I’ve started describing 2020 as the year I did the most yet have the least to show for it. My workdays were longer, harder and more stressful than usual, even though I saw far fewer patients than I typically do. I worried about my staff because we didn’t have appropriate personal protective equipment at times, and we continue to wear N95s until they break even as I write this. And I still worry about bringing COVID-19 home to my family on top of worrying about my patients.
When we got our first vial of COVID vaccine I had hope. It felt so uplifting to call patients and offer them a shot. And for a couple of months that made me feel as though there was going to be an end to this. As more people signed up for the vaccine, I felt that my community was growing safer and more protected. I felt the tightness in my chest diminish a bit. But there also was a dark side to that scenario because some people refused vaccination. People who had trusted me with their health care, trusted me to care for their grandchildren or their grandparents, didn’t trust my opinion that this vaccine was safe for them to receive. My own office staff didn’t have 100% uptake.
I also had patients presenting to my office who were sicker than in the past. They had waited to deal with their complaints due to fear of COVID-19. So even as I felt defeated by vaccine hesitancy, I was facing more critically ill patients and more mental health emergencies. I got tired of calling for an ambulance for an unstable patient and being told there were none in the entire county. People were sick, emergency medical services couldn’t keep up, I was overwhelmed, the hospitals were full, and I questioned why I ever went into medicine if it was only to be faced with one impossible task after another.
I finally hit a turning point in December 2020 when a patient was explaining to me that he thought every COVID-19 test I did in my office falsely returned a positive result, because he had heard I made more money if the tests were positive. Obviously, this wasn’t true. We were seeing mostly positive COVID tests at that time, as was the rest of the country. I left the room. I had already discussed his heart disease, diabetes and depression and had completed his exam without any concerning findings. So I left. He wasn’t the first person to spew conspiracy theories at me or the first to suggest I was somehow doing something wrong related to COVID. But something about what he said, as one of my higher-risk patients who rarely takes my medical advice and often makes choices that I think increase his morbidity, changed my perspective on my role as a family doctor in rural America.
My story about the past year is not unique. Many family doctors ― actually, many health care workers in general ― at all levels of training and all levels of experience have had a year just like mine. Many have left health care because of the memories of hopelessness we all share. What I think I have come to understand about my own experiences and traumas is that I still have work to do here. None of us went into medicine because we thought it would be easy. And being forced to fight misinformation is not something we can avoid by relocating, because it’s everywhere. I went into family medicine to improve the health of a community. Everyone deserves access to high-quality health care and a doctor who will try to forget how offensive they were during this pandemic and continue to care for generations of their families. We can’t hold grudges against our patients, but we sure can have more realistic goals for ourselves.
Despite what CMS and other payers like to think, we truly can’t be held accountable for what our patients do. Patients’ A1c levels are no measure of my competency as a physician, they are a measure of those patients’ willingness to accept my treatment advice. And I have to let go of that burden, and the disappointment I feel, when they choose to not take my advice. What I now am able to see is that I’m not responsible for the decisions people make, even though the medical infrastructure and our employers have too often framed it that way.
Medical school and residency change us as people. We are different at the end of our training because of the walls we build to survive what we have to see and hear. We also grow as we serve a community. We adapt to our patients’ interests and culture to become more effective physicians. But the past seven years have taught me that we can never get comfortable. We can never forget that we need to take care of ourselves because often we put our patients’ well-being above our own, and COVID-19 has demonstrated that altruism won’t always be reciprocated.
Kimberly Becher, M.D., practices at a rural federally qualified health center in Clay County, W.Va. You can follow her on Twitter @BecherKimberly.