I don’t like who I’ve become, working in primary care.
In the medical community, it seems like we’ve discussed the root causes of burnout ad nauseam: too much paperwork, too many in-basket messages and inane patient requests, too many clicks in the EMR, too-short appointment times, too much corporate consolidation and insurance overreach. But as I see it, the end result, the final common pathway, is this: Most of us have stopped being able to see the patient in front of us as a real human being. Instead, they’re a barrier, a hurdle we need to clear, just to get to the next patient, and the next, and the next, and then to get home, where, inevitably, we’ll just do more charting to stay afloat.
Once, during my last visit of the morning before lunch, I stood to leave, so close to liberation, when the patient said, “My mom just died, and I have to go identify the body tomorrow.” She needed to get it off her chest, and once she said it, I could see she felt relieved to have shared it with someone.
But instead of empathizing with her grief, the first thought in my head was an expletive.
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I stayed with her past the end of her appointment time and into my lunch break, offering cursory words of condolence. But I was not really present. My mind and body were internally protesting, in fight-or-flight mode, wanting so desperately to get out of the room, admittedly, just so I could get to the rest of the charting I was behind on.
It’s a dilemma all of us face, on a daily basis. Should we take those extra minutes to really be there for someone in distress, knowing how much it will set us behind?
Due to the average primary care schedule, many of us decide that the answer is no. Or, more commonly, we’ll decide on an in-between solution, as I did that day. We stay in the room, nod along while the patient talks, but we’re really only half-listening. And we suffer a visceral anxiety from performing this charade, forcing our face into an expression of concern but really thinking about how we can gracefully exit the room the fastest. And maybe we’re even surreptitiously trying to respond to some refill requests or inbox messages at the same time.
I think back to all the harrowing things people have told me over the years. Children crossing the border alone, refugees fleeing totalitarian regimes, domestic violence, sexual assault, addiction, mental illness, tragic accidents. The isolation people feel when they have a disability, or when they’re rejected by their family, or when their spouse dies.
I think of how often these accounts have rolled off me. It’s as though I’m made of Teflon, not really absorbing anything, not fully seeing the person’s story as worthy of my full attention and care, because I’m always looking at the clock.
Professional detachment is one thing, but many of us have become callous to human suffering. Patients cease to be people, and instead become mere obstacles standing in the way of our leaving the office on time.
This is who I’ve become, and I don’t like it. This is not who I want to be, not who any of us wanted to be.
This is not really going to change, as long as PCPs continue to be as hyper-scheduled as they are. No one is coming to save health care. And so each of us is left, individually, to find our own personal solution to this problem. Some of us work part-time, or transition to DPC practices. Some of us try to be better about setting boundaries and practicing mindfulness. I’m still trying to navigate all of this myself. But in the meantime I continue to work, continue to fight the good fight, continue to see patients, and continue to try and have as much compassion for their suffering, and my own, as I can muster.
This essay is cited in the KevinMD record on primary care.
Wendy Shue is a family physician.
