Stretched

Dinosaurs in the American Museum of Natural History

“I want to change doctors.”

Reviewing her chart before entering the room I could see that she had been asking for this for months. The medical assistant had warned me that she was going to bring it up again.

“Why?”

“Well, I never get to see her when I need to. She’s always out or I have to see the nurse practitioner because she’s too busy. Besides, you were the one recommended to me by several coworkers but you weren’t taking new patients.” She stared at me, accusation in her voice. 

“Well, the reason I stopped taking new patients is because the ones that I did have could not get in to see me when they needed it.”

Some days I have open slots that don’t fill. It makes me antsy but I try to remind myself that not overloading the schedule ensures that people can get in if they need to. I want to be able to see them, have a relationship with them, even if it hurts my bottom line. THAT gives me joy.

“….But you should also know that I have kids. Sometimes they get sick. Or I get sick. Or some other emergency pops up…”

“Well, she doesn’t have kids. At least not that I know of.”

In truth she is undergoing a fertility work up, hoping to have kids but it was not my place to tell a patient this without her permission. A woman should have the right to have a child if she wants one, shouldn’t she, even if it inconveniences others.

I agree to take her on as a patient. The very next day:

“Uh, mom?”

“Yes?”

“I just puked.”

The smell of vomit began to waft through the car. I cracked a window.

“Block my open slots until I can get to the clinic and see what is going on.”

“You don’t HAVE any open slots.”

As my daughter retches again into the plastic sack I know I don’t have a choice. They will all have to be rescheduled. There is no one else that can watch her.

“He’s going to have surgery. I’ll need to be out for at least a week….” 

It makes me nauseated to think about it, rescheduling that many people, but it just cannot be helped. 

He needs me.

No doubt someone, somewhere is asking to change doctors. Knowing that bothers me on some level but being a mom also brings me joy. My kids deserve a mom who can be present for them. It strikes me that this sort of issue is unique to female physicians. It is partly why we make less money. It is partly why we don’t hold as many leadership positions as our male counterparts. 

I choose my kids. 

I choose my family.

Meanwhile, I am sitting in a hospital room with my laptop, trying to do as much as I possibly can from here.

That doesn’t make me better. Or worse. Just different. 

Or maybe the just same. 

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115 thoughts on “Stretched

  1. I don’t know, it might make you better. I’ve seen the benefit from giving up certain opportunities in order to better support your family. It pays dividends that are easily recognized but hard to quantify. .

    Liked by 5 people

  2. I’m currently debating how to go about switching dentists. For different reasons, though. But I want to be in the same clinic, just not with the guy who has botched things one way or other two out of two times. The other (older, more experienced) dentist, I like. I like their staff, their facility, their location and their hours. They take my insurance. It just feels so awkward to say “Not that guy ever again” and stay with the same practice.

    As for the patients getting stuck with the nurse practitioner, and other things, I see both sides of it. I point to a lousy system that is becoming the norm. When I worked for Behemoth, in their family practice clinic (which is huge as expected for a Behemoth), they were working to move more and more to rotating patients to “whoever” had a slot. Sometimes you need that so people can get in last minute. But they were emphasizing that they are a group practice and so the doctors and practitioners interchangeable. Um, no, not even close. And our nurse practitioner, though female, was the biggest dick in the department and I wouldn’t have wanted my gerbil (if I had one) to see her. Maybe my worst enemy though… Treating doctors as interchangeable ruins the doctor-patient relationship. It is annoying to have to explain things each time to the 400th person you see. On the other hand, we had a fabulous (female) doctor that was very popular, had limited hours due to a teaching career, and her schedule booked 6 months out. If that is the choice people make as patients (and I would have loved to have been one of her patients), then they have to be realistic. But people aren’t. People are weird, stupid, and self-absorbed, especially when they have a painful hangnail. I blame the bean counters and insurance who push doctors’ schedules to the point of ridiculous, because it isn’t about health care, it is about patient turn-around and therefore dollars. (Cynics Anon now?)

