Editorial: Being Drained of Spirit

September 2018
J. Michael Pontious, M.D.

I often feel guilty about being emotionally drained. Quite frankly, I have no clue about how some physicians can provide care on a constant basis and never seem to be phased by the human misery that confronts most of us on a constant basis.

It is not lost on me that many of us choose our specialty to protect us from the constant flow of humanness that invades our world as physicians. Sitting reading films or looking into a microscope day in and day out sounds like a wonderful thing some days… or my anesthesia friends… who are able to just give a bit more medication to take the patient away for at least a moment.

I did not think ahead when I made the decision to become a family physician. I was not aware of the burdens and the insight that this pilgrimage would give me. I am often overwhelmed by the weight of the patient stories.

Training to distance yourself from this level of emotional wear and tear is the norm. That professional distance is protective and will assist in dealing with the constant stream that is present in our world.

Yet, no amount of training totally prepares you for much of this.

Do not misunderstand me, I am not complaining… rather I am burdened and need to make sure that I share the burden. I have this belief system that reminds me on a rather frequent basis that I do not have the skill or insight to fix all that is presented to me. As the diagnostician, I have a role. As a confidant, I play another role. As the scientist, I need to see if there is a pattern or prescribe an intervention that might be helpful… but as a fixer, I have to admit I typically have extremely poor skills.

Most of you that know me have come to expect the humor that has been part of my approach to life and my profession from the beginning. It is one of those genetic gifts… passed from my father and a gift I have always found to be useful in the practice of medicine. The humor has changed over the years, yet my patients have come to expect it and they are puzzled when I abandon it for another approach. Without meaning to, I send a different message as I become rigid or confrontational. I suppose it surprises and frustrates some of my patients, others accept it as my own humanness.

I have always appreciated patients allowing me to be pensive and thoughtful. They allow me the moments to look out the sixth-floor window overlooking Enid, America, and its railroads, older neighborhoods, and wheat storage. They know I am not daydreaming; they understand that sometimes I need a moment or two to contemplate the situation. They have figured out that the practice of medicine is something different than providing fast food; this is not an assembly line… this is old-fashioned, let’s give this a little thought type medicine.

Healthcare systems are not fond of me or the like-minded physicians of my era. Efficiency is not measured in RVUs; oddly enough, it is not even measured in patient satisfaction or in monetary rewards. I get the impression that it is taking moments to look at a clinical situation and sort out the options for the patient that has trusted me all these years. I get distracted by the burdens, I get distracted by the fatigue and the wear and tear, and I get distracted by all the rules and often get distracted by the agenda.

I note that truth is not always part of the agenda… that often the agenda is motivated by cutting corners and making lots of money. I see it repeatedly… and I see it more and more these days.

So I take time to wonder to myself… does it have to be that way? .