Getting fired and liking it

Some patients just can’t be rewired,

We go out of our way, but get fired.

It comes as relief,

Way out of belief,

And gives energy back to the tired.

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  In May 2010, I left my position of 23 years, and honoring my non-compete clause, traveled for a year doing locum tenens work.  In June of 2011 I joined up with the Community Health Center, which provides care for the underserved.  I’m now working part-time, which, for a doctor, means 54 hours a week.

Not all patients like me.  I have a sense of humor, not everybody does, and my patients with no sense of humor generally find doctors with no sense of humor.  I don’t mind; everybody wins if the patient sees the doctor they want to see most, and no one wins if the patient gets assigned to a doctor they can’t stand.

My work week theoretically ends on Wednesday, but today I needed to come into the office for paperwork.   While there, I went out of my way to tell my partners we’d been fired by a particular patient.

Docs divide patients up into the easy and the difficult.  Different difficult patients are difficult for different reasons.  We make a show of saying that we just don’t get along, but, in fact, most difficult patients don’t get along with anyone, and especially not doctors.  I used to worry that such patients might besmirch my reputation, till a colleague pointed out that bad advertising from someone who nobody likes constitutes great advertising. 

By the same token, a doc who speaks badly of the majority of his or her patients tells me that the problem lies with the physician and not with the patient.  Such doctors don’t last long in my town.

I can’t give specifics as to why all of our docs don’t get along with this patient, but every one of us has encountered the same frustrations.

I saw the patient in the hospital and did a great job of not judging.  I used my motivational interviewing skills; I asked, “Well, how’s that working out for you?”  when I might have yielded to the temptation of trying to point out the error of his/her ways.  At the end of the interview I received a thorough dressing down.

I didn’t leave upset; I left relieved, but our clinic has a process and protocol to formalize the termination of the relationship, and I made sure I sent the right emails.

Yet within the same twenty-four hours I spoke to two patients whose lives I had saved.  They still thank me effusively when they see me.  I believe they’re among the lucky ones who wake up appreciative and thankful for every day they have alive.

Contrast is the essence of meaning.


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