    Liked by 1 person

    • I am with you on the NPs. We have one that we share between three providers because we really want her to be an emergency alternative and not the PCP. The quality of NPs and PAs varies widely with the majority being marginal at best. Not all are bad, mind you, but you don’t know what you are getting until it is too late. Patients need to have a *relationship* with their doctor. And doctors need it just as much, as it combats job dissatisfaction. It is much more rewarding to have a connection with someone.

      Liked by 3 people

      • Sad to hear that you feel the NP’s and PA’s are marginal at best. That’s actually how I feel about physicians and personally prefer to have a Nurse Practitioner as my primary. I have worked as a RN for over 30 years and most of the the NP’s I know have amazing hands on experience that I respect and admire. I’ve put my job on the line many times to stay at home with one of my ill children. Which is a sad state of affairs right there, that your job is in jeopardy, because you are taking care of your child, that is too ill to be accepted at school or day care and you need to be home with them. It’s such a difficult balancing act that work places still do not support at any level. If you are a housekeeper in the hospital, food server, CNA, Nurse, Physician, doesn’t matter, your job will be jeopardized if you can’t come in. Have to admit the higher up on this chain you are you have to show up no matter what. I admire you for finding that balance!!!

        Liked by 3 people

      • If you will note, I did make the distinction that not all NPs or PAs are marginal. In fact, I utilize one in my practice who is very good. There ARE good ones. Just like there are plenty of very bad physicians. The problem is that patients don’t know what they are getting until it is too late. Like the NP who told my father he should be taking aspirin for his hemorrhagic stroke. Or the one who treated a patient’s strep (a patient with absolutely no drug allergies) with cipro and when that did not get work, used levaquin. Or the one who told my patient who had a systolic BP of 86 with lightheadedness after a major abdominal surgery with serious complications and multiple blood pressure meds that he just needed to drink more water. But that is all irrelevant to the point here that being a woman who works and is a caregiver (whether a caregiver of kids or ailing adults) is a tough balance between duty and guilt.

        Liked by 1 person

      • It is interesting to hear from a provider about NP’s and their competency and their role in health care. I am trying to apply to NP school and I enjoy hearing your perspective.

        Personally, I believe that of course your family needs to be a priority. Anyone can get another provider, but your children can only have 1 mother.

        The sad reality is that healthcare is expensive and access to any healthcare is difficult. In the end though, you are irreplaceable to your children. That is not necessarily the case with your patients.

        Liked by 1 person

      • NPs and PAs can be powerful resources. I learned more about delivering babies vaginally from the nirse midwife than I did from the OB/gyns in residency. I learned to place a central line from a critical care PA that was better than all of the residents put together. That being said, the quality of education has steeply declined as the need has increased. What makes that dangerous is that they often don’t know what they don’t know and are told over and over again by their training programs that they are just as good as physicians and should be allowed to operate autonomously. Patients typically don’t know how to recognize if they are being diagnosed and treated incorrectly. They need oversight. It protects NPs and PAs and it protects patients. I used to be involved in training NPs, had them rotating through my office for months at a time, so I think I have a fairly good idea of quality at least in my area. I stopped a couple of years ago, just too frustrated by what I was seeing. I don’t say all of that to discourage you. YOU can make sure you get a good education. Don’t stop at what they feed you, look up things, dig deeper. Make sure you do rotations in places that are hard and will challenge you. Ask questions. Make sure your first job is working closely with a physician from whom you can continue to learn for a few years. That’ll make you pretty darn kick ass and you can write your own ticket after that. πŸ™‚

        Liked by 1 person

      • My concern is that the doctors I see do not respect the NPs that I see and they are not very forthcoming about sharing and training them as they are with the medical residents. Most of my knowledge comes from personal experience and years in mental health. I am truly hoping I will find a doctor in addition to other NPs who will value what I can contribute and who will be willing to mentor me. Books and journals are good, but medicine in general and mental health in particular is both an art and a science. That being said, as an NP, I believe I can make a unique contribution. In my area, it is almost impossible to find a good psychiatrist that will even take health insurance. There is a huge gap in care, that I believe needs to be filled.

