Mel is a mess

For all of those reading this to experience the fun and excitement of preparing for a voyage, you might want to skip to another post.  Because this is going to be a rant about modern medicine instead.

Mel is a mess right now.  Her departure from Mayo, where she has proudly been for 10 years, is imminent.  And every day she goes through an emotional roller coaster.  Her workload is insane right now as her patients are requesting to see her one last time before she leaves.  We are talking 14 hour days.  Here is a glimpse inside her inner world:

6-7 a.m.: Mel wakes up and is groggy from the Benadryl she had to take last night to calm down her nocturnal ruminations so she could sleep.

7:30 a.m. Mel leaves her husband who is getting the kids ready for school because he is awesome.  She gets in her car and drives cautiously over icy, hilly roads.  She gets trapped behind a terrified old man, driving slowly.  If this is a Friday, her drive takes 1 hour.

8:00 a.m. Upon arrival at any of her four practice sites, Mel departs her vehicle and feels as if her face is going to fall off because it is -8 degrees F.  If she is in Faribault, as she opens the door to work, she hears the Faribault theme song she wrote herself and has sung to no one: “Everything is harder in Faribault…”

8 or 8:30 a.m. After going through some papers, she sees her first patient.  10 minutes of this visit was consumed by her nurse/assistant, who had to confirm and enter into the computer all 20 medications this demented, elderly, diabetic person was on.  The middle 10 minutes are spent trying to tell this person exactly why they can’t drive anymore.  The last 10 minutes of the visit was consumed by Mel having to enter orders and medications.  If this is Faribault, she is doing this into the single most user-unfriendly piece of junk software ever invented: Cerner Powerchart.  Mel feels the first twinges of the low-grade level of irritation this software program produces that will gradually build throughout the day.  After the visit, she eats her breakfast, a banana, to calm her nerves.

9am to 5 pm: Mel sees patients back-to-back, with no time to dictate her notes in between. At the end of each visit, she has to budget extra time somehow to tell her regular patients she is leaving.  This usually does not go well.  It’s as if she is a good doctor or something.  She begins to run late.  She waits for a Somali/Arabic/Spanish/Vietnamese/deaf translator.  A pile of notes to dictate later builds on her desk. She is asked three times to overbook patients for various reasons, as her schedule is full.  She is curbsided by someone who did not do a neuro exam.  She eats her lunch in 5 minutes, bent over her disgusting keyboard, laden with crumbs. This is what is in her head:

Dear patient, you are so sweet but complicated, I feel so guilty for leaving you to the next neurologist! …But you, I am glad I won’t have to see you again.

Why couldn’t I have stuck it out like all of my colleagues at Mayo — I must not be tough!…  I am so glad I was smart enough to get out of here while I can!…I am so fortunate to be able to do this! …Why am I so fortunate when you, my dear hardworking patient, can’t afford your Lyrica copay?… I worked my butt off for years for this, so why not enjoy it?…But others worked their butt off, and are still working hard, so why can’t I just suck it up?…If I want a research career that Mayo won’t permit me to have, shouldn’t I just go work somewhere else for a while instead of stop working altogether?  Maybe I don’t want a research career?

The administration out here sucks!  Why do they treat doctors this way?…My job isn’t bad — I work four days a week and have no call, and I am paid fairly — I should be more grateful!…Mayo is the best place for a doctor to work in the country…My nurses and staff are so good…I am so proud to be at Mayo…They could have treated me better — they should show some respect for my opinions…Am I a fool for giving up this “status”?

Do I want to come back and do medicine?…I studied for a decade to be a doctor, I can’t give up now!…But this is NOT what I signed up for, and medicine won’t change dramatically in just a couple of years!…But it won’t get better if I don’t help!..There is nothing one person can do.  The system is irreparably broken.  No “burnout committee” is going to be able to fix it.  I DO NOT need to meditate more.

This trip is going to be so awesome — can’t wait to be warm!…What are we thinking?  We barely just learned to sail…Dolphins!  Lightning!  Flying fish!  Hurricanes! Beaches! Seasickness! Sundowner parties! Robbery! Our ignorance of sailing!  Our resourcefulness! Our awesome boat! Having to fix things! More time with my husband and kids!  More time with my husband and kids!  No schedule!  No schedule!

That takes her until 5, at which point her nurse goes home and she watches cars pull out of the parking lot, one by one.  She and the cleaning crew exchange pleasantries; they see each other all of the time.  At least the roller coaster has calmed down a bit.  There is only one emotion experienced as she dictates her notes, fills out forms, reads rejection notes from insurance companies and Medicaid, and fills out prior auths for Botox for the next three hours:

I hate insurance companies!  I hate drug companies!  I hate paperwork!  I hate this crappy, crappy EMR!

9 p.m.: She is usually home by now.  Why does your face always feel puffy when you are tired?  Mels reheats the dinner made by her awesome husband, puts the kids to bed, stares at the TV for a couple hours, and then goes to bed.  Because she has to work in the morning!

So there it is, Mel’s excuse for why she might be a tad grumpy at times, even though this amazing trip is just around the corner.  Just reading this exhausts her.  Time to get back to the fun stuff!  No more rants for a while, I promise!