The problem with....

I have decided that the problem with medicine is the patients. I'm sure this is not a very popular opinion, but hear me out. When you apply to medical school they always ask you why you want to be a doctor, and its always some altruistic image of helping the less fortunate. Filled with some childhood fantasy of filling a great void in an under served population we apply in spite of mounting financial pressures on physicians, lack of time and an increase in back pain directly correlated with an decrease in job satisfaction. We are trained in history and physical taking and diagnostic skills. We marvel at the intricacies of the human body. We experiment with different specialties and we make a decision. For me that decision was family practice. It seemed like a natural choice. I enjoy seeing children but I like the variety of problems an adult patient brings. We start our training, we are thrilled when we sign our first real prescription. We marvel at the correct diagnoses we make and we are terrified if we almost missed something. But creeping into the scene, imperceptibly, at first are the time-sinks, the people who refuse to listen, the people who carry some axis II (personality disorder) who make you want to tear your hair out (called trichitilomania by the way). You counsel, you order tests, you lecture, you listen, you plead, you threaten... the patient remains steadfast. In the medical world of today, physicians no longer have the luxury of saying "I tried." With pay for performance on the horizon we have to prove that our counseling, or threatening, our tests are not only cost-effective but productive. In the medical world of today, patients want to be an active participant in their care. They want to know the options, make an informed decision regarding their plan of care. Sometimes this means that what the physician wants to do or thinks is appropriate is dismissed by the patient. Don't get me wrong. I think that one of the greatest things I can do for a patient as a physician is to listen and respect my patients decisions and sometimes a patient feels better just knowing that they have some control over a diagnosis that is scary... even if that control means choosing to ignore treatment. But now the pressure is to treat, to cure, to show standard of care. Even if that standard is against the patients wishes. When such a situation arises, say in the care of a diabetic patient. The patient is for whatever reason unwilling to start insulin. The physician has diligently discussed the ramifications of this decision including potential dialysis, amputation, death, neuropathy, etc. But the patient is steadfast. Checking their blood sugar 4 times a day and then giving insulin injections is not worth the potential prolongation of life. IN the pay for performance world, this means a reduction in your reimbursement... and often that the patient is dismissed from the practice for non-compliance. As a physician I cannot "help" these people because I have to worry about the bottom line...But more frustrating are the patients who just don't care. They don't listen to you, they come and complain and then refuse to try your treatments. Again, as physician I am dissatisfied because I cannot "fix" them, I cannot even help them. And I went into medicine to help...