Your Career Guide

Eager to quit? Be careful what you wish for

Forced to give up medicine, this doctor still reaches the sick through her writings. But she misses clinical practice—a lot.

By Wendy S. Harpham, MD

My office was poised for work, save for the eerie absence of staff and patients. Two weeks earlier, I'd closed my solo internal medicine practice. The decision to retire so young, at 37, was my choice. The circumstances were not. Knowing that closure was best for all did not ease the choking grief or my fear of a future without clinical medicine.

Practicing medicine was the realization of a teenage dream. Never just a job, my practice was like a true friend. Always there—daytime, nighttime, weekdays, holidays. My office was reliable, predictable, and comfortable. Suite 508 became my private retreat where patients showed up seeking repair or reassurance, no matter what was going on in my personal life or with hospital or national politics.

I knew my practice inside and out, and accepted it the way it was. Every niche reflected the intimacy of patient care. The exam rooms echoed the sounds of patients—their cries of pain, anxiety, fear, relief, and joy. On the corridor walls hung watercolor landscapes purchased with pinched pennies, postcards sent by patients, and countless pictures of (and by) my children that documented their growth.

Each chart held a snapshot of the patient, recorded in Polaroid and in words. Stacks of journals, their height a reliable barometer of my "busy-ness," were a constant reminder of the challenge and excitement of practicing medicine.

As the boss, I systematized and personalized every detail of patient care. My patients filled out questionnaires I'd developed, after which they were entertained by photo albums filled with my favorite comic strips. After undressing, my patients were kept warm (and relatively dignified) in cloth gowns I'd designed to open discreetly on the sides. More important, being in solo practice allowed me to choose how long I spent evaluating, treating, teaching, or comforting each patient.

Yet I was like a slave, forever responding to the unquenchable needs of my patients and business. Whenever I was on call, my husband and I shared our bed with my beeper, a noisy mate whose simple presence kept me in work mode. My practice stole innumerable hours from family time by expecting me to oversee the office purchases and patient accounts, keep up with Medicare regulations, and smooth over staff conflicts. With ever-increasing overhead, choosing the luxury of thorough patient evaluations obliged me to work long hours.

During these hours, my practice was a gifted teacher, and I the student learning the art of medicine. Medical school may have taught me the language and physiology of disease, but caring for my own patients enlightened me about the consequences of illness and doctors' interventions, and taught me how to help patients understand and adjust to their realities.

In learning the art of medicine, I was learning about life. Privy to my patients' most personal malfunctions and thoughts, I learned how to cope and even grow from loss and change. They showed me how to find happiness in difficult situations.

I put those lessons to use in 1990 when I was diagnosed with non-Hodgkin's lymphoma. Excruciating leg pain due to progressive cancer, and the intensive treatment that followed, made me too sick to care for others and forced me to stop working. The sting of reducing my office to one employee answering one phone was eased by the knowledge that my retirement was temporary and would enrich my ability to care for my patients when I returned.

Ten months later, with the lymphoma in remission, I reopened my office doors, full of hope and expectation. Many old patients returned; new ones arrived. Ever grateful for the comfort and life that my doctors' therapeutic touch had given me, I did my work with heightened awareness. Years and years of caring for patients would be one way I could give back something for all that I had received.

But nine months later, cancer again vied for my time, making it impossible to satisfy the inflexible demands of private practice. Prematurely, unfairly, I had to close my practice for good. The equipment was sold, the charts scattered. I lingered in the lifeless shell of my office, reluctant to let go of what remained. "Goodbye my friend," I mumbled. "I will miss you."

No longer the boss, and no longer the slave, I felt disoriented. Emancipated from my beeper and call schedule, I suddenly had time to read and write, play music, pick up my children at school, and cheer at their games. These simple pleasures helped me deal with the reason behind the closing: I had to be free to focus my energy on survival.

