Why No Job Can Ever Be Perfect

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Photo: totalAldo

I love what I do.  Being a doctor challenges me every day to think critically and creatively, to learn new things, and to make the vast machine that is the American medical system run smoothly.  The relationships I’ve formed provide me great power to do good:  my patients trust me like no one else in their lives, which gives me enormous influence over their decisions (which, of course, also provides equal opportunity to do harm).  I’ve witnessed moving dramas, seen people rise to greatness they didn’t know they had in them, and enjoyed idiosyncrasies so outrageous I couldn’t have invented them in my wildest imagination.  Though many people think doctors routinely save lives, in my field, internal medicine, that happens only rarely.  Most of my time is spent managing chronic illnesses and minimizing future risks.  Occasionally I do make an astute diagnosis no one else has been able to make or catch a critical lab value no one else has thought to check, but mostly I just talk to people about what’s bothering them and try to make them feel better.  And it’s enormously gratifying.

But there’s a lot to dislike about my job as well.  The amount of paperwork I’m required to complete is enormous.  The system in which I work is inefficient and overburdened, often requiring me to become involved in far too many non-medical tasks, like calling in favors with colleagues to get patients seen or even scheduled for tests.  I often don’t have enough time to spend with patients who need it (I spend it anyway and suffer the consequences of being late to meetings or falling behind in returning phone calls or answering emails or getting enough exercise).  Important services for patients are becoming scarcer:  I dread sending anyone to the ER where the wait is often on the order of 10-15 hours for urgent (but non-emergent) care.  Insurance coverage for mental health care is embarrassingly inadequate in many, if not most plans, and especially in Medicaid which serves a population often more in need of it than any other group.  In fact, some surveys have shown almost 50% of primary care physicians are dissatisfied with their careers and would quit if presented a viable alternative.

Not me, though.  I am often frustrated and the field of medicine is obviously going through enormous upheaval right now.  But not only am I profoundly grateful I have a job (given how many people currently don’t), I recognize that no job involves doing only the part that drew us to it in the first place.  Any and all dream jobs we could imagine will always have peripheral parts to them that support the exciting, central part but which we almost certainly won’t enjoy.

But the real reason no job can ever be perfect is because we won’t ever be perfect.  We’ll always have a constantly shifting life-condition that makes today seem awful even though yesterday we felt great doing the exact same thing; we’ll always keep making new mistakes; we’ll always on occasion fail in a big way; and we’ll never be able avoid having others dislike our work.

It would be terrific if something in our lives were only and always good.  But nothing in my life—even the most cherished parts of it—is only wonderful.  I’ll confess here that sometimes, even though I love him to pieces, I find my son boring (think about what a 20-month-old likes to spend his time doing…).  My great passion, writing, is hard work, and though I don’t begrudge the effort, to enjoy the success I dream about will require me to do several things I’d prefer not to do—marketing myself and my work chief among them.  But I will do them.  Because I recognize that to believe that anything in life—even something we love—could ever be only and always good is to believe a child’s fantasy.  And because having to work hard to accomplish something provides two benefits:  the goal itself and the satisfaction of having had to work for it.

Next WeekHow World Peace Is Possible

14 comments to Why No Job Can Ever Be Perfect

  • Amy

    Alex,

    Thanks so much for passing on your thoughts each week; much appreciated.

    I’ve been going through a tough time trying to figure out what’s wrong with me and have been feeling increasingly frustrated with my primary care doc. I feel like he’s not vigilant enough with me, like he just concentrates on the “regular” stuff (high cholesterol, etc.) and doesn’t seem to really care about helping me track down why I feel so crappy…on the other hand, he doesn’t “order” me around like so many other docs I’ve had in the past.

    It’s interesting to read your take on being a doc…how as you said “mostly I just talk to people about what’s bothering them and try to make them feel better.” For me that was a good thing at first, but now I need more than that…I don’t think my doc knows how to go beyond that to try to help me and I’m about to “fire” him, but it’s daunting to find a new doc.

    I see a cardiologist for atrial tachycardia, an endocrinologist for thyroid nodules, and a psychiatrist for anxiety…and…I feel like my primary care doc should be coordinating the specialist care to consolidate things. But I don’t feel like he’s doing that. Each specialist seems to have their own view of why I’m feeling crappy…I want someone to pull it all together, but I don’t know how to make that happen.

    Question for you…if you had a patient who fairly suddenly became excessively anxious, who has lost weight without trying, who is nauseated all the time, who is cold all the time (or sometimes sweating like a maniac), who has no eyebrows, who cannot even vacuum without becoming so sore she can barely walk the next day or so…what would you do? What would you tell that patient?

