This is a highly encapsulated but accurate portrayal of the emotional weight of the conversation and the tension between a physician’s personal challenges and the desire to heal, both for themselves and their patients.
Patient/Physician (P): I’m an old blues man, and I think you understand I’ve been singing the blues ever since the world began.
Psychiatrist (Me): I hear you. That timeless blues spirit runs deep, carrying the weight of lived experience and heartache. It’s like a rhythm that never fades, just keeps echoing through every generation. What’s got you singing the blues today?
P: Medicine has devolved into a shit show.
Me: I feel that frustration. Medicine has become so entangled in bureaucracy, profit-driven motives, and administrative burdens that it’s easy to lose sight of patient care. It’s a system where compassion and time are often sacrificed for metrics and margins. What aspects of it feel like the biggest failures to you right now?
P: I don’t know where to begin. I just feel so let down by the system. It doesn’t work for the benefit of patients or providers.
Me: It’s a betrayal, really, when the system that’s supposed to heal becomes one that harms—not only patients but those who’ve dedicated their lives to care for them. When the focus shifts to profits, efficiency, and control, the humanity of medicine fades. Providers are overworked, patients are rushed, and no one feels heard or cared for. What do you think could turn it around? Or at least soften the sharp edges?
P: Honestly, I think it’s hopeless. Maybe put more doctors in control of the decisions. Take the administrators and politicians out of the exam room.
Me: That would be a real step in the right direction—letting the people who actually understand patient care, the doctors, guide the system. The problem is that medicine has become too corporate, with too many non-medical folks pulling the strings, turning health care into a commodity. When business decisions overshadow clinical judgment, it’s the patients and providers who suffer. It’s easy to feel hopeless when it feels like no one’s steering the ship with compassion. Do you think there’s any way doctors can reclaim some of that control, or is it too far gone?
P: Well, I mentioned that I’m an old blues man. I actually came of age during the era of rock and roll, and your comment that medicine may be “too far gone” reminds me of the Eagles song “Already Gone.” I suppose that’s my answer, that in my mind, I’ve already left it behind. But I don’t know what my next step will be. It frightens me, and departing my very sick patients makes me feel guilty.
Me: That makes a lot of sense. Letting go is tough when you’ve poured so much of yourself into your work, especially when people’s lives and well-being are involved. But it sounds like you’ve given so much already, and the toll this broken system has taken on you is real. “Already Gone” fits the feeling—of knowing it’s time to move on, but not without some heartache. Maybe it’s not about abandoning your patients, but finding a different way to support them or channel your experience. The path ahead might not be clear yet, but there’s still so much you can do, even outside the system. How do you think you might continue to make a difference?
P: Again, your choice of words is uncanny. The Eagles also sang “Heartache Tonight,” a romp about getting hurt by staying in a toxic relationship—I’m married to medicine. But to answer your question, I definitely still feel passionate about the medical field, and I would like to make a contribution, to continue to impact patient care, even if it’s through indirect means. Do you have any suggestions?
Me: I’m glad to hear that passion for medicine is still alive in you—it can be channeled in ways that bring fulfillment without being caught up in the mess of the system. Here are a few ideas on how you could make an impact indirectly:
- Teaching and mentorship: Sharing your knowledge with younger physicians or medical students could shape the next generation of compassionate, patient-centered doctors. You can pass on the values you feel the system is missing.
- Writing and advocacy: Judging by your publications, you’re a capable writer. Maybe you could become a voice for change through writing or public speaking, shedding light on systemic issues while advocating for reforms that prioritize patient care.
- Volunteering: There are many opportunities to use your expertise in non-profit organizations, free clinics, or community health initiatives that don’t have the same bureaucratic weight as hospitals and large systems.
- Consulting: Your experience could be invaluable in advising health care organizations or startups on how to create patient-centered systems or improve current practices.
- Telemedicine or specialty care: You might still be able to see patients in a more controlled, flexible environment through telemedicine or by offering second opinions or specialty consultations that don’t involve the same administrative burden.
Do any of these resonate with where you’re at?
P: Actually, all of these options are appealing. I just don’t know how to get started. Also, I’ve been thinking about working as a locum tenens physician. I’ve read positive stories about this type of work.
Me: It’s great that all those options resonate with you—it shows that you’ve got a lot of potential paths forward. Locum tenens work could be a solid bridge, too, giving you the chance to continue practicing while having more control over your schedule and environment. To get started with each of these options, here’s a breakdown:
- Locum tenens: There are several agencies that specialize in locum tenens placements. You could start by researching reputable agencies to find a good fit. Many of them offer flexible opportunities that might allow you to explore other interests alongside practicing medicine. Talk to other physicians who have worked locum tenens to get their perspective and advice.
- Teaching/mentorship: Reach out to medical schools, residency programs, or even online platforms like Coursera or MedEd platforms where you could contribute as a lecturer or mentor. Consider joining professional organizations that have mentorship programs, or look for conferences that offer opportunities to teach workshops.
- Writing/advocacy: Perhaps starting a blog or contributing op-eds to medical journals or mainstream publications could be the next step. Advocacy groups often look for people with your kind of experience to help frame important issues. Joining professional networks or organizations that focus on health care reform or patient advocacy could give you a platform to push for change.
- Volunteering: Look into organizations like Doctors Without Borders, local free clinics, or national medical outreach programs. Many allow for short-term or flexible commitments that align with your skills and experience.
- Consulting: You could begin by offering pro bono advice to health care startups or non-profits, then build your reputation and expand your network. Platforms like LinkedIn are great for showcasing your expertise and connecting with companies in need of medical insight.
Locum tenens could also give you time to explore these indirect paths without fully committing to one right away.
P: That sounds great. Thanks for your advice. Same time next week?
Me: Why? There’s no point in crying the blues anymore!
Arthur Lazarus is a former Doximity Fellow, a member of the editorial board of the American Association for Physician Leadership, and an adjunct professor of psychiatry at the Lewis Katz School of Medicine at Temple University in Philadelphia, PA. He is the author of several books on narrative medicine, including Medicine on Fire: A Narrative Travelogue and Story Treasures: Medical Essays and Insights in the Narrative Tradition.