        Liked by 1 person

  3. All working mothers (if they’re decent mothers) suffer with this. I put my kids first ALWAYS. I walked away from a job when an irritating and demanding boss (a woman in her late 50’s who’d never married or had children and was wedded to her job heart and soul) demanded that I stay late in the evenings AND work weekends. I was being groomed as her replacement when she retired. We were paralegals not doctors or anyone who made a real difference by being there long hours. This was at the time my youngest son had just been diagnosed on the autism spectrum and needed more of my time not less. I quit so fast it wasn’t funny. I took a job that allowed me to work part-time, flexible hours. She got angry when I quit and hadn’t come to her when I got the job offer. Some people! They don’t get that family comes first, and they never will.

    Liked by 6 people

  4. Ahh, work guilt, mom guilt, patient guilt, the never ending stress of trying to be in 3 places at once meeting the needs of EVERYONE all at once.

    You should come here. Huge doctor shortages, weird insurance bottle necks. You can’t get a primary doctor and our urgent care has to schedule backup appointments. It’s tragic but it’s comical too, because some of us fondly remember actually “shopping” for a doctor. Golf and vacations were a big drawback. If the guy had a reputation for being a world traveler, odds were pretty good he’d be out of the country when you needed him.

    Liked by 2 people

  5. I was part of a counseling group who thought nothing of working long hours, weekends and nights. I had two kids at home…both teens. They needed me as much as they had when much younger. I ended up, after much fussing on my partner’s side leaving the partnership and went into private practice. I cut my hours by 2/3, and income by about the same. It was the best thing I ever did and my adult children have thanked me for doing so. Children do not ask to be brought into this world; we invite them. We should put their needs first. Always.

    Liked by 5 people

  6. Kids are a luxury. But not the sort of luxury you can easily toss out like an old stuffed chair. Once you have them, the parenting instinct kicks in, and then you’re stuck. Here’s hoping your kids will remember with gratitude all the many hours of devotion you’ve given them.

    Liked by 2 people

      • A delicate balance. You manage it well. I didn’t (sad to say). But at least I have time now to make up for that–a little. I take my granddaughter to school and everywhere else when her mom is working. Single moms are really stretched and torn.

        Liked by 2 people

  7. I’d imagine very much the same as so many other moms in your field. I chose/was able to stay home with my kids, and I wonder all the time how working parents do it. The freakout factor I feel when they catch a bug & I have to reschedule the stuff I have going on has got to be massive for people who deal with workplace responsibilities, too.
    But…that being said, your daughter will always feel the tiniest bit better (even when she’s sick as a dog) because her mom is there.

    Liked by 3 people

  8. I admire this. We should not live in a world where we ‘have’ to choose anything over our children’s well being and be sanctioned for it. I know we can sometimes maneuver life around our, our family, needs. But it shouldn’t be this hard.

    Liked by 3 people

  9. It’s frustrating. My GP retired . She was never there when I needed her. She was old and thus only worked certain afternoons so my new one I made sure it’s one that’s accessible . A middle age male doctor. I only goes to the doctor once a year but I want him there when I need him.

    Liked by 2 people

  10. My friend is a GP. She went into business with her sister and a few friends. Their clinic works on rotation as they are mums and thus only so do a few days each. My other friend is a haematologist . She also works part time for a hospital as her husband is away quite a bit with his job so she’s it for her two girls.

    Liked by 2 people

  11. I think it’s unreasonable to expect any professional anything to be available always. I’ve sat in the waiting room on Monday with people complaining that my dr no longer saw patients on Friday. And?!? He never saw patients on Saturday and Sunday, either, who cares? There’s a service, and urgent care… and there were on those Fridays too. Isn’t part of running your own practice making your own hours? I don’t know why it would be different for doctors’ offices.
    And uh, not that you need validation, but family first, cause family forever.

