The Hard Parts of Practicing


As much as I love what I do, I have days that are just really tough, or entire weeks, like this one.  When I first started working, there were more days and weeks like this just because I felt like I didn't have a great grasp on dermatology and felt like I should already know everything.  It's definitely gotten easier, but there are still some days that are just so hard.  

I feel like we mostly talk about the good stuff of practicing medicine while we're in school, but there's a lot more to it than that.  Occasionally, we'll learn about difficult or non-compliant patients, but that just barely scrapes the surface of what it's like in the real world.  You can role-play situations as much as you want, but you won't know how to react or what to say until you're actually encountering patients.  I work in dermatology, so I know there are others in specialties that deal with even more difficult situations than me.  

These are the things that I've found difficult during my first year of working, and during this incredibly long week:  

  • When patients are frustrated that the treatment regimen you gave them for their eczema or acne didn't work
    • I promise I gave you what I thought would work the best and be most cost effective.  But sometimes, I'm wrong.  I didn't do it on purpose, and I will keep working to find what works for you.  
  • When a patient wants you to inject an area that you know may cause blindness 
    • There isn't always a quick fix for everything, and I would never purposefully do something that would harm my patient.  Like injecting steroid into a stubborn acne bump in an area (the glabella, aka in between the eyebrows) that could potentially cause blindness.  Sometimes we have to wait it out and let our body heal itself, even if it takes longer than we would like.  
  • Having to make a phone call to a patient to tell them they have melanoma
    • I hate melanoma phone calls.  That's about the worst thing to do in dermatology, and it can be a really tough conversation.  Most of the public is not very knowledgeable about skin cancers, or don't consider them "real cancers."  I think once you have a 50-year old patient with a melanoma that gives him a 15% 5-year survival rate, that counts as real cancer.  
  • Having 3 patients in a row no-show, but also patients showing up 30 minutes late or with no appointment at all, which just throws the whole day off
    • This is something I still have trouble not getting frustrated about, but things happen and I try to give patients the benefit of the doubt.  
  • Having to tell a patient she might have MRSA and probably shouldn't hold her new grandbaby until the culture results come back, and then her calling saying I "didn't help at all"
    • It's not a good feeling to have a patient call with a complaint like that.  Especially when I treated her appropriately.  That's where emotions of the patient get involved, and things get complicated.  A phone call usually helps.  I was dreading calling this patient back, but when I did it actually made the situation better.  I was able to tell her she has normal Staph and not resistant Staph, and although I still want her to avoid the baby, it made it not quite as bad.  Patients will most always appreciate your time, and I think as providers we should take the time to make situations like this better if we can.  
  • Seeing a 7-year old with a skin disease that could potentially cause him to lose mobility of his leg
    • Kid stuff is hard.  This kid had something called lichen sclerosus et atrophicus, and areas had progressed to morphea.  This was something I had read about, but never actually seen.  Hopefully, we should be able to help him before things progress too far.  

Honestly, those are just the few highlights, and there were plenty of other situations I could talk about.  Part of what makes my job so tough is that at times I get the feeling that patients are thinking I just gave them a medicine for the heck of it, or that I didn't make them better on purpose, or that I don't care that I'm 30 minutes behind and they had to wait a little longer.  Truthfully, these things actually bother me.  A lot.  And I know they bother most other providers as well.  I wish patients were able to see the behind the scenes sometimes, instead of thinking we just mosey around at our leisure.  

I've been on the patient side too.  At my annual GYN appointment last year, I waited for 3 hours to see my physician.  And she spent about 5 minutes with me.  But she had an emergency patient that had to be seen to, and when it comes down to it, I know that if I was the one having an emergency she would have made someone else wait.  People are very quick to make judgments these days and very impatient.  I see Facebook posts almost weekly about "Why would my appointment be at 3:00, but the doctor didn't see me until 3:30?" or continual updates about how long the person has been sitting in the doctor's office.

 As someone who has seen both sides, and is sometimes responsible for people sitting in the waiting room, I think we need a little more grace.  Both patients and providers.  It is not uncommon for my patients to be late.  And not just a few minutes.  I've had patients show up an hour late and most of the time they don't even mention it.  If I make a patient wait more than 5 minutes, I apologize because I hold myself to higher standards than that.  So I do get frustrated with those patients who are late.  At the end of the day, we're all just people.  Both patients and providers, and we all make mistakes, so I hope we can give each other a break.