September 20, 2019

Dear Hippocrates: I want a divorce

LS Lara Photo

Dear Hippocrates,

I want a divorce.

Let’s face it, you and I were young, idealistic, and naive when we met. Everyone said we were “perfect for each other”, valedictorian and humanitarian. We thought we could change the world, one sacrifice at a time. Sleep deprivation, grueling academic hurdles, delayed gratification. We proudly wore those badges as a testament to our commitment together when we started our board certified family medicine profession in 2003.

I should’ve signed a pre-nup.

Slowly, the tendrils of distrust curled around our world. Insurance didn’t trust our decision-making, so formularies became a paradoxical, rigid moving target. Patients wouldn’t trust our recommendations, certain that their latest Google search was far more medically sound. Hospital administration stopped trusting. Our world became a time and date-stamped arena, visible to all, helpful to none. Once a pillar of scientific benevolence, doctors were now stripped of power and treated with public skepticism.

To rein in this metastatic distrust, you suggested we collect and curate data. Surely, this would “improve” our nation’s floundering healthcare system, right?! Never mind the suicidal grandfather in room 3….but did he agree to get his colonoscopy and tetanus updated?! Who cares if the basal cell skin cancer was recognized and treated on Mrs. Jones, did she sign up for a mammogram?!   My resentment grew with each step into this minefield of check boxes.

This wasn’t the life I planned for us. The inequality felt oppressive. I gazed longingly at our neighbors: The Specialists. Their grassy-green lives appeared unfettered by regulations because they could just advise, “Follow up with your primary care doctor. They’ll take care of it all.”

But I couldn’t.

Your expectations of our relationship had morphed into something unrecognizable. Gone were the moments I hoped to bask in the glow of empathy, caring, and healing. Do you recall the vows we took, Hippocrates? “I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.”

A far cry from your modern version. Today’s words are icily brisk as we shiver past each other in the crowded hallways. You speak in modifiers, ICD-10 codes, and triplicate forms. My Love Languages are Touch and Words. Yours is EMR. Your eyes practically glow brighter than the screen when a new data collection feature is unveiled, lengthening the nurse’s duties from 15 to 20 minutes for each patient check-in. It’s obvious you love to flirt with inefficiency.

You shift the boundaries of our relationship on a daily basis, expecting me to jump through unnecessary hoops against the backdrop of “more patient access.” How can I detect the insidious hemochromatosis, or educate the infertile polycystic patient when I’m interrupted with your ridiculous demands to answer every message or refill with neck-breaking speed?

First, do no harm….correct?

Yet, I continued to adapt my workflow to be more efficient, clinging to the knowledge that if I didn’t care, who would? I work harder, you pay me less. (Even less as a female physician). And now all we do is fight over money, when we really should be fighting over the real downfall of us: your adultery. When you stepped out and had an affair with Press Ganey, you changed the tapestry of our relationship forever.

In your short-sighted effort to measure value based on antiquated patient satisfaction scores, you adeptly placed my vitality and compassion in hospice. How can my worth be stripped down to a number, when I’m pressured to see more volume, squeezing as much as I can in 15 minutes? I feel under appreciated, and I deserve better.

It’s not about the money, Hippocrates. It never was. No matter how many miles I run, sun salutations I cycle through, or glasses of wine I sip, I decided:

We have become incompatible.

Our core values have diverged so far apart, it’s impossible to reconcile our differences. Despite the tone of this letter, I am not angry, I’m disappointed. However, I’m filled more with gratitude for our chapter together. Relationships aren’t measured in time, but rather the amount of growth and meaning. Because of you, I have an amazing skill set, memories to fill my heart, and a clear foundation to pursue my next passion….customizable to my definitions.

“In the end, only three things matter: how much you loved, how gently you lived, and how gracefully you let go of things not meant for you.” -Buddha

Best wishes,

Your American Family Doctor

P.S.— you can keep my stethoscope, but please return my boxed set of “The Walking Dead”. The moment those zombies hit, I’ll volunteer to be everyone’s Hershel.

This guest blog first appeared on KevinMD and was written by my client Dr. Lara Salyer.  After working things out with Hippocrates, Dr. Lara is opening her own Functional Medicine practice in Wisconsin in 2017.  Thank you, Dr. Lara, for sharing your wonderfully clever and timely post with us.

Comments

  1. Wonderful, witty and beautifully written essay ! I loved it 🙂
    I would just add that the unfortunate changes in the practice of medicine is not only affecting primary care docs in our country – it is affecting ALL docs- specialists , primary care , pathologists – everyone. Let us all stick together and hope we can salvage this relationship. Change maybe inevitable in life but doesn’t any true love story deserve a second chance ?

    Anita

    • Thank you Anita! Yes, I agree that Dr. Lara’s piece is beautifully written and captures so well the challenges in medicine. And you are absolutely correct that in all areas, doctors are feeling burned out, disillusioned and troubled by the way they are being told to practice. There is power in numbers and we do need to have a voice and not be silent. We can speak up and do what we can to help change a dysfunctional system.

  2. Fred Ebstien says:

    I don’t get it! Why is it Hippocrates’ fault?

    • Lara Salyer says:

      Hi Fred,
      The piece was written as a metaphor to explain how a career in medicine is not “just a job”. It’s a chosen partnership. When two participants enter a relationship, they each bring expectations. Some spoken, some unspoken. It’s important to discuss these expectations and their “fit” into reality. When a marriage is dissolved, it’s usually no one’s “fault”; each person has their side of the story. Everything feels subjective and the only truth lies in the fact that the system as a whole became unbalanced. Toxic. Unsupportive of continued growth as a couple. This is precisely the reason it’s not Hippocrates’ fault. Nor is it the physician’s. It’s no longer a sustainable, life-affirming relationship. Until we collectively start mending these errors, we will continue to witness the sad “divorce” of many physicians from their treasured medical careers. Thanks for reading and commenting!!!

  3. This young & naive family doctor (take it from an old & jaded one) doesn’t quite understand that, in the United States, health care is not a right of citizenship, it is a privilege of wealth. When the cost of an EpiPen can be ratched up to unbelievable cost, it proves that US Capitalism does not care whether your kid dies from anaphylaxis from a single peanut, as long as the shareholders make a profit.
    Every other First World country provides more equitable health care at lower cost than the USA. Why is that? Don’t we have smart people here, too? I’m amused when politicians assert that the US is a “Christian” nation. I’ll give them this; our healthcare IS Biblical. “And he, crossing over, saw that the wounded man had neither gold, nor silver, nor health insurance, and so passed by, on the other side”.

  4. Christina M. Fonseca says:

    Dear Dr. Lara:
    I enjoyed reading your clever “divorce announcement” to the father of medicine, but as any father knows, once grown into adulthood, a son becomes his own man with his own path and agenda. I wish you more satisfaction in your private practice, however, that path too is a winding way to the same destination, often without a clear map.
    However, just the opportunity of writing this letter, may have helped your psyche. As Hippocrates once stated, “Let food be your medicine and medicine be your food,” which in your case you’ve let thoughts be your words and, perhaps, words be your thoughts. (I’m hoping my chosen field’s mentor, Gutenburg, would somewhat be happy with the evolution to an instant electronic press.)
    Again, praise to your letter for bringing to the forefront the burdened plight of the healing, insurance and consumer communities in a much larger global population than in ancient Greece.

  5. Andrew Maas says:

    This is perfect, exactly how I am feeling after 20 years of practice. It is all check boxes and measurements, I am not sure if anyone cares if I actually think about the patient at all.

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