I’ve been reading a lot of articles lately on the topics of physician career dissatisfaction, physician burnout, physician suicide, etc., etc. Medical conferences now offer seminars on one or more of these topics. And when reading comments to these articles or hearing feedback from the audience during lectures, a common thread is how “no one cares about the doctors.” Another is how “we’ve done this to ourselves” by “allowing” administrators, insurance companies, and regulators to dictate our careers.

Both sentiments may be somewhat true. But if that is indeed the case, then it is largely up to us physicians to do something about it. We have to change public perception about what we do and who we are. We have to stop allowing administrators and others in the periphery of our practices to dictate every aspect of how we do what we have been trained to do and take care of our patients. We have to fight back.

But how do we do this without being dismissed as “whiners” and “troublemakers”? When I’ve shared blogs and articles on these topics on social media, you could hear the virtual pin drop in the room. People are more apt to pay attention and comment when you post a picture of the latest microbrew you’ve sampled. And there is a legitimate fear that complaining will affect the bottom line, especially for those of us employed by healthcare systems that have taken over in this country.

I subscribe to the belief that wars can also be won one skirmish at a time. When a patient comes at me with a complaint about the price of a new drug or why they didn’t get their refill right away, rather than get defensive, I empathize with them. I tell them that I (genuinely) share their frustration. I then offer a brief lesson on the multiple factors underlying their complaint, be it insurance issues and prior authorizations, the role of “big pharma,” and other administrative hassles. Patients are often filled with misconceptions and surprised to learn about what goes into their care. There are still plenty of people who truly believe that doctors get a commission every time we prescribe a new medication! And most of the time they are willing to admit that we’re just fellow humans who are doing the best we can and do have their best interests at heart.

If I’m told to jump by an administrator, I’ve decided that asking “how high?” does no good for my well-being. Like most physicians, I’m a people pleaser as well as a caretaker, and I generally prefer to color within the solid lines. But there are times when we are asked to do things that have no clinical bearing for the sake of checking sensless boxes. Those are the battles I have chosen to fight.

Last summer I found myself logging onto the EHR during a long weekend getaway for a friend’s beach wedding. My life partner and I were taking a break from the festivities for a little sun by the surf, when I started dreading all the treatment plans awaiting my approval as medical director upon returning to the office Monday morning. So I sat up in the lounge chair, pulled out my laptop, and got to work. Notwithstanding the sluggish VOIP connection over the resort’s Wi-Fi, the process was already slow because of poor EHR design. I had already lodged my complaint to IT and had been promised a fix that was still in the “queue” a year later. After taking 30 minutes just to approve 2 treatment plans when I should have been able to approve at least 30, I gave up and shot off an email to the head of IT, cc’d to the head administrator and chief medical officer. My statement was simple — here’s the problem, and this is the solution. I told them I’d be happy to continue approving treatment plans “old school” on paper, but would no longer do them on the EHR until the promised fix was completed. I signed treatment plans on paper until IT implemented the software patch, which was done in two weeks.

Another recent opportunity to fight back came when the university where I’ve taught residents and medical students for 20 years sent out a mandatory HIPAA training. In previous years I’d done what was asked without question because, as full-time clinical faculty, fulfilling their HIPAA requirement (in addition to completing it elsewhere I saw patients) made sense. But since the last round of training I had divested from all clinical activity at the university. I still give lectures while students come to see my patients at the facility where I now practice full time. Of course, we have our own mandatory HIPAA training, which I’ve completed. When the University sent out the announcement for its training (consisting of a series of online videos and questionnaires that would have taken at least a couple of hours to complete), it stated that evidence of training at affiliated programs would be accepted in lieu of completing their version. So I submitted our certificate of completion thinking that would be the end of it.

I was surprised and dismayed to receive an email from an administrator summarily rejecting my certificate. No explanation. Please complete the training by said deadline.

I responded with a request for an explanation. I reminded them I no longer see patients at any of the university’s clinical sites and have no access to Patient Health Information at the university. My request was rejected once more, again with no explanation, so I copied and pasted my email and climbed the administrative ladder with my requests for an explanation. After some buck passing between administrators, I received an email about a month later accepting the original certificate of completion I had already submitted. Thank you for your patience.

Small victories indeed, but they feel pretty good.