The chronicle of a lonely do-gooder family doctor who survived.

Tuesday, November 18, 2008

I am out of here...

Well, I did it.

I told everyone I'd wait until the election to make a decision about my future career plans, but in the end it didn't matter. Every day as I drive in to the hospital that sense of dread starts to fill up my stomach and grows stronger until I pull in to my parking space and trudge up the stairs confident I am about to spend another 12 hours doing mostly unpaid work as the agent of a system that utterly fails everyone involved.

I expect headaches in my job. I mean, it's the doctor who is supposed to be the lone hero in the middle of the bureaucratic insurance mess, who is desperately trying to make the system work for the patients, and even once in a while trying to save a life. And it's important work. There are times when families genuinely appreciate the work I do, moments when I feel actual satisfaction.

But those moments are becoming less frequent and the personal cost to me is becoming too difficult to bear. When I approach the end of each year and take stock of what it is I'm doing with my life, I can't ignore the fact that I am working longer and longer hours, doing less and less good for my patients, for a salary that still causes me to sweat the end of the month, hoping I won't have to use credit cards to pick up the short fall of the mortgage and student loan payments.

I love my patients. I mean, I really pour my heart into my practice and try to see the joy I used to know playing an active role in the most intimate, powerful moments in the lives of those I serve. Saying goodbye to them has been truly wrenching.

Despite the hope that the Obama election has given me, I am getting out of the private medical insurance game. The system is totally corrupt, likely unsalvagable. I hope to never go back. I have taken a job at a small community health center, much closer to home, at a reduced schedule, seeing mostly homeless and uninsured patients.

The doctors who work here still have some of that joy that led them to answer the call of medicine. They are dynamic and have an energy about what they do that I have only rarely seen in 8 years of private practice. They are true family physicians who see their patients in the hospital, who deliver their babies, and who help those babies grow up as healthy as they can. That's what I want.

Sure they have bureaucracy and headaches to deal with, but it's not from a system that is financially gouging their patients, it's not from a system that is supposed to be working. There's no illusion that this here is the safety net, the clinic of last resort and no one feels unappreciated.

Going back to The Suitcase Clinic at Berkeley, where I was first exposed to the difference that access to health care could make in someone's life, and extending through my residency at the county hospital here in Seattle, this is the work I have wanted to do for a long time. I just never thought I could do it, and still have a family, and a house, and pay off my loans, and who knows maybe every once in a while pay for a ski holiday. But with a baby on the way, I see myself coming home later and later every day with less and less job satisfaction and I now realize that I can't afford to *not* work in a place that preserves the integrity, the soul of medicine. The paycheck doesn't matter, the work does.

Monday, November 17, 2008


Yep, that's right. In this optimistic time of change, the Mrs. and I decided to go and make ourselves a kid. The little Sour Kitten is due in April. Things are going pretty well, Shireesha seems mostly over the morning sickness but is starting to feel the weight of the baby.

It's been a weird experience. Neither of us are what you would call baby-crazy and we hadn't even discussed it much prior to this year. There is so much uncertainty in the world, and with two careers in medicine specifically, that it seems fool hardy to throw a huge variable into the equation. But I do have more hope lately than I have had in years and with that hope comes a sense of freedom and possibility. Shireesha's career is finally in a somewhat state of stability and with my options wide open, this seems like a good time to bring a child into our lives. I mean, we aren't committed to the idea of being childless forever, so if not now, then when?

I think it's fitting that we don't have any expectations. I want to greet the new little one with an open heart, confident only of the idea that Shireesha will be a fantastic mother and that this experience will bring out the best in both of us.

Wednesday, November 5, 2008

Obama like me

There has never been a president who looked more like me.

Monday, November 3, 2008

Washington State Proposition 1000

Washington State Proposition 1000, the Right-to-Die initiative. Modeled after Oregon's generally successful Physician-Assisted-Suicide law.

Initiative Measure No. 1000 concerns allowing certain terminally ill competent adults to obtain lethal prescriptions.

This measure would permit terminally ill, competent, adult Washington residents, who are medically predicted to have six months or less to live, to request and self-administer lethal medication prescribed by a physician.

Should this measure be enacted into law?

Yes [ ] No [ ]

I voted no.

Yes, I am a bad liberal. Yes, I am another fascist physician trying to foist my personal ethical beliefs on my patients.

Actually, I am neither and I have really mixed feelings about this, something that is rare in this age of divided politics. I won't be heartbroken if it passes and I am pretty sure I signed a petition to get this on the ballot.

Here is my thinking. My day is divided into 15 minute blocks of time that I spend with patients. 2 minutes is spent with the nurse, checking in the patient and taking vital signs. 6 minutes is spent on documentation and insurance paperwork. 2 minutes is spent on the acute medical issue that I insist we deal with, which the patient could care less about: the blood pressure of 235/115 or the psychosis or the 50 pounds of weight loss since I last saw them. That leaves about 5 minutes, on a good day where I'm not behind from the previous 10 visits that looked like this.

Pain and suffering during a terminal illness is a Really Important Thing to discuss, certainly one of the most important conversations you could have with your physician. I absolutely believe that a rationally thinking person might choose to end their life, on their own terms as a logical and even morally correct thing to do. I just don't see how the current health care system is set up to do this the right way, granting enough time for consideration and safeguards that actively ending life deserves.

To be clear, the current system is so broken that we cut corners on hundreds of other important conversations: the new diagnosis of cancer, the decision to begin hospice care, whether grandma should be moved into a nursing home. Proposition 1000 is just where I have finally decided to draw my own personal line.