Yet the physician in me couldn't rest. Hospital operating suites, doctors' reception rooms, phlebotomy labs, cancer support groups, and even health food stores became my new classrooms for an extraordinary education in illness and healing. I experienced the effects of friendly appointment clerks, soft cloth gowns, and nurses' reassuring pats on the back. I felt the terror of disease, the lure of alternative therapies, and the comfort of satisfying interactions with my health care team. Each of my physicians (and there were many) treated me with the kind of care I had dedicated myself to giving in my office.

Instinctively, I began to write down my thoughts and feelings about being a patient. I shared my writing with hospital colleagues, then with medical journals. But there was another audience I felt compelled to reach: patients. With a new sense of calling, I found myself writing down what I used to say in my office, only this time with the voice of someone who has been there.

Writing and speaking about survivorship, I discovered a broad arc of the healing circle that had been invisible to me when I was busy in my office. Thousands of individuals, loosely knit groups, academic consortia, and national coalitions are devoted to improving our understanding of optimal patient care, and to narrowing the gap between that ideal and the care that patients actually receive.

Having experienced illness from both sides of the stethoscope, I could address physicians as a patient advocate,* and appeal to patients as a physician advocate. I found myself back within the guild of healers. Writing and speaking became my new passions, enabling me to reach more people than I ever could in my office.

But it just wasn't the same as clinical medicine. So I continued to read journals, listen to audiotaped reviews of internal medicine, and attend the hospital's weekly medicine conference whenever my schedule and energy allowed. One day, as I worked my way through the buffet line before the noon lecture, a colleague came up from behind and rested his hand on my shoulder. Then he whispered through a wry smile: "You got out of medicine just in time. You wouldn't recognize it. Everything's changed, and the joy is gone. We're no longer taking care of people; we're fixing jalopies."

I bit my tongue. He hadn't been the first to point out the good fortune in my disability, or to suggest that clinical medicine had lost its humanity. But I couldn't accept his despair. Taking care of patients is not like repairing cars. I'd believed this as a doctor before I got sick; I absolutely knew it as a patient. There is nothing else like practicing medicine.

The heart of modern-day medicine is helping others through the synergy of science and caring. Sure, I'm gratified when people tell me how much my books help them deal with illness. But writing and lecturing are nothing like connecting one-on-one with patients—listening to their stories, examining their bodies, processing, guiding, prescribing, hoping, sharing—and facilitating their healing, be it physical, emotional, or spiritual. How I miss that! It would be an incredible tragedy if physicians let the changes in health care destroy the joy of practicing medicine.

Today, innovative therapies and the caring attention of my skilled physicians have led to my most recent remission, one that nourishes my hopes with each added month. I haven't died, but I'm not cured. My poor stamina, which is improving slowly, still obviates a return to clinical medicine at this time. So I keep listening to my audiotapes and going to conferences.

My white coat and stethoscope hang just inside my closet door. Whenever I brush up against them, vivid images of my old office come to mind—the patients and staff, the charts, the challenge, and the caring. Eight years have passed since I closed my practice. A hematologist's office occupies Suite 508. And I'm at home wearing blue jeans, grateful for the opportunity to touch patients through books.

Memories soften the finality of my loss—memories that live in my patients who remember the care they received, and in me, reminding me of the doctor I was, shaping the doctor I am today, and inspiring the doctor I hope to become.

*Antioch University is starting a professional certificate program for physicians interested in paid work as patient advocates. For details, look under the heading "Nonclinical opportunities" in "Where to go for help: Your career resource guide".

The author, formerly a practicing internist in Richardson, TX, now devotes her time to writing and lecturing. Her books include When a Parent Has Cancer: A Guide to Caring for Your Children (HarperCollins, 1997); Diagnosis Cancer: Your Guide Through the First Few Months (W.W. Norton, 1998); and After Cancer: A Guide to Your New Life (HarperCollins, 1995).

 

Wendy Harpham. Eager to quit? Be careful what you wish for. Medical Economics 2001;3:106.