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Beyond Late Night Calls: What Keeps Physicians Up at Night?

Beyond Late Night Calls: What Keeps Physicians Up at Night?
Author Information (click to view)

Madhukar Kasarla, MD

Madhukar Kasarla, MD, works as a hospitalist physician with APOGEE Physicians at Parkway Surgical and Cardiovascular Hospital in Fort Worth, Texas. He also works for Texas Health Physicians Group at Texas Health Harris Methodist Hospital and Health Harris Methodist Hospital Southwest in Fort Worth, and Texas Health Harris Methodist Hospital in Azle, Texas. He did his Internal Medicine residency at Mercy Hospital & Medical Center, Chicago. For more information, please contact kasarla29@yahoo.commadhukarreddy.kasarla@apogeephysicians.com.

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Madhukar Kasarla, MD (click to view)

Madhukar Kasarla, MD

Madhukar Kasarla, MD, works as a hospitalist physician with APOGEE Physicians at Parkway Surgical and Cardiovascular Hospital in Fort Worth, Texas. He also works for Texas Health Physicians Group at Texas Health Harris Methodist Hospital and Health Harris Methodist Hospital Southwest in Fort Worth, and Texas Health Harris Methodist Hospital in Azle, Texas. He did his Internal Medicine residency at Mercy Hospital & Medical Center, Chicago. For more information, please contact kasarla29@yahoo.commadhukarreddy.kasarla@apogeephysicians.com.

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In television and movie medical dramas, there’s always that one scene in which a physician receives a call in the middle of the night—the one where the physician needs to dispense advice or rush back to the office or hospital. While that still happens (though not always as dramatically as in the Hollywood versions), there are countless other issues that keep physicians from getting a full night’s sleep.


Patient Issues

It’s no surprise that many factors occupying physicians’ minds throughout the night are related to their patients. Some patients may be suffering from unexpected complications from surgery and require additional treatment. Others may be experiencing adverse effects from prescribed treatment or aren’t responding to their treatments and require additional research into the underlying causes. Especially disconcerting for physicians are patients with terminal outcomes or unclear diagnoses. And some patients are so ill that they require more than the usual attention from medical staff.

Physicians also must manage problematic patients. These patients fall into several categories: difficult, unhappy, non-compliant, and malingering. Each patient type requires a different approach by the physician, especially if there is interference from the patient’s family. One of the newer challenges for physicians is the current opioid crisis. Physicians are tasked with determining strategies for patient pain management and how to handle patient requests for additional narcotics.

 

Administration Concerns

Whether physicians own or work in a private practice or in a hospital setting, they are faced with a variety of administration problems that contribute to sleepless nights. For some it may be increasing practice costs and decreasing reimbursements. Others struggle with scrutiny, pressure, and emotional neglect from administration or even uncooperative staff. Technology is ever changing, requiring physicians to stay up to date with the latest advancements. On the other hand, there are times when physicians must revise treatment plans to compensate for the unavailability of proper resources. And virtually all physicians have nightmares when it comes to the never-ending documentation required by administration and health insurance companies.


Ethical & Personal Dilemmas

When physicians treat critically ill patients, they face difficult decisions regarding palliative care and allocation of resources. Physicians are worried about the possibility of making medical mistakes or being sued by patients. In some medical centers, physicians are faced with pressure by administration or other medical staff, including in the use of patient satisfaction scores to evaluate physicians and medical centers. The stress from administration to receive high scores may sway physicians to make decisions that aren’t always in the best interest of their patients.

Sleepless nights are also brought about by the struggle of working long hours and being unable to spend quality time with families. Some physicians fear rejection by patients and other medical staff, or they dwell on disagreements with other physicians. Finally, there are tremendous financial issues caused by student loans and other debt incurred by physicians due to their many years of education and the requirement for continuing education.


Physician Burnout

Physicians are under an enormous amount of pressure to provide top-quality medical care while controlling costs. It’s important to recognize when this quandary begins to affect both physicians and their patients. Some of the signs of physician burnout include developing a negative or cynical attitude toward work and patients, as well as limited ability to recover from emotional or physical exhaustion when not working. The solution is to do what physicians prescribe for their stressed patients: find the balance between work and non-work, prioritize self-care, and engage in stress-reducing activities such as exercise and meditation. When physicians take care of themselves first, they are better able to care for their patients and finally get that good night’s sleep.

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