specialty. I am just clarifying.
Another stressor is the fact that there has been a huge breakdown in the concept of the doctor patient team relationship. Patients are now viewed as consumers rather than patients and as such, this wave of consumer-oriented thinking has brought a wave of bossy, entitled, demanding behavior that is often hard to stomach. I am extremely fortunate that I do not have a lot of these patients, but when I do, it is very exhausting. I have spent too much time invested in my education and have worked too hard and too long to have patients shake their finger at me, dictating their own care without listening as if I am their secretary or sales rep, rather than their doctor. It’s just not right.
One of the biggest stressors is the fact that doctors, even with all of their training and medical knowledge, do not really have the final say in what they can recommend for patients. The insurance companies do. The expenses do. The patient’s ability to pay does. I cannot tell you how many thousands of times in the last 25 years that I have had to change the optimum management, prescription, procedure, etc for a patient because of insurance and cost. Most of the time, my poor patients have to go through multiple treatment failures, medication side effects, extra office visits, etc before I am allowed to finally do the right thing for them because of some insurance criteria. To make it worse, most of them do not understand that I am not the one dictating these delays. They are under the impression that I am just “nickel and diming” them. Nothing could be further from the truth, yet I bear the brunt of their frustration and mine anyway.
Last but not least, let’s touch on the impact of COVID 19 for a minute. Wow talk about a stressor! Now we have to worry about exposure, like the rest of the world. We can’t hug our patients, hold their hand or comfort them in any way except with words, which is just not enough for some patients. If you thought insurance companies were bad about dictating care, they have nothing on COVID. We are being told when we can do procedures. I didn’t operate for months. We are being told what care is essential and what care isn’t. (Apparently vaginas fell in the isn’t category for awhile, unless a baby was coming out.) Our businesses are shut down and employees are sent home because there weren’t enough patients to keep them. Employees are afraid to come to work even when we have enough patients. We are told to do virtual consults instead of bringing patients to the office. How exactly are you supposed to do that with ObGyn patients? Hold their vaginas up to the screen? Generalization and conformity rules over sense and applicability. Even now when we are allowed to see patients, fear keeps most of them home anyway, crippling my ability to adequately care for them. I can say 100 times that it has never been safer to go to the office with all the precautions and prescreening, but I cannot force them to come in.
Long story short, physician burnout is a real thing. It affects nearly half the physicians in a lot of different specialties, and obgyn is no exception. I just want everyone to keep in mind that we doctors realize that everyone is struggling right now, but we need you to realize that we are right there with you.
So, I am sitting here right now, trying to relax. I am supposed to be on vacation and yet my mind is spinning with thoughts about my business. Are my patients going to be okay? Will my colleagues care for them like I would? Are any bills going to be late? Did we tie up all the loose ends before we left? Will there be any money in the bank when we come back? Is there anything I forgot? Will all my followers move on when I don’t post for a week? Will I miss any job applications? Will I miss a deadline I didn’t know I had while I am gone? It just goes on and on.
I guess that that is the life I signed up for. You are never truly “off” …..at least, not if you are really in it to win it. It is the compromise that you strike the second you sign on the dotted line to commit to a private practice sans safety net type of scenario. I have no set hours or guaranteed salary. However, I am at least philosophically the master of my own destiny. In reality, my success also depends on a number of third parties like insurances, reimbursements, billing companies, vendors, and employee work ethics. So, I am kidding myself if I think that I alone can guarantee or swamp my career.
I am not a 9 to 5 type of physician and I never wanted to be. I look all around me and see the significant disincentive to starting private practice. Medical school graduates now seemed to be groomed to think that private practice is impossible and that they NEED the backing of a large conglomerate, set hours, employed practice in order to even entertain the possibility of being a physician. It’s a shame really. What these new docs have traded for this implied security is stamina, work ethic, commitment, and dedication. To be 100% transparent, this is only my opinion based upon what I have observed all around me with the newest generation of doctors. I am not trying to be some hard core, stone age dinosaur, but I have literally seen resident physicians turn away mid conversation about a patient if that conversation was occurring when their shift was over. That is just not what I want, nor do I feel that that is appropriate. That is going too far in the 9 to 5 direction. We are not office workers. We are responsible for lives.
The private physician is slowly but surely going the way of the dodo and being replaced by shift workers with set hours and volume driven goals at the expense of quality. For me, the world does not stop the second that the office phones get turned off. My responsibilities are not just handed off to the next guy. That is not my reality and that is OK. I am not saying that I never need a break because, in fact, I do. I really do sometimes. It’s just that I am not going to spend time whining about the inconvenience when I chose to have it this way. It would be kind of ridiculous. Now, having said that, I am sure that my family would not agree that I should always be on. It definitely goes against that eternal quest for balance that I am always talking about. Yes, yes, I do actually listen to myself when I am attempting to espouse wisdom to the masses. I guess what I really saying is that I still just need to work on it.
A family practitioner colleague of mine used to say this all the time to patients. ” I am a physician, not a magician.” Initially it always made me laugh because I am generally a fan of quippy sayings. But then, the truth of it really began to sink in…….A truer statement was never uttered. We are physicians not magicians. We are here to guide and provide evidence-based recommendations to attempt to better the lives of our patients. We are not here to bully or coerce. We cannot force anyone to do anything. The only time that I really get bossy is when it is a matter of life or death, which I feel is reasonable…lol When we take the time to advise a patient on their next move, it is essential that we are not in the game by ourselves. There needs to be a team effort relationship between the doctor and the patient in order to be successful and mold the desired outcome. This holds true for every type of patient that I care for: aesthetic patients, addiction patients and obgyn patients. In order for the doctor patient team relationship to remain stable and fruitful, there has to be personal investment on both sides. For me, that is guaranteed. I would not be in this profession if I were not invested in every single patient in every single scenario. That is the whole reason I got into the practice of medicine: to improve and save lives and to help as many patients as my faculties allow for as long as I can.
From the patient side, however, nothing is guaranteed. I have many wonderful patients that seem to value my advice, attempt to follow it to the best of their ability and actually are able to achieve the outcomes that they want to a reasonable extent. These patients are truly a joy to care for. They are the kind of patients that you reflect on to get you through a tough day and remind you why you are doing this in the first place.
Then, there is the other subgroup of patients. These are the ones that come in after years of absence and personal neglect with high expectations that you will be able to wave your magic wand and fix all of their issues with a single sweep of your arm. These are the morbidly obese diabetics who have never even attempted to modify their lifestyles or their mental relationships with food and demand that you refer them for a gastric bypass and are outraged when you hesitate. You try to explain to them how important it is to change their mental views about food and stick with some sort of weight loss plan and even psychological counselling for six months to increase their chances of success. This just further infuriates them since they are already frustrated and blinded by their quest for a quick fix for a problem that is many many years in the making. These are the patients that request CoolSculpting ( a non-invasive fat freezing procedure) thinking that it will shrink them from a size 24 to a size 2 with absolutely no effort on their part in terms of diet and exercise and then get angry when you advise them against it, because you are not out to take their money by doing something that you know won’t work. Shame on you right? Wrong. These are the kind of patients that frustrate you, make you second guess yourself, and leave you questioning if you will ever be able to make a difference in their lives. Every interaction with them is like walking an agonizingly fine tightrope. Fall off on one side and you may satisfy them for a second, but you compromise your ethics. Fall off on the other side and you have done what’s right but they may leave and never come back. Either way someone loses, whether it is you or the patient.
The bottom line is that the doctor and the patient have to be a team. It makes sense doesn’t it? Both parties should have the same goal: the well-being of the patient. It is ideal if both parties are on the same page, but not always possible. However, even if both sides are not in agreement, goals can be achieved as long as there is a personal investment on both sides. Both parties have to play an active role in order to achieve the desired outcome. The doctor has to be actively engaged in researching and recommending solutions for the patient and the patient has to be willing to take the necessary steps to attempt to follow those recommendations in order to achieve their goals. The doctor cannot wave a magic wand any more than the patient can just sit and wish for change without taking any action. It just won’t work. Have a great day everyone.
