I just finished my 4.5 month contract with a family health center as a primary care nurse practitioner. Working in primary care, as always, is extremely rewarding…and painful. I can’t deny those facts. For the second time in the last year, I have had the opportunity to assist in being the primary provider in opening a brand new clinic and it is rewarding.
In the typical fashion, I saw the entire range of primary care patients, and I am touched to have had the opportunity to play a role in people’s lives. Being a primary care nurse practitioner is a special role to have, indeed, but it is very difficult for me to maintain, particularly because of the level of empathy that is demanded day in and day out in an environment that requires quick thinking and little time to decompress and process my own emotional reactions between patients.
I decided a few weeks ago that I would create a list of the types of complaints and conditions that I have diagnosed and treated while in this position. The list grew so quickly from broken bones, to serious mental illness, women’s health problems, breast cancer, diabetes, strokes, pneumonia, whooping cough, sexually transmitted infections, child abuse, addictions, and more. I also helped prevent a number of unintended pregnancies, assisted some in adoptions, and some in preventing heart disease, diabetes and cancer. As the list grew, it gave me a great deal of satisfaction in knowing that I made a dent in the world’s problems. But when I really think about it, it makes a dent in me as well.
This work is so hard. So hard that I have a great deal of difficulty explaining it. It’s hard to describe to onlookers about why it becomes difficult to love this work that can help people so much. In fact, one person who I was talking about this with responded, “At least you are in a job where you are helping people.” Yes, that’s an excellent guilt trip, but after a couple years thinking about it, trying to reconcile it, this hasn’t changed the fact that it still dents me.
I know why though. It is personally disappointing to me when my brain enters into this level of deep thinking and processing, constantly putting new pieces of puzzles together, without the opportunity for down time to process my own emotional reactions to what I’ve just witnessed. It’s hard to tell someone they probably have cancer, or difficult to counsel a parent who is putting their child in danger and that you will be contacting CPS, then walk out of the room, and immediately enter the next room with a clear fresh mind to talk about the next patient’s problems. It’s hard. Because I’m human. And they are human. And I care. And they care.
I think to be good at this job, a person has to care. When providers lose their ability to empathize, that’s when they’ve become too stressed, too overwhelmed, with all the things that are thrown at them by the system, and they have a crisis of their own because they feel no one cares about them. When a provider feels uncared for by the administration that they are working with, they lose their ability to care for the patients they encounter within that practice. Patients experience this as a provider responding abruptly, or rudely, to their complaint or problem. But no patient deserves this because they are human (1) and because they pay a lot of money (2) and should be treated kindly and thanked for paying that amount of money.
Primary care in the USA is in crisis for these reasons and also because the demand is so high. Primary care providers are among the lowest paid health care professionals, especially nurse practitioners! This means provider retention is a big problem. This is exactly the reason why patients are currently struggling to find a primary care provider who will take care of them throughout the ensuing years.
The dismantling of the Affordable Care Act (ACA) will only deepen this problem because patient needs don’t cease to exist just because they lack insurance, which is what repeal of the ACA threatens. I know, because I worked in primary care before the ACA, and, well, it only added another layer of stress to the primary care provider who knew what the recommended treatment was, but, now, was restricted by the patient’s ability to pay for it in order to provide it.