A Retired Physician Wonders Whether To Rejoin The Fray

Many moons ago, in the 1970’s era, when no imposition from physically brutal on-call schedules to laudable scut to demeaning attendings was outside the boundaries of the house staff training curriculum, our leaders informed us that we were being introduced to the worst-case medical environment. That familiarity with setting aside our own creature comforts would enable us to save patient lives when the circumstances demanded our resilience.

Not quite two years into retirement, I still don’t know if my elders were right, though the stress of coronavirus on the current medical teams may be taking another era’s medical leadership theory to the laboratory. By being on call one night in three, with no day off for two weeks if one of those days fell on Sunday, we only missed just over half the available experience, perhaps a little more if we nodded off the afternoon following our call night. By the end of internship, we could make critical decisions with our midbrains, spear a non-palpable radial artery for ABGs by finding the flexor carpi radialis tendon, knew what tubes to put on the vacutainers, and picked up enough skill with snide retorts to hold our own at morning report.

For mostly good reasons, medical training and practice no longer resembles a fraternity hazing. Thinking has acquired some semblance of parity with responding. The phlebotomist has a crib sheet to color-match tube tops with computer-generated test requisitions. Even our order sheets are no longer a blank page to be mentally sorted by nursing tasks, diagnostics, therapeutics, and help me please consultations in that order.

Unless there was a communal disaster like a plane crash or train derailment, practiced in mock drills, for most American physicians, that worst-case never materialized, but we more than proved ourselves ready to pitch in the few times it did. People of my era had our challenges, to be sure. Malpractice insurance premium escalations occurred, though unavailability never materialized. Our clinical insights expanded through the research of others, or sometimes our own, but our accountability shifted to the less satisfying metrics imposed upon us, usually without input from the clinicians. Our appointment schedules eventually filled with little regard to our capacity, evoking no end of negative transference reactions to the off-site clerks instructed to do this. Overwhelmed, burned out, irritated, devalued became the terms exchanged most frequently over donuts in the doctor’s lounge.

Being retired forces me to watch from afar as my still active colleagues cope with the professional stresses of a COVID-19 pandemic that left them little time to plan. Professional voyeurism may not be the optimal preference for a healthy 60-something clinical retiree. People of my age usually do not have young dependents. Were we to acquire lethal COVID-19, there would be sorrow among our relatives but not the sense of tragedy that we read about when young physicians or those in their prime have succumbed in Italy or China while stabilizing their populations. We get a meager taste of this concern for our younger colleagues every Christmas when the on-call schedule defaults to the Jewish, Hindu, and Islamic physicians. For the groups that have none, many in my community, some give call that holiday to the associate with least seniority, but more often, it is the senior empty nester partner that makes rounds so that the physicians with young children can share the family joys. No matter how gruff an imprint was left by our mentors a generation ago, they had a soft spot for us as we developed, and we return that concern to the younger physicians as they rise to prominence.

Perhaps more importantly for physicians recently departed from decades amid the grand health care pageant, as non-participants in the current crisis, or any lesser previous crisis, we might wonder if the intensity of our training really succeeded in enabling us to demonstrate top form and prolonged stamina in the way own teachers had anticipated. FOMO, the acronym for fear of missing out, is usually directed to young’uns whose iPhone screens remain visible at all hours to avoid missing the most trivial text message. But physicians have this in a different form.

As I read about my active colleagues drawing upon their reserves, our managers shifting their focus from beating on them to enabling them, my not being there to offer my own skill reinforces a sense of being in exile. I could kvetch about the EHR with the best of them, but COVID-19 has changed the formal and informal discussions for the better. Gone from physician social media are the snipes about how poorly we are treated or devalued by the public. Anyone who watches TV wants somebody to hit the gong when the president takes the podium and let the learned medical officer take over. Physicians have recaptured the respect that drives so many of us to excel in the most trying of circumstances. We rise to the occasion, much as those trained in another era were forced to do. I wish I could rejoin my active colleagues amid the medical fray, but the best I can do right now may be to join the rest of the public in offering admiration for the physicians and numerous others who have their importance returned to the public psyche. Our value has been restored. For many of us, our self-worth along with it.

Richard Plotzker is an endocrinologist who blogs at Consult Maven.

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