Shirah Vollmer MD

The Musings of Dr. Vollmer

You’re Fired-II

Posted by Dr. Vollmer on February 12, 2010

    Teri, the subject of my earlier blog, had an in-depth personal relationship with her psychiatrist/psychoanalyst. The termination was crushing. Her sense of betrayal echoed my story What happens when a doctor patient relationship is less intense, but the psychiatrist walks away, seemingly without any thought or care?

    Theo, a  fictional character, a 22-year-old  schizophrenic patient, was seeing  Dr. G. three to four times a year. Theo was relatively stable, but occasionally he needed his medications tweaked. When Theo was an adolescent, his behavior became scary such that he required three hospitalizations over  four years. Dr. G followed Theo through these multiple crises. More recently, Theo had done very well. Dr. G resigned from his care. He did not give Theo any referrals. He did not give Theo an explanation.

    To get into Dr. G’s mind is a game of wild speculation, but with sudden changes, one is left to try to make a narrative. How does this happen? Is Dr. G unethical? Is there any recourse? How does Theo find another doctor who won’t do this? By way of conjecture, I propose that Dr. G was overwhelmed by Theo. When Theo was going in and out of crisis, Dr. G felt anxious, uncertain and ill at ease. Dr. G knew that in such a high acuity time, he could not leave the case. As Theo calmed down, Dr. G saw his exit plan. Leaving a patient when he is stable makes sense. The problem is that Dr. G is responding to Theo’s history, whereas Theo is looking at the present, thinking that he is doing well, so of course he is not a burden on his physician.

    Wait a minute. Doctors are supposed to take care of sick people, not healthy people, so why does Theo have to be well for Dr. G. to want to take care of him? It is a myth that doctors want to take care of sick people. I think that young doctors have ideals, but as  the physician gets older, has more personal problems, sees the finite nature of his own life, then he wants to have a life that feels good. Sometimes feeling good involves helping people, but when the person you are helping, also makes you worry, then it can be hard to cope.

   Dr. G. was cruel to terminate Theo without an explanation, without a referral. Dr. G. has to weigh his job satisfaction, his quality of life, against the impact of his termination on the patient.   This is not an easy determination, but I suspect that all doctors are faced with these dilemmas throughout their careers. Perhaps there should be more transparency in this process. Perhaps more transparency would create less shame, for both the patient and the physician. Relationships are hard. Some do not endure. It is a hard truth.

One Response to “You’re Fired-II”

  1. Shelly said

    Bravo. We sometimes forget that physicians are human too.

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