    Liked by 4 people

  12. The trouble with being in a profession where the underlying motivation is to care for people means that you get to carry the load for others who are only in it to amass wealth and kudos. And the hardest thing to do is to do more than you can. And then there is the ‘handicap’ of having a family.
    PS, I’m back in a different guise.

    Liked by 3 people

  13. I’m considering changing my PCP. She never ever returns calls even though her staff says they will call me back and it takes two to three reminders to our in referrals for other services. But I would never change because a doctor had an emergency at home. THAT I understand.

    Liked by 2 people

  14. My brother once had a man working for him who took a day off to watch a sick child…his wife was a teacher, and he felt it made more sense, since he could do some work at home…my brother admitted that even though he knew it was wrong, he got really angry, thinking it was the mother’s job to stay home. I can’t see this attitude ever changing. It’s a rare father who would think it was actually his job as well in the first place! (who ever heard of a mother telling anyone she had to babysit for her own children…? that statement from a man still amazes me). (K)

    Liked by 3 people

  15. Two things: First I was talking to a man recently about whildren and he asked me if I ever got up to attend to a crying child in the night. He was surprised when I said I did. He told me he never did, which I thought sad. Secondly I am on my third doctor. Oh relax – the reason for this is that this is a country town and many doctors come, do their “country service”and leave. That’s what happened to us when we first came here – we got transient doctors. Our current doctor, who we have been with for about 15 years now – I wouldn’t change for the world.

    Liked by 2 people

  16. If it makes you feel better, just seeing the photo made me sit up straighter. (Plus I have just halved my work load for the next 6 months. My family needs me. And why else did God invent credit cards, if not for times like these?)

    Liked by 2 people

  17. I remember days ago when the doctor came to your house…. what happened to medicine being about people including the doctor? I feel bad for mother’s who need to take off when a child is sick. I get it…but then, we who do not have children have to pick up the slack. I always thought there should be a bonus for childless folks who did not take time off. There are two sides to every coin….

    Liked by 2 people

    • I was totally in your field before kids. And honestly, I don’t think that it is a bad thing that I am not doing as much in leadership as I did before. Others can have those opportunities. They deserve reward for being present.

      Like

  18. It is so difficult for parents to manage their working life with family commitments. Countries like Sweden manage to have the right work/family balance and it is a first world country. I would always choose family over work so I applaud you. Glad to hear that you are all better. 😍

    Liked by 2 people

  19. Applesauce, Doc… The constant internal conflict (not to mention dealing with the patients)… I would have pulled out every hair on my head before a week was over. I don’t know how you do it. Kudos. You are an inspiration.. Great big hug.

    Liked by 2 people

  20. It is quite all right Victoire. Some people will find every way to make you feel guilty. Get used to it. And Doctors do have issues of their own. Daughter #2, your colleague, came for lunch yesterday with Grandbaby Gonzalo, after her first day back at the hospital after the vacation, and the first words she said were: “I want to be a housewife! I had to see 12 patients in 4 and half hours!”
    Now, most important: is your daughter ok?
    πŸ™‚

    Liked by 2 people

  21. When my kids were young, I had an abundance of paid sick time available and their father had none, so I’d usually be the one to take off, but I always felt guilty having to reschedule my counseling clients. I tended to save my sick days for my kids. The thing is, most clients understood because that’s life, and the world didn’t fall apart without me.

    Liked by 2 people

  22. I often get angry and sad about that. There have been jobs I couldn’t even apply for due to scheduling – jobs I would have been amazing at. I can’t work late because of carpool. When a kid gets sick or has a field trip, it’s my leave that’s eaten. But when push comes to shove, I wouldn’t have it any other way, either.

    Liked by 2 people

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