There are few decisions in life that are black or white. Our entire society seems to live in shades of grey. At some point in every physician’s career one must decide which shade of grey is most comfortable for him or herself. It is actually impossible to do “the right thing” everyday and with every single decision. Many “right things” are actually in direct conflict with each other, and doing that right thing consistently often means not getting enough sleep, poor eating habits, bad posture, loss of income, and forget about getting enough exercise. I have personally found the best balance i am able to achieve by making certain things non-negotiable. In essence I triage my entire day and week. Eating lunch comes before headache patients, getting off of my shift in time comes before chronic back pain patients, but children in pain are seen before I eat and regardless of if it means I won’t get out on time. Cardiac or respiratory arrests clearly trump everything.
Perhaps it is just a way to justify putting some of my needs first, but I think it is important to practice sustainable habits to be a good physician today, tomorrow, and ten years from now. Burning out will do nobody any good in the long run. Furthermore, burned out doctors have bad attitudes that patients remember more than any brilliant medical miracle one may perform. There is a reason airlines tell us to apply our own mask first before attempting to help others. If you run out of air yourself you will be absolutely no help to anyone else. That passenger sitting next to you who can’t figure out how to put on a simple plastic mask is certainly not going to help you if you go down.
As a physician these shades of grey extend far past clinical duties and patient related decisions. I recently reviewed a malpractice case. The Emergency Physician had done an ok job. It was just on the border of meeting the standard of care. One could make a strong argument in either direction. As I looked further into the details of the case, I read between the lines and understood the situation that doctor had faced. He was essentially fed to the wolves. The surgeon he asked to help would not bother to help, the patient had a very unusual presentation, and he was working in a very poorly functioning hospital system. As I read through the case, and advised the plaintiff of my opinion I knew very well that I could have made thousands of dollars with very little work by just saying this doctor fell below the standard of care. It didn’t even matter if the lawyer won or lost the case, I would still be paid well to argue that the standard of care was not met. I chose instead to look at the case more realistically, and not place it in a black or white category. Ultimately we decided it was not appropriate to pursue, and I lost out on thousands of dollars. But I must say it makes me feel good. It makes me feel like I did the right thing. There have been many scenarios in my career where i have turned my back on thousands of dollars because it just didn’t feel like the right things to do. At first I felt like a dumb ass for walking away from that kind of easy money, but now everytime I do I feel good. I feel like temptation has come knocking again, and I politely decline and sleep well at night. I can only hope that if my clean record and career are brought into question, the expert reviewing it will feel the same way and seek the truth even if it means doing the right thing will cost him or her thousands of dollars.