Old Timer’s Disease

Today’s Jack Handy-like Deep Thoughts are brought to you because of a comment from one of my frequent blog readers. Thank you, Rob, for making me think. 

My work life is busy enough, yo? I see telepsychiatry consults from two to four days per week, and then I do a mental  health clinic another two or three days per week. I work an average of seventy hours per week. Yeah. Lots of reasons for that that go pretty deep too, but we won’t go there today.

Patient after patient, chief complaint after chief complaint, mental status after mental status. It is good work, intense work, fulfilling work, and it keeps me on my toes. Most of the time it gives me a sense of pride and accomplishment and makes me want to come back the next day to do it all again. Most days I do. Ad infinitum.

I find that one thing happens as time goes by and the sheer number of patients I see goes up by orders of magnitude. 

I have a hard time keeping all of them and their stories in my head. In my professional RAM, you might say. Easily accessible instantaneously, called up from the fastest part of my brain that holds information that I expect to be able to access at almost any time, quickly.

Now, my father could do this. The man’s capacity for information and stories was infinite. It awed me. There were lots of things I did not like about my father, but I wanted to be like him in this way. To be able to walk up to someone he had not seen in days, weeks, months, years even, and say hello, call them by name, and ask how their spouse and all their kids were, also by name. It blew me away how he could do that. 

He did not pass along that ability to me.

I used to be better at it than I am now. I used to be able to see a patient’s name on my schedule for the day, think for a split second, and pretty much recall the last visit with them, what I did, the reason for today’s follow up, and other pertinent details. Today, the sheer volume of patients and the severity of their illnesses and the desperation of their circumstances makes it very, very difficult for me to do that. Sometimes, I look at that name and cannot bring a picture of the patent into my head at will. I need more prompting. I need more clues. 

Where do these come from?

Nowadays it’s mostly from the Electronic Medical Record (EMR) or the Electronic Health Record (EHR) depending on where you practice. A record keeping system by any other name…

The volume of people who need our help as doctors is huge. The broader healthcare systems are overloaded. The information to be managed and recalled and manipulated is boundless. The treatment options are many, many more than we had even twenty or thirty years ago, in my practice lifetime. I sometimes feel, and I’m quite sure other doctors feel the same (but they don’t write about it, so here goes) that I am frantically treading water in a huge ocean of misery, red tape, government regulations and insurance company oversight that has completely taken away my ability to swim freely but has forced me to comply or drown.

Part of that manifests itself, at least to me personally, as disconnection from the object of my primary affection, my patients. 

If I cannot take the time to listen to you and your stories, to learn about you and take you into my brain and formulate my therapeutic responses and treatment plans that I think will help you, why am I practicing medicine? If I cannot keep your basic list of medications in my head, not on a server somewhere, if I cannot care enough about what our last visit entailed to make it a springboard to this one, without relying so heavily on an electronic record to drive my actions, then what were all those years of training for? 

If I see your name on my list of appointments today, and I cannot even remember who you are without all these external prompts, if I cannot even see your face, then how long will it be before I forget who I am as a doctor?

How long after I lose meaningful therapeutic contact with you will I completely lose myself?