Below is a letter I wrote shortly before going on medical leave.

I’m angry.  I don’t like being angry.  Being angry is unhealthy and counterproductive.  Physicians are not supposed to get angry at their patients.  I can’t help it!  This week I’ve seen multiple patients for self-induced illnesses.  Health is a precious commodity and watching patients piss away their health makes me angry.

I’m supposed to repair the damage my patients are creating.  I’m supposed to perform that miracle without running all sorts of tests and without prescribing all kinds of expensive medications.  After all, Docs are accused of running unnecessary tests and prescribing expensive medications.  Aren’t they?

I’m also expected to deal with angry family members who, by law, aren’t privy to the facts of their loved one’s case.  All they know is their family member’s health is failing and it must be the doc’s fault or the medication’s fault.  They also complain about the cost of all the tests and treatments and specialists.

“Doc, you’re bankrupting my parents.  We can’t afford to pay their bills.  How did things get this bad?  You’ve taken care of my dad for 20 years.”

Exactly!  For 20 years, I’ve instructed my patient in the intricacies of diabetic care.  I’ve sent him to diabetic educators.  I’ve sent him to see a nutritionist.  I’ve provided literature.  I’ve explained that diabetics need to develop a Master’s level of education in the disease and manage themselves.  I’ve met with his wife and gone over things with her.  She’s tried to help but failed.  For 20 years, my patient has refused to do anything for himself!  The end result is not pretty.  It makes me angry.

It’s not just diabetes.  There’s the overweight hypertensive, basking in salt and lard whose family can’t understand why his kidneys are failing and why he’s had his third heart attack.  There’s the alcoholic who can’t understand why he’s so broke and can’t keep a job.  He refuses counseling:

“Doc, I can’t afford to see a counselor and I don’t have a drinking problem.  I’m just down on my luck!”

Of course, he can’t afford to see a counselor.  A fifth of booze a night plus a pack and a half of cigarettes eats up a lot of cash!

Wow, I feel better now that I’ve got that off my chest!  I can only do so much.  The person who has to care the most about my patient is my patient!  I can’t do it alone.  I can’t save a person from years of self-abuse.  

So, please help me help you!

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  1. I often felt like this when I worked as a Community Health Nurse in one of the housing projects of an unnamed city. Young girls (and I mean young as in 13 or 14) would come in pregnant year after year pregnant with yet another baby. I would counsel them year after year, send them to a family planning clinic for birth control and do as much as I could to help them. Some learned but a lot did not. Talk about being frustrated and angry. Some just never listened or learned. So many babies! So many young moms. So many lives staying in a never cycle.

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