    My current doc just says it’s the anxiety, like I’ve been branded with the “A” diagnosis and nothing else comes into play in his mind. My endo says I have Hashimoto’s, but blood tests don’t corroborate hyperthyroidism or hypothyroidism. My cardiologist says I have atrial tachycardia due to errant pacemaking firing in my heart muscle…cardiac ablation seems to be on the horizon.

    My dilemma…how do I know it’s not a thyroid problem (I have so many clinical symptoms, but not the blood test proof) or really a core heart problem…I don’t believe I have a psychological anxiety problem. How do I find a doc who can (and is willing to) put all of these disparate findings together? I feel like I’m the doc and I’m so tired of having to be the vigilant one. Any thoughts would be appreciated.

    Amy: You’re facing a challenging situation. You do need a primary care doctor who is not only willing to listen attentively to you, to truly coordinate your care (often by communicating himself with your specialists to understand their views), but most importantly to explain his thought process to you in detail. Why does he think your soreness, for example, is the result of anxiety? It is hard to find someone like that. I would suggest you explain in detail to your doctor (without criticizing his efforts so far) just exactly what you’re looking for in a primary care doctor, being as concrete and specific as possible. Then give him one more chance (see one of my previous posts, How To Give And Receive Feedback). If he doesn’t meet or exceed your expectations, go looking for another one. One of the best ways to increase your odds of finding a good doctor is to ask the support staff (e.g., secretaries, front desk coordinators) who in their practice they would go to if they were sick, as they often have a surprisingly accurate view of who’s really good. Finally, if you haven’t already, you might want to read another previous post, When Doctors Don’t Know What’s Wrong. I know how frustrating this can be, but don’t give up! Good luck!

    Alex

  • Chris

    Alex, you don’t say how having tamed restlessness and cultivated acceptance has brought you to this level of peace and satisfaction with your profession . . .

    You don’t say that you struggle with medicine as a business rather than as an altruistic professional pursuit . . .

    You don’t talk about being hide-bound by rules, policies and procedures . . .

    You don’t talk about self-doubt that may haunt a medical professional after a medical mistake or misdiagnosis . . . How have you escaped all these traps?!

    Chris: I’ve tamed restlessness and cultivated acceptance (for those things that should be accepted) by my practice of Buddhism, which helps me sort out wise action from foolish action. My struggle with medicine as a business has mostly come in the form of frustration at seeing Medicaid patients marginalized by our government (which has chosen to reimburse medical services at a rate so low that many hospitals are twisting themselves into pretzels to figure out how to avoid treating the poor). This is a battle I had been fighting as a former director of primary care but am now leaving to others, choosing instead to focus on doing the best for the patients I currently have (including Medicaid patients who remain in my practice). The rules, policies, and procedures are often frustrating when they don’t make sense or require an inefficient use of my time (I think I’ve reached learned helplessness on that one). And as to your last point, I discussed it briefly in a previous post, Tribute To A Patient.

    Alex

  • Ondrej

    A wonderful piece of writing and just the reminder I needed this Monday! Thanks. I sometimes wonder where this pressure on productivity and not having enough time to do the job right will lead us to…

    PS—Maybe the headline doesn’t need the “why.”

  • Jill MacGregor

    Alex,
    I can’t imagine the time, energy and dedication you’ve put into becoming the doctor you are today. As someone who’s been a patient (3 hip surgeries), I have such great respect for the doctors and nurses who have taken care of me while I healed. I’m glad this profession has built you up instead of worn you down.

    Thanks for the insights. You are a great way to start my week!

    Take Care,
    Jill

    When People Leave

  • I often wonder how I’m going to balance the non-doc stuff when I’m finally a physician. I hate bureaucratic stuff so that part of the career is more than a bit concerning, especially when it’s such a major complaint in the life of a physician.

  • Hi Alex,

    You really inspire me with your love of your job and dedication to your patients!! You are right about all jobs having some unpleasantries—that’s just the nature of work.

    What impresses me about you is that you are very concerned about your patients and take the time to listen to them. I agree with your advice to Amy that she should find a doctor who is the right fit for her and her needs.

    Amy, if you are reading this, I offer advice on how to hire and fire doctors from a patient’s perspective in my Calling the Shots blog:

    http://bethlgainer.blogspot.com/2009/04/youre-fired.html

    I have had experiences with poor doctors as well as outstanding ones. Today marks the third anniversary of my preventive double mastectomy with reconstruction (I was diagnosed with breast cancer in Jan 2001).

    As a primary care physician, you have more impact on your patients than you might think. I will always remember my PCP’s kind words and callbacks. I will always remember her concern for me as a person, and she was an integral player in getting me to the right oncologist. She, too, saved my life, and I regard her as my guardian angel.

