What's Your Doctor Like? On Burnout, Distance, and a Better Way

What's your doctor like?

When I talk to people about their doctors, I get every kind of story. Some really liked theirs — or did, until that doctor "left." Quit the job, moved to another clinic, maybe left medicine altogether. Those patients approach finding the next doctor with extreme caution, and they were guarded in the exam room where I first met them as that new, unproven face.

Others are in my office precisely because their last doctor was "terrible" — didn't listen, seemed to have an agenda, or came up short on the very things the patient wanted to discuss. Same trepidation. Meeting a new doctor makes people nervous. They're cautious, reluctant to give too much, still feeling the sting of the last time they opened up to a physician — and determined not to feel that rejection again.

Nobody's There on a Good Day

When you're at the doctor's office, it's rarely because things are going well. More often than not I was seeing someone at the end of their rope: an injury, a long-standing undiagnosed discomfort, a food intolerance, fatigue, something they'd been puzzling over.

Just as often, I'd see people who told me they didn't know why they were there — no problems, but they'd gotten a note from their insurer saying they had to come in, or a wild lab result had shown up, or the pharmacy wouldn't refill their medication until they were seen. The easiest visits were the physicals with no concerns. The hardest were the "syndromes."

Chronic pain syndrome. Irritable bowel syndrome. Postural orthostatic tachycardia syndrome. In medical school I learned that the word "syndrome" denotes a mystery — a collection of loosely related symptoms with no definitive cause and wildly varying responses to treatment. Some treatments work fine for some people; others get no relief from anything.

These patients would arrive having been burned by a cavalcade of physicians who'd failed to help them, who rarely took a collaborative approach and instead positioned themselves as authorities. This is the shadow of the doctor-that-was: the stern taskmaster, the "I know better than you, you have to listen to me" figure — algorithm-driven, treating patients like a number instead of a name, ready to say "I told you so" when a plan is ignored and things go wrong.

Almost No One Is In It for the Money

I didn't meet anyone in med school who was in it for the money.

There were people who seemed destined for fields with less patient contact — I knew a guy shadowing a primary care doc at a federally qualified health center serving the underserved. One day, after a well-child physical, he asked what was next. Another well-child exam, she told him. "Another one?!" he said, exasperated. (He's a talented anesthesiologist now, and barely has to talk to a patient again:)

Overwhelmingly, the motivation for a career in medicine is service. If it isn't, it's very hard to get through. Medicine is a mountain of work with a badly delayed reward: four years of college, four years of med school, then a minimum of three years of residency — during which you're paid 20–25% of what a practicing doctor makes while working two to three times the hours. It is not for the faint of heart.

So Where Does It Sour?

When do doctors stop listening and start snapping?

I think the desensitization sets in as the workload intensifies. The transformation from citizen to clinician is thorough and complete — and it takes a lot with it. Cadaver labs toughen you up; dissecting a human body paradoxically thickens your skin. Long hours studying pathology with your peers breed a unique social bond and some remarkable inside jokes built from very long words.

Sometimes I thought of med school as a language lesson. We were learning a whole new vocabulary that separated us from everyone else — and a huge part of training is spent reminding us not to alienate patients with the big words. Don't say "intracranial," say "inside the head." About three months in, I realized I understood what they were saying on the TV show House. It felt like joining a club. And joining a club builds community through shared experience — but it also builds a wall between the job and those we serve.

Residency accelerates all of it. Since 2003, U.S. residency programs have been required to cap resident hours at 80 per week, averaged over four weeks — and even in the first year of that rule, 43% of interns reported violating it. Those hours take your sleep, and the act of caring for others gets transmuted into a series of repetitive side-quests. The goal is repetition and exposure, and it does catalyze a real metamorphosis — but the price is desensitization. The mind reaches for humor, camaraderie, and distance as defense mechanisms against the task list you wake up to every day.

The System Makes It Worse

Empathy suffers further in fee-for-service medicine, where everything you learned about caring for patients becomes impractical in a system that values volume over the individual. And it almost has to: the machinery that serves most of our population would go financially insolvent without that eye toward volume.

So the things we can't fix take a backseat to the things we can. We get protocol-driven approaches to the most common problems in the sickest patients — and no time for the syndromes. When you see 20 people a day with five to seven minutes each, true listening goes out the window. Not because doctors are bad people, but because they need boundaries to survive the schedule and still go home to their families.

There's a cute name for the work doctors do after dinner, while their spouses put the kids to bed — laptop open, grinding through unfinished charts and the day's flood of patient messages. They call it "pajama time." It's worse than it sounds: a necessary feature of a system that doesn't value a physician's ability to put work away and be present for their own life. How else could that show up in the room of a puzzling patient, except as reflected disregard for the problems we can't solve?

When a Doctor Doesn't Know

And this is the heart of it: when a doctor doesn't know something, there's no time to learn about it.

We all have continuing-education requirements to keep our licenses, and that's a sliver of opportunity — but we're still confined by the biases of our industry. Our practice is built overwhelmingly on male-centric research, on the assumption that the male body is a neutral default. Women were long deemed "too unpredictable" — despite the menstrual cycle being extremely predictable — and even today women make up only about 40% of participants even in trials