Today a patient returned to my office for followup of my treatment of her spinal problems. She has back pain that clearly will not do well with surgery, so I’ve been trying to treat her with other modalities. She has been through PT, medications, and (most recently) 2 epidural injections. I do most of my own patients’ injections and did both of hers, spaced several months apart. She’s not a candidate for surgery, but I’m trying to help her.
At her first visit, I spent 45 minutes with her, evaluating and discussing her problem, showing her the MRI films, explaining what the options were. We discussed her anxiety and depression and talked about how that fed into her chronic pain. She did well with one injection, and seemed fine at that 20 minute followup visit. Now she returns after the second injection:
“Why didn’t you make me numb for this shot like you did the first time?” Tears. “It hurt so bad!” Tears. “Why did you let me be so anxious in the recovery room?” Angry stare. “I have some QUESTIONS.”
Now, I do the same protocol with every injection, including IV Versed for sedation. I know I did nothing different the second time, but no matter what I say, she gets more upset. Finally, after accusing me of telling her at her first visit that she needed surgery, and now telling her something different, she announces, “You and I are done, then.” I offer to refer her to another physician, and she snaps, “My own doctor can find me plenty of doctors who will care more!”
As a professional, I’ve been here before, and I know not every patient is going to get along with me. It’s her choice, and I’m fine with that. My brain tells me I shouldn’t let it bother me and that this patient has issues I’m not going to be able to solve anyway. *You can’t make everybody happy all the time.* I can’t even make the fixable problems better 100% of the time. The studies confirm that.
My heart tells me that I went into neurosurgery to fix people’s problems, and I should be able to help every patient I see. Because I do care so much about every patient and because I try so hard, every patient should understand that and be happy and grateful. If a patient doesn’t get better or doesn’t like me, that’s my fault. I’ve done something wrong or not done enough, been supportive enough.
No matter how much my brain tells my heart to shut up and be realistic, I can’t reason it away. This will bother me for days. It always does. The 29 patients I saw back today doing great, who’ve thanked me for my help, don’t make this better. I love the successes, but I wish the failures wouldn’t hurt so much.
gcs 15 is a 39 year old full-time neurosurgeon in private practice in a beautiful Southern state. She has a 10 year old son who plays travel soccer and ice hockey. Her wonderful, Type B husband is a primary care MD who quit medicine to be a college professor and loves teaching premed students. She adores her job but hates the politics involved in the practice of medicine. She's always struggling to find ways to get more hours in the day.