I recently bumped into my cardiologist a week before my yearly follow up. Fortunately, I continue to do well after my quintuple bypass six years ago. "I'll be seeing you Thursday," I told him. "Last patient of the day … an easy one," I added for emphasis. As a fellow physician, I recognize that beyond new patients, return visits, and post-operative classifications, some encounters will be easy, and some will be hard. The right ratio will determine how manageable the day is. My colleague looked at me after my "easy one" proclamation. "Jay," he replied, "May you always be an easy one."
John F. Kennedy famously said, "We do these things not because they are easy, but because they are hard." While he was referring to going to the moon, the same principle could be applied to being a physician. There are trials and hardships on the journey. The path is undoubtedly gratifying and undeniably difficult. To become more skilled clinicians, we need a steady diet of complicated and challenging patients.
These "hard ones" test our patience, listening, communication, fund of knowledge, and clinical skills. There are patients with multiple complaints to review in an overbooked and time constrained clinic. There are patients being seen for a second or third opinion in search of a diagnosis and cure for their ongoing symptoms. There is the risk of unmet expectations and unanswered questions. These encounters can be uncomfortable and are not always gratifying.
The hard ones give me the most pause. I take a deep breath as I enter the exam room. I try to stay positive and try to acknowledge and validate a multitude of symptoms and previous treatment failures. After seeing several hard or challenging patients in a session, my head starts to spin. I feel drained and find it difficult to stay sharp and focused. I wonder if patients can sense my declining energy levels and frustration. As the day teeters into unmanageable territory, I go into survival mode … working to get through the day versus truly helping each patient.
Hard or difficult is inherently subjective. Difficulty can be quantified by the sheer volume of tasks (patient visits, messages, etc.) or the challenges associated with each task. We need some degree of difficulty to push us and learn from as we strive to improve and deliver the best care we can. Only by seeing and managing the hard ones can they become easier and less stressful over time.
While difficulty is critical to growth and improvement, a high or persistent dose of great difficulty can be toxic to our spirit. The right manageability ratio is more important than we may realize. Too many second opinions or revision procedures in a day will leave me exhausted. I value the challenge and growth in seeing the more difficult patients and cases, but capacity and willingness for growth is limited if degree of difficulty is too great. During these times, I find myself craving an "easy one" to change the pace and revive my depleted reserves.
The easy ones are oftentimes less complex. They are return patients with symptoms or diseases that have improved with medical or surgical intervention. They are frequently success stories. They bring a smile to our faces. The positivity and gratification fuel us. Easy ones can also be new patients with a single or established diagnosis and a straightforward treatment plan. I feel lighter and more relaxed during these encounters. I breathe a little easier. I feel the rising energy and enthusiasm. The hard ones can teach us, but the easy ones can restore us.
What was hard earlier in our careers can become easy with time and experience. What starts out as easy does not always end that way. Regardless, without proper balance, the day can become mentally and physically draining and potentially unmanageable. Likewise, a full day of suture removals and medication refills is manageable but boring and unfulfilling.
As time marches on in our lives and careers, our definition of difficulty changes as does our tolerance for degrees of difficulty. The hard ones will always push and test us. They can be rewarding as we overcome the difficulty, especially if the overall result is positive. We may prefer positive experiences, but we grow from more painful ones. There is risk with what we do, a risk we embraced as physicians and surgeons. These risks and potential negative outcomes do not necessarily get easier to deal with over time. We do not have much control in what walks through the door. Patients are not always predictable. As a result, I have started to appreciate the value of the easy ones and savor the patients, encounters, and procedures that are simpler and more straightforward.
Hard and difficult is ingrained in the job description. There is value in "the hard," but we should not underestimate the value of "the easy." We need the hard ones to challenge us and improve, but we cannot go through the day facing "third and long" on every encounter. It is unsustainable. The easy ones maintain our energy, enthusiasm, and focus. They are vital for our well-being, and we should not take that for granted. I am not sure how you quantify your day, but I'm hoping there is always a little bit of easy in yours.
Who was your last "easy" patient? "Hard" patient? Share in the comments.
Dr. Greenberg is an otolaryngologist-head and neck surgeon. He is a proud husband, father of three, physician, founder of a t-shirt company, and certified professional coach.
Image by GoodStudio / Shutterstock
