Sharing with a patient

Admittedly, that was a first time for me. A patient telling me he was worried about me.

A patient, a guy I have known for 8 years, having treated him for his diabetes, but more recently noted on exam to have a thyroid nodule- one thing led to another and eventually he was found to have papillary thyroid cancer.

Anyways, I know him well enough to consider him a friend. We share stories of our wives and kids, who are about the same age. But at our last visit, he said something that struck a different chord with me.

He said: "Doc, I'm worried about you. I'm worried about your profession."

He had read some articles recently about burnout and depression and suicide rates amongst doctors. He had heard too about the long waitlist to see a specialist in our state (3 months)- because there is a shortage regionally of endocrinologists. He read about how it is so damn complicated now to be a doctor in the USA, not because of medical reasons, but because of the bureaucracy and the paperwork involved. How a prescription generates a 3 page "prior authorization" form that is faxed to me and I have to fill in, justifying to some non-medical clerk in some office why a test or medication is needed. And he/she probably has to follow a script to approve/disapprove my request.

It was a timely question- for that afternoon I was just fuming as I spent 32 minutes on the phone being transferred to 5 different people (yes, that's you, United Healthcare) regarding a prescription I send in. And at the end of the call, it wasn't even resolved. The last gentleman said I should talk to Department A, which was the first person I spoke to. I ended that call with a very unprofessional "Dude, are you kidding me? That was the person I spoke to 30 minutes ago. You guys have to get your act together!" Right before I slammed down the phone.

So yes, Mr. W's statement was timely, and therapeutic. Apparently he wasn't in a hurry, and he was my last patient for the day. So when he asked me how difficult it was to be be a physician, I offloaded on him. Being his physician, I shouldn't have. But I shared some of the frustrations our fraternity faces.

It did make me feel 100% better though I felt guilty that I shared as much as I did.

The truth is, sometimes all it takes is one or two appreciative patients, who do really believe that you have their best health interests in mind, to make all the work seem worthwhile.

Always in our hearts and minds

Dr. Tan Tow Shung

November 6th 1978- May 18th 2011

I can't believe it's been 6 years. The time just flew by, the 6 years since you left us here on Earth to be at a better place. In that 6 years, we've all aged but you remain ageless in our hearts, my friend. In that 6 years, our families have grown, our outlook in life has changed significantly. We have learnt much professionally.

But yet, it doesn't seem like that long ago when we were together, as room-mates and best of friends. I remember fondly the simpler days, days without other responsibilities, days when we would hit the Xbox and play round-the clock Halo on weekends. Our hitting the buffets postcall as our comfort food. All that crazy shit only bored Malaysian boys can think of.

I think about life's unfairness. How, you, at the prime of your life and at the start of a very promising medical career, how a cancer doctor can himself be stricken by esophageal cancer. I think about the long hard battle you fought, the times we visited you in the hospital when you had reactions to chemo, or when you underwent surgery. I remember that time when played cards in the hospital family room.

Truth be told, I miss my confidante. I know you're somewhere up there, watching us. But I miss our talks, and your words of wisdom.

It's been 6 years. But we'll never forget you. And till we meet again some sunny day, memories of our friendship and brotherhood will always hold you near to the heart.

A Note

I got this in the mail today, coincidentally.

From the spouse of the patient I wrote about the last time.

I wasn't expecting this- but it was sent to my office. And the shameless softy that I am, I'll admit that it made me shed a few tears.

It's been a frustrating last few weeks; between the stupid bureaucracy of  insurance, having unhappy patients who are upset at me that I can't fix their obesity/fatigue/sex issues, the guilty of putting patients into financial hardship because of the expensive insulin prescriptions I write. And so, sometimes things like this make all the work worthwhile. Sometimes, all we need is just a few patients who really appreciate us, to make all the difference.