Monday, December 19, 2016

Legislated Out

I have a breathtakingly difficult confession to make.  A confession, that on its face, seems rather innocuous, but in many ways shakes the foundations of who I always thought I was.  How I identify myself.

I no longer love being a physician.

There, I said it.  I winced even as I strung the words together to write the sentence.  You see, to admit this is almost inconceivable.  So much of who I was and who I have become is enmeshed in this intricate quilt of a profession. I view most every aspect of my life through this lens.

How could I not?  Wanting to be a doctor is the first cognition I can recall from childhood.  A childhood marked by a learning disability which brought into contention the idea of being a professional at all.  A childhood in which a father's death became a precursor.  A foreshadowing of who I was fated to become.  I would follow in my father's footsteps.  I would finish the work that was prematurely wrenched from his clutches.  There was never a question whether I would succeed.  The calling was too great.  The pull too strong.

To deny my profession is to deny my father's legacy.  To deny my own reflection.

Yet here I stand.  It didn't happen all at once.  Medical school was difficult and time consuming, but it didn't happen there.  Residency was strenuous and terrifying, but it didn't happen there.  My first days as an attending were grueling, and sometimes awful, but also energizing.

I suppose the change happened sometime after we started using electronic medical records.  It happened with meaningful use.  And MACRA.  And Medicare audits.  And ICD-10.  And face to face encounters.  And attestations.  And PQRS.  And QAPI.  And the ACA.  And MOC. And on and on.

What I do today is no longer practicing medicine.  Instead its like dancing the waltz, tango, and salsa simultaneously to a double timed techno beat.  It's sloppy, rushed, unpleasant to look at, and often leaves my partner more confused and anxious then when we started.

I have become ineffective.  Not by the weight of ever expanding medical knowledge or even the complexity of the human body.  Instead, my hard drive is being spammed by thousands of outside servers.

But make no mistake, I'll never leave.  My love for taking care of people is unwavering.

As for the joy and utter exhilaration of what used to be...

Frankly, it's all been legislated out.

1 comment:

Maggie said...

Your words leave me crying.

Reading you, over the years, I have seen glimpses of the best kind of doctor, the doctor I would most want looking after this body, speaking honestly to me about what is, and what may be.

I've watched the love you have shown your patients, and sometimes have seen the love you share with colleagues. I've seen your love and pride in the way you occasionally speak of your family.

I knew the EMRs were terrible -- as a chaplain resident I hated them too, and had much less interaction with them than the doctors and nurses.

But I never thought the current over-regulation would steal from you your love of this fine profession.

My deepest sympathies.