I had the morning off yesterday to work on “research”, which meant I had to be physically present in the workroom so an administrative person who wanders through could check off that I was there. I was running late and wanted to get breakfast and coffee anyways because nothing really needed to be done, but I got a message from one of the chief residents letting me know the Program Coordinator (Marge) was looking for me. Well, shit. So I skipped the coffee run, and a few minutes later I was unpacking my things in the workroom. There was no sense in going to look for her, I took the message to be more of an FYI than like a “page” on behalf of the Coordinator. I was feeling like shit from just generally not sleeping enough and not having coffee. I had old clinic notes to write and my in-basket to clear out, but I just cannot bring myself to those kinds of tasks when I feel lousy.

I sat around for about 30 minutes and finally decided to go to the nurse’s workroom to at least get some calories from the vending machine and some of their coffee. It seems hypocritical, but I have totally accepted that I don’t get to follow my own best advice about diet, exercise, sleep as a resident. No guilt. I ate a pop-tart. Marge, who seemed to be coming to the workroom as I was leaving, didn’t say anything to me and I imagine she checked some box noting that I was first seen around 9am.

Back in the room, I never got around to completing any work. I wandered over to Kevin MD, and then to studentdoctor.net where I opened a couple tabs about doing locum tenens work. One of my post-residency ideas has been to travel in my car, doing short jobs at rural hospitals. I think (hope) that the training I am getting is suited or adequate to prepare me for those kinds of experiences. Where there is a lot of need, as a family medicine doctor I am supposed to have the broad set of skills to “do it all.” That’s what I used to think, but as graduation nears, it is clear to me how many of those situations might still be so uncomfortable to me. I hate to be in a position where I feel like a patient is not getting the best care, and it feels like it’s my fault. I think there is enough material on inadequacy or “imposter syndrome” for a whole other post. But thinking about being in a rural hospital without supervision managing problems I would refer to specialists throughout my training sounds like a bigger task than I am looking for right now.

One of the bloggers spoke very positively about doing mostly urgent care work. She apparently eventually found a job site through that work that led to a permanent position, and she now has benefits and a contract for 10 shifts a month and still does plenty of locums work in between. Her attitude, which is classic for the profession, is that when she is on a site she wants to work as much as possible. No sense in wasting her time in the hotel when she on site to make money. Another thread from the website had a medical student asking about salaries in family medicine and the older docs that replied commented about “earning potential” rather than starting salary, because they had the traditional view that we should be working harder, seeing more patients, generating more revenue. That is a tidy little worldview. It is compatible with the system. The administrators are happy, and to the world, you look like a heroic, hard working doc. My problem is that seeing patients is exhausting, and seeing more of them sounds worse.

Today I heard one of my classmates (Doug) ranting about how he liked working in the toxicology department for an elective with the Emergency docs because he likes “real problems”. He is frustrated in clinic with so many patients who “feel bad.” He doesn’t like taking care of patients who “feel bad,” he likes taking care of patients with a problem he can fix. And I understand his sentiment. In that moment I thought of how he will do just fine in an urgent care if he wants, churning them through, assigning diagnoses, prescribing antibiotics or NSAIDS or antidepressants, and generating plenty of revenue. There are patients who do want that kind of medicine. Unfortunately for me, the medicine I’m interested in doesn’t fit into this system so well.