It began with a post on Twitter from a physician inviting colleagues to relate in 140 keyboard taps or less what provokes them professionally. His post received overwhelming responses, suggesting that a lot of physicians follow things on Twitter and really are pretty disaffected. To bring this to a more physician focused forum, one of the editors of Medscape imported this to her forum, inviting the same question from Medscape subscribers who include a wide spectrum of health care workers.
There have been about 250 responses to the invitation, including one of mine. Some are specialty specific, some more general annoyance with the plight of health professionals. Some wise, some with levity, some with sarcasm. I'll offer a few of mine.
People who try to deceive me. This includes patients whose diabetes log numbers all end in 0 or 5, who ask for far more test strips than they actually use, presumably with the intent of selling the rest to the brokers who post yellow signs on telephone poles all over West Philadelphia offering to pay for unused strips.
I intensely dislike being called a provider. I resent the expectation of parity with others who really do not share my level of skill. What bothers me more, maybe, is how fluently this has been incorporated into discussions by the levels of managers, from those in an alcove to those with expensive desks. These are good people who have allowed their insight to falter.
Our Electronic Health Records and the burdens of using them are a public blight.
Measures of my performance that are really the illusions of measures of my performance.
Consults done at my invitation performed by people who know less than me without the real involvement of the expected person whose expertise exceeds mine and was therefore solicited.
Having to send somebody from my exam room who obviously needs to be admitted but is not in any distress to the ER first.
Overscheduling so that the request of the ignoramus resident that a patient seen in the hospital can return in one week when the next meaningful assessment should really be in two months when the newly prescribed medicine has a chance to do what it is supposed to do.
The fellow who brings coffee to the doctors lounge not having a substitute when he takes a day off.
Patients who have been permanent residents of the USA for decades with chronic illnesses who never thought it important enough to acquire enough local language skills to enable their doctors to do the best they can for them.
Copy and Paste as a surrogate for thoughtful analysis expressed in a medical note.
The law that requires me to pay more for a sign language interpreter out of my own funds double the money that the office visit would bring in.
Fictional Review of Systems documented but never solicited from the patient. The presence of dyspareunia may protect from psychosis since everyone admitted to the psych floor specifically does not have it.
Documentation of physical exam components that were really never done.
Having to obtain preauthorization from a functionary who knows less than me and cannot discuss reasonable alternatives with the threshold of knowledge needed to advocate for the patient being discussed.
Dietary solutions for people who weigh 400 pounds who really need medicine to address their problem.
Insufficient financial and talent support to go off on a tangent to explore something that catches my interest.
The hospitalist giving my longstanding office patient's consult or office followup to a colleague instead of me, and my own colleague not making the correction.
Not a bad list. The longer I think, the longer it grows.
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