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The Overextended Primary-care Physician


When is it OK to refuse extra responsibilities in your medical group?

Our call group was recently asked to add to our call responsibilities and provide increased nursing home coverage. The basis of this request was to support a fledgling nursing home service that, in all fairness, provides service to some of our patients. It is a request that has caused an unusual divide within our call group. I will not get into the details of the objections or reasons for doing the call. What I wanted to discuss was the dynamics of a call group. This decision is challenging how we work together and how we support each other.

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Those of us in favor of accepting the extra call feel the need to be good citizens within our larger medical group. However, as our colleagues struggle with issues of work-life balance and feeling overwhelmed with the increasing demands that face a primary-care doctor, we are challenged with a loyalty to our call partners as well. These are the colleagues that I work with every day, who offer advice and support, who cover my patients while I am away, and who I trust. They are my professional family.

I feel very acutely the pressures facing my colleagues who do not support taking extra call. I also struggle with nights spent at clinic far later than I ever intended. I bemoan the 2 a.m. phone call for something that should've been dealt with at 2 p.m. I am never looking for more hours to add to my already packed schedule. Therefore, when a colleague tells me that he is at the limit of what he can do, I respect that.

However, I am also concerned that I was not aware of the tremendous pressures facing my colleagues until this highly charged and emotional discussion we shared. How is it possible to work 20 feet away from someone who feels at the limit of her endurance and not notice? What is the best response to a colleague who is really struggling with work hours or unfinished charts or personal issues?

I think in medicine that we are amazingly adept at ignoring the obvious. For physicians who can walk in an exam room and determine within three seconds whether a patient is kind of sick or really sick, we are pretty lousy at detecting what is going on around us. We do not often encourage colleagues to share the painful parts of their lives and we rarely confess our own struggles.

We were trained in an unforgiving environment. We were expected to make sacrifices during medical school and residency, in part to train us for a profession where we would continue to make sacrifices. Complaining did not get you very far with attending physicians or other trainees and it certainly did not make anything better. We learned to "suck it up and drive on" and that became the norm, even when we were so tired we couldn't see straight or didn't have the opportunity to eat for 24 hours.

I hope our call group can do better and navigate a way to support both each other within our call group and also the larger medical group to which we belong.

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