For real doctors, what is the hardest thing about your job?

Is it the long hours or having to deal with sick patients?

Reason I'm not in med is I don't know how I would take people dying on me. Might beat myself up over it.

In my experience it is a number of things:

1. The expectations I put on myself to provide as high as possible quality of care all of the time regardless of anything else that is happening at that time.

2. The politics of working in medicine.

3. Patients who have unrealistic expectations.

I appreciate that it might sound weird but 'sick patients' or 'pathology' is actually the most interesting part. Of course, I don't ever wish that someone would become sick simply for my intellectual enjoyment, however it is a unfortunate truth that being human means being sick and suffering from disease and that part I find interesting. Especially the detective part of diagnosis.

The dying part generally doesn't bother me so much. We all have to die of something and if you're in front of me dying from an age related or chronic disease, then you dying is probably a pretty expected part of your disease process. If you're younger then you're more likely to be a victim of trauma and while I definitely identify more with the patient in these circumstances, my rationalization is generally that the world is a chaotic place, and that bad things happen to good people. If you end up in front of me, I'll sweat blood to fix your problems and change your outcome, but at the end of the day your survival or not is more or less out of my hands.

A nurse whose sole job was giving travel inoculations once told me that, whilst her work could be monotonous, she enjoyed it because she never had to deal with ill patients.

First off, I am not a doctor, however, I have been around enough doctors that have been personal friends and had many interesting conversations over the years. I've had doctors who have been very critical of other doctors with just cause. You have different doctors as in attitudes, dedication, etc. and the ones that I admire are the ones that are caring and still have there humanity intact. From my experience, a doctor without humanity raises a red flag. I have seen good doctors have to deal with the assholes over at the DEA and other regulatory bodies that have political agendas and don't care whether a doctor is good or bad.

Dr Alex, what is unreasonable? I was told I was unreasonable because I was wanting to address ongoing pain that was variable but was and is impacting my life. If I do what I usually do there is very noticeable pain, and said doc just dismissed it and wouldn't listen because it was mild right then. Yes, I can live with it in that I'm not lying on the floor except on rare occasions, but I would kind of like to know what is up and if it can be fixed.

If I'm truly unreasonable I'll live with it, if not...

Please be careful with this topic boys. It has the potential to quickly spin out of control when it comes to the issues of pain and pain management. Just a little friendly reminder.

Mashie

For what its worth I don't want drugs. Living with it would be preferable to drugs, and as it tends to ease up when I lie down I don't need them. I just was hoping that he would have told me what was going on and what I could do about it that would hopefully fix the problem or at least gain some control over it (beyond laying around...)

My question here is at what point can I legitimately go to the doctor (a different one) and say "no, this needs to be addressed if possible"? and be reasonably confident I'm not wasting their time with meaningless trifles.

Maybe I messed it up at the beginning. I went in and said something very close to "I can live with it but I don't really like it"

As a practicing internist I really enjoyed caring for very sick patients. They presented the greatest opportunity for a rapid turnaround in their status and that was hugely satisfying. I did a lot of ICU work, especially in the first decade of practice, just because it was an opportunity to make a huge difference. However, I have to say that in the last 3 or 4 years of practice the thing I came to dread most was the 3 AM phone call from the emergency department with a patient to admit. I found that in my later years I could never quite recover from the middle of the night call so that I could be at the top of my game the next day. Maybe one of the best things about retirement is that the phone doesn't ring at night anymore.

Long unsocial hours. That chest tightening fear you've made the wrong call in an acute situation. As someone else alluded to, increasing expectations from patients and families.

moliere said

Dr Alex, what is unreasonable?

Dr Alex said UNREALISTIC expectations, NOT unreasonable expectations.

There is a BIG difference between the two. For example, a person with severe MS may want to get out of his wheelchair and walk again. WANTING to be able to do this is not unreasonable but expecting to do this is an unrealistic expectation because it isn't going to happen.

Dr Alex said UNREALISTIC expectations, NOT unreasonable expectations.

There is a BIG difference between the two. For example, a person with severe MS may want to get out of his wheelchair and walk again. WANTING to be able to do this is not unreasonable but expecting to do this is an unrealistic expectation because it isn't going to happen.

Couldn’t agree more. At some point, you just accept you're never going to get out of that chair - it isn’t going to happen.

I’m retired now but the two worst things were telling a patients family that their loved one had died despite everything we had done AND trying to feel motivated at 4AM when I was totally exhausted—my eyes felt like sandpaper. I always wished we would get a good Code 3 or a crunch so that the epinephrine would wake me up. There are many things I miss about my emergency practice but not either of these.

What @liquidsky said. Plus for me a couple of additional thoughts. First, the time you don't have for family. At first, in the rush of being a clinician and being in demand to help people, that's entirely bearable, although it did cost me 2 marriages. But in later life it becomes a drag. Second, and a more minor issue, are those patients who come to you with easy to fix problems. You counsel them and give them appropriate remedies. But they return in a month or so with the same problem but never having tried what you prescribed earlier. Didn't happen too often but it was very annoying!

Dealing with unexpected deaths was up there, but politics, and government/insurance red tape and paperwork are what drove me into retirement. As has been said, dealing with and helping sick patients is absolutely a positive.

The most difficult thing I’ve had to do is inform a patient that their particular illness is a lifelong condition and, while ongoing treatment with medication(s) will greatly lessen their symptoms, there is no cure.

The thing I resent most about being a physician is the long, often grueling, hours spent away from family. I missed so many of my two children’s “firsts”: smiles, giggles, laughs, words, steps, etc. No amount of money can compensate for the loss of those magical moments.