Confessions of a disruptive physician

At the lowest depths of burnout, I was a “disruptive physician.” I got away with a lot. I frequently lashed out in anger with inappropriate comments to nurses and staff. I yelled at my husband and my kids. I was in full “victim” mode and I let everyone know it.

As an OB/GYN, I was available to my patients 24/7/365. This was the way it was in my private practice. I didn’t push back because, initially, I loved it. I had full control over the medical decision-making with my patients. I had a continuity with them that was rewarding for them and for me. The “private practice way” of OB management was actively trying to deliver patients on clinic days. We would strip membranes and schedule labor inductions that would work for our schedules. Then we would rupture membranes, use Pitocin to optimize labor, and try to get the baby out before dinner.

As time went on, that level of control became difficult to maintain. Labor and delivery would refuse to admit scheduled inductions; there were too many patients, not enough nurses, or there wasn’t an ACOG-approved indication to induce. No, you can’t induce your mom of three at 38 weeks six days, even if she’s already dilated to 4 cm and lives 45 minutes away. She’s not 39 weeks and does not have a medical indication.

Often, when I would call to check on a patient’s progress in labor, the nurse would tell me that she hadn’t started Pitocin because it was too close to a change of shift. She would leave it for the oncoming nurse. When I asked to have the cervical exam updated on the AirStrip app, and it wasn’t, I was frequently told, “The patient was sleeping, so I didn’t want to check her,” or “She has ruptured membranes, so I didn’t want to check her too often.” These actions clearly put the nurse in charge of my patient’s medical management instead of me. Yet, they were working their 10-hour shift and could go home and sleep when they were off. I was ON until my patient was delivered.

Sometimes I would call and ask, “How’s she doing?” meaning, “Is she making progress? How’s the fetal heart rate tracing? Has anything changed in her clinical status?” and the answer would be, “She’s doing great!”

And that means what, exactly?

Often, this meant the patient was still comfortable, not in active labor, and had not been examined. Sure, she felt great. This answer infuriated me, and I did not hold back my feelings about the inadequacy of the nurse’s assessment or her incomplete answer to my question. She should know how to give a report.

When it became commonplace to refuse to admit a scheduled induction, the charge nurse might get on the phone and offer me the option to admit her the following day or on my day off. This was not met with an agreeable demeanor on my part. I would ask her to tell me about every nurse’s census and every patient currently in labor. Given that information, I would defend my position that they COULD indeed admit my patient and then start the induction later.

But as much as I needed to be, I was not the one in control. My life was at the mercy of these shift workers. They did not care that a delayed admission might lead to a 4 a.m. delivery on a day I had surgery or a full day of patients in the clinic or on my day off; they would be home in bed. At the peak of my OB career, I had 15 to 20 patients due each month and had two active kids who needed rides to and from after-school activities, doctor and dentist appointments, and a husband who sometimes traveled. I could not afford to have no control over my life.

So, when my receptionist would say, “Good morning, Doc!” I might reply, “We’ll see,” or “Not yet,” or just scowl and say nothing. When the offer would come to admit the patient on my day off, I would exclaim, “Well, let’s see you come in on your day off!” When I would grumble about the various inadequacies of nursing care, loud enough for all to hear, I think I was secretly hoping that someone would report me. Maybe then I could explain why my life was so difficult, and someone would understand. As it was, I was tortured, and I felt like there was no way out. I was drowning. I was burning out.

Why was I burning out? Because I was experiencing a lack of control, autonomy, and fairness. My innate desire for these things was being eroded by people and factors outside of my control. More importantly, my values were being tested. My commitment to my family was being challenged by that deep-seated oath of “The patient comes first.” I was conflicted. My patients needed me. My family needed me. I couldn’t do it all. How was everyone else doing it all? I was failing. I felt inadequate. And I was deeply ashamed of my incapacity to manage it all.

Finally, I was called out.

It wasn’t pretty.

It came from one of my practice partners. She read me the riot act. I had to change my behavior, or I was OUT of the practice.

As painful as it was, this tongue-lashing was my ticket out of pain. If it hadn’t happened, something far worse might have. After some time away and much soul-searching and self-reflection, I recognized the problem– a conflict of values, a need for control, and the accumulation of stress inside my body that led to chronic sympathetic nervous system overdrive and anxiety.

I slowly made my way out of that dark hole. With some new-found mental, emotional, and physical tools for self-regulation, I rededicated myself to my values, self-care, and a life in service to other physicians who may be struggling. If this is you, please ask for help. There is a way out.