Yes, that’s in honor of the hit song “With or Without You” by U2.
So sue me (grin).
I’m not a martyr. I’m not someone to burn themselves out and say, “poor me, look at what all I do for everyone else!” And yet that’s exactly what I ended up doing. I didn’t intend to, not by a long shot. But I did anyway. Live and learn…
I think it starts in chiropractic school. We’re taught on one hand that our services are worth the moon. Listening to that professor, you’d think we were going to graduate with the ability to walk on water. On the other hand, we’re taught that we can’t handle anything but musculoskeletal problems and that we should refer out to the “real doctors” for everything else. They don’t actually come out and say “real doctors” but we all get that message anyway.
As a result of this dichotomy, we graduate with a schizophrenic outlook – a semi-entitlement to prosperity (after all, we are indeed doctors!) and an equal and opposite under-confidence that leads to a good old-fashioned poverty complex.
Some of us become frustrated with ourselves and our prospective (or even existing) patients, knowing on one hand that our office visits deliver much more than a conventional medical visit and at a fraction of the cost, and yet attempting to communicate that value to the public. Some of us come to resent a public who won’t even pay our paltry fees for our physically-intensive care.
So when I set my rates for my lifestyle counseling (Functional Medicine) services, I set them on the low end, just under my ideal threshold. I wanted there to be no question or doubt – I wanted to be confident in my fees and I wanted to convey that they were indeed truly a good deal. And you know what else? I’ll even throw in the offer to email me any time and I’ll answer short emails for free.
After a year of doing that, I can say unequivocally: don’t ever do that.
Short questions often require long explanations. This lengthens the email, as well as the time it takes to write them. Now instead of taking your entire evening or weekend for yourself and relaxing after work, you get to spend your downtime doing MORE work. It’s almost as if you never left the office. After a while, you’re living the nightmare you hoped would never happen: your life calling, your life purpose Stops Being Fun.
I understand that my practice typically attracts people who don’t feel well and who have a lot of questions. I do welcome those people, those cases, and those questions. However, I let it get out of hand. I didn’t set any other limits or boundaries, so the only limitations on the amount of care I provided were set by how many hours (or minutes) had elapsed since I last checked my email.
Eventually, I specified that I’ll answer emails about a current treatment plan. Well, it didn’t stay that way; people started having questions about later as well. Or their daughter. Or their mother. Or a friend at church. “[Relative/friend] has [x, y, and z] symptoms. Do you think that might be the same [food allergy/low thyroid/etc] thing I have?”
Then my epiphany came, in a small wave of minor events:
I had been helping Patient A through one mini-crisis after another and after having to make a particularly drastic change to his/her plan that required some pharmaceutical intervention, we would need to backtrack a little to deal with recovering from the side effects of the medication. Patient A asked (to paraphrase), “do I have to make an appointment or can you explain it to me when I pick up the supplies I’ll need for the protocol?”
I fought every urge to say, “are you kidding?” This is a patient who has benefited from literally dozens of hours of clarification, hand-holding, and advice via email at zero charge. This is someone on whose behalf I have done countless hours of research and put forth much effort. This is someone for whom I have spent additional time behind the scenes constructing customized protocols.
I don’t expect the patient to care, as it was my decision to do this (some of which just comes with the territory) and it’s not their problem. However, the public should realize (to a certain extent) that doctors of all types put forth a hell of a lot of effort, expense, and energy to go through school, sometimes even sacrificing their own health, family, and sanity in the process. They do so with the end goal in mind: helping people and living a comfortable lifestyle off the fruits of their labor. It’s the ultimate in delayed gratification: live like no one else now so that you can live like no one else later.
If all I have to sell are my time and information, then yes…. you MUST make (and pay for) the appointment. Especially if I’m about to give out NEW information (and not just support for an existing protocol, as I had specified before). It also helps to mention that this particular patient has always had lots and lots of questions, so I know that to agree to give the information on the fly to this particular person wouldn’t last just 5 minutes – it would be more like 30 minutes…which is definitely worth a paid appointment.
This was an eye-opener, though – it definitely let me know that my time and expertise had been devalued, and that had been of my own (accidental) doing.
Patient B keeps his/her emails short and to the point, but the questions asked have already been answered on handouts I’ve given out. Either the patient hasn’t read through them, or they’ve left them at home when leaving town, or what-have-you. Or, they fail to exercise common sense. “It says I can’t have corn, but could I have organic corn tortillas?” No. “I know I can’t have potatoes, but what about potato chips?” No. Read the info sheet and avoid ALL derivatives of that food. No soy means no soy milk either, even if it’s organic. No wheat means no wheat germ, either. No eggs also means no bread, if the bread was made with eggs. Again, I’m happy to clarify, but it does help to filter out common-sense logic before saddling the doctor with emails.
Patient C complains that they cannot come up with food ideas. I understand that going on restricted diets and cleanses isn’t the most interesting or fun. Comfort foods often have to go by the wayside, a rule that may have to become permanent. It’s less convenient. It’s less familiar. It requires expanding horizons, stepping out of comfort zones, breaking habits and routines, doing some research, field trips to unfamiliar places such as health food stores or ethnic grocery stores, fact-finding grocery missions, learning to work the bulk section system, joining a co-op, finding a local butcher, ordering online, etc. It requires more imagination, experimentation, preparation, and home cooking. You can’t swing by McDonald’s anymore. However, it’s a little frustrating for me when I take the time (at no charge) to run the same internet search that I suggested they run, and copy-paste a half-dozen approved links into an email, offer some further explanation (“sometimes you might have to substitute some ingredients; here are some substitution ideas…”), only to get the same “I’m still having lots of trouble figuring out what to eat” a week later.
Fourth event that led to my epiphany: I took a recent trip out of town. It was short and uneventful, but I remember thinking how I could really use even a couple-day break and that it might allow me to get a fresh new outlook come my first day back to the office. Imagine my sense of impending doom when the day before, I wasn’t super excited to get back to the office. I had *always* looked forward to getting back to the office and jumping right in again. This time, I was lukewarm about it, if that. Not a good sign. I thought back to the time off and realized that I was off the hook for checking email. Everyone knew I’d be gone, with little (if any) email or phone access. And everyone survived. And I remembered how carefree and de-stressed I felt. And I started to wish that EVERY weekend or vacation could be like that. I realized then that I give too much with too little reward. And now, given the situation with Patient A, I wasn’t even being appreciated for it.
So, unfortunately, I have reached a crossroads: burn out and start resenting people, or reel the situation in and at least insist on paid appointments to handle anything but the simplest yes-no question, and getting to retain my health and sanity, even if it means ticking some people off. Yes, I wanted to be that doctor that no one else is, but I need to be able to KEEP being that doctor without risking admission into an asylum or hospital. I never want to dread coming to work.
It’s not that I want to hide behind a fortress, or to be distant and stuffy. I do, however, have to stop this out-of-control situation, start setting professional boundaries on my time and services, and start asking for a compensation structure that’s much fairer to both parties. Believe it or not, this means even greater benefit to the patient. People respect and value what they have to pay for. The more people value my services, the more likely they are to follow through, and the more improvement and success they’re likely to see.