Why being a doctor sucks sometimes

[Nathans_Dad]

I changed my original post, I didn't want to include too many specific details in order to protect patient privacy.

The gist of it is thirty something patient comes in with severe infection, had it for several days and did not seek care (despite friends urging him to do so) until he was literally near death. I'm not exaggerating here, if he had stayed home a few more hours he would have died at home. So, we do everything we can for him and despite this he ends up spiking a massive fever (109 degrees) and may have suffered brain damage despite our efforts to bring his fever down as quickly as possible.

I have this bad habit of going back and replaying every move I and the other doctors made in a case with a less than optimal outcome. Somehow I seem to think I should have been able to see the future and treat problems before they occur. I often wonder if my tendency to beat myself up when a patient does poorly will end up shortening my medical career.

[GH85Carrera]

Wow, that sucks for everyone.

You say young patient. Is that a teenager, or 20s?

The pain much have been tremendous for the guy.

[widgeon13]

Terrible situation, you have to feel helpless.

I had a facial abscess (due to bad dental work) as a kid and fortunately my parent got to to the ER and antibiotics before it got really bad. All happened very quickly.

Sorry for your situation and the young man but it certainly doesn't sound encouraging.

[HardDrive]

My wife does pediatric pain and palliative care. She deals with situations that on a daily basis that would leave me a sobbing blob on the floor.

[flipper35]

Originally Posted by Nathans_Dad

I have this bad habit of going back and replaying every move I and the other doctors made in a case with a less than optimal outcome. Somehow I seem to think I should have been able to see the future and treat problems before they occur. I often wonder if my tendency to beat myself up when a patient does poorly will end up shortening my medical career.

It is how you deal with this information that determines if you improve your skills or shorten your career. If you can be objective I see this as a benefit.

[wayner]

I am no expert but for your career I would think you need an internal tape constantly playing in your head that says something like:

"I did the best that I could do. Nobody could expect more from me."

As for wondering if you could have done better, I'll bet that if you got those thoughts out of your head and on to paper (or a white board) they wouldn't play on your mind so much.

In my consulting practice I often teach businesses and their staff to create an opportunity log where they can track improvement opportunities, the impact of doing nothing different and a column for ideas with associated reduced impact.

It really helps put things into context and prioritize efforts versus trying to boil the ocean and feal guilty for not doing everything that is swimming around inside your head.

Maybe you could try something similar?

Also, one of my internal tapes that I had to create for myself was "Don't be silly. It is unreasonable to expect that I can prevent everything bad that might happen."

When you have the power to help others and the power to change things, you have to be careful to preserve a reasonable outlook.

Once you finally have tapes like that in your head, resolve not to argue with yourself

Just my uneducated two cents.

[Nathans_Dad]

That's true Flipper, the reality is that there was nothing I could have done differently here. Somehow that still doesn't keep me from obsessing about it and having a pit in my stomach.

[flipper35]

If you didn't have that pit in your stomach, I doubt you would be a doctor.

[Nathans_Dad]

Also, one of my internal tapes that I had to create for myself was "Don't be silly. It is unreasonable to expect that I can prevent everything bad that might happen."

Hammer, meet nail.

Can you send me a copy of that tape??

[BlueSkyJaunte]

Never, not in a million years, could I do what you guys do.

Nothing but respect.

[recycled sixtie]

When I see folks with problems I suggest going to see a doctor. Some do and some don't. I don't why they don't - no $$$$ or not insured etc etc.

I would suggest moving on to the next case as you did the best you could for this person. I am extremely respectful of your profession. Tough profession but there are as you say moments where it can get you down. Hang in there. When you look in the rear view mirror on your life a year from now this incident should become a mere speck in your memory.

Guy

[weseeeee]

Self reflection is healthy and it shows you care. You know you can't see the future, you can only look at the evidence in front of you and take action based on your education. At 30+ the patient should have gotten medical attention sooner than waiting til he was within a couple hours of death.

[Don Ro]

This may sound silly and simple, but when I'm around what I sense is a good Dr., I want to be a good patient - and I tell them so.
And they all have said that they like hearing that.

[Tobra]

Rick,

You play the cards you are dealt. You can analyze how you played them, but you can't turn a six into an ace. You can't make them care as much as you do, no matter how much you try.

Toby

[Bill Douglas]

It's a shame when people's own stupidity become a problem for their doctor.

An example of stupidity. A friend from school days got a splinter in his hand from the hickory handle of a shovel. Tiny infection became bigger infection (still no doctor) and he died.

[wayner]

Originally Posted by Nathans_Dad

Hammer, meet nail.

Can you send me a copy of that tape??

It is inside my head.

Please recognize that I am trying to respond the best way that I can by sharing something that helped me.

I know professionals might have better advice but that's the best I can do.

I know that your job carries a lot more responsibility than mine does.
I hope it gets easier for you.

I don't think enough doctors care enough to look for ways to do better, even in a small way. I've met some good ones, and others that haven't cared nearly enough.

You sound like one of the good ones.

[Nathans_Dad]

Thanks. I appreciate that and I appreciate your advice. It is well taken.

[livi]

I know that feeling, Rick.

[DRONE]

I can only hope that all doctors have this same predicament, including my soon to be my son

[speeder]

I have nothing to add other than, "good for you for lacing up your shoes everyday and going out there and trying to heal people." I have a couple MDs in my family and they are good people too.

I've gotten the impression that it's a huge part of their own health, (mental and physical), to leave their job at work, though. You need to get home and go to a baseball game or otherwise cross over into the *happy world* to stay sane. Good for you for caring.