    Of course, there are terrible doctors, and when I got a second opinion regarding cancer treatment, the doctor told me that I would likely not realize my dream of having a child because I was likely to die if I didn’t succumb to his treatment plan ASAP.

    I left the office crying.

    I chose the oncologist my PCP recommended.

    I am now healthy and although the chemotherapy resulted in premature menopause, I am a mom: four months ago I adopted a baby girl from China. I am enjoying life more than ever and consider myself blessed.

    Thank you for such excellent postings!!

    — Beth

    Beth: Thank you for sharing your comment.

    Alex

  • Thanks for taking the time to share another important piece of wisdom, Alex.

    This is an important message for everyone—and one I’ve often repeated to my kids—but you’ve said it so much better!

    And even better, you’ve explained why one shouldn’t even expect any job, or any situation to be perfect.

    “But the real reason no job can ever be perfect is because we won’t ever be perfect. We’ll always have a constantly shifting life-condition that makes today seem awful even though yesterday we felt great doing the exact same thing; we’ll always keep making new mistakes; we’ll always on occasion fail in a big way; and we’ll never be able avoid having others dislike our work.”

    “It would be terrific if something in our lives were only and always good. But nothing in my life—even the most cherished parts of it—is only wonderful.”

    As always, thanks for your candor.

  • Maureen

    Thank you for sharing your insight and for your honesty. I live in Canada and my brother-in-law is a doctor and I hear from him how challenging the conditions are. He says, given his time back, he would not again go into medicine at all.

    I admire doctors greatly and the conditions in which you work are not great and the pressure is high.

    I am not a doctor but struggle greatly with my job dissatisfaction even though I have a great job. I just want more—more recognition, more room to advance, etc. Your thoughts on why each job is a give and take and your reasoning is a great help to me.

  • logos coaching

    Your post reinforces for me the see-saw action of the world today; the new vs. the old mentality. Caring individuals who wish to help others are increasingly having time they could devote to that taken up with paperwork.

    Those who demand all the paperwork to be done within professions need to realize that it is the people who matter and not the data which is collected or the “numbers” that count.

    Another great post from you, Alex.

  • I can certainly sympathize with Amy…I wrote about how I felt I was my own PCP over a year ago.

    Those of us with complex, not well-defined medical issues are often frustrated. This is especially true where chronic pain is a factor.

  • Amy

    Alex, Beth and Donna,

    Thanks so much for your thoughts. I’ve taken a look at the links you all recommended and they are certainly helpful. We’ll see what happens the next time I see my PCP. I guess I’ll give him one more chance for now.

  • Erika Mitchell

    I hear you fully as a physician myself. I am frustrated, often angry, because of the lack of emphasis on patients and the ever-increasing emphasis on money, malpractice and governance. Having read the book you had recommended, I am now more aware of the natural states behind my behavior and feelings. But I am concerned that in accepting the system for what it is and trying to work to the best of my abilities withing its limits, that I become complacent. I try to convince myself that I do the paperwork, argue with insurance companies, work long hours and ignore my own needs for the great privilege of being a surgeon. It is a privilege and I am insanely grateful for it. But how do I stay thankful in this imperfect system? I feel the need to be angry, to fight it, to not just accept it for what it is and work with a smile, despite the fact that I know it is bigger than me and that my voice is small. My lower worlds are still so strong.

    Erika: As they are in all of us! Finding a way to enjoy an imperfect job doesn’t, in my mind, preclude you from fighting to improve it. I share your sense of impotence in contributing to the change our medical system so desperately needs, but my answer is to fight for better solutions right where I am in whatever way I can, which really has led to meaningful, if only local change.

    Alex

  • Brenda Keefe

    Thanks again for a wonderful post.

    I have to say that even with all the frustrations, unending piles of paperwork, and what seems like too many phone calls to professionals that never seem to return them and having to make them all over again, I still love the work I do and the job I have. No job is perfect but I think I have the next best thing. I am truly grateful for having a job today and having one I love. This may change tomorrow, but for today all is well.

    I think of my dad who worked in a factory for 35 years, worked his butt off with all the overtime he did, supporting my mother and 9 siblings, supporting me through my undergrad so that I could have a job I loved. I don’t remember him complaining about his work. I do remember comments when his pension fund went bankrupt, having worked all those years, and that happening.

    So, maybe the perfect job is in the eyes of the beholder?

  • Tracy

    Thank you so much for your post! I am a nurse and studying to be a nurse practitioner. I appreciate your insight and candor. As a nurse, I often feel frustrated with the system. However, I truly feel blessed to have the chance to make important impacts on people’s lives.

    Tracy: Me, too.

    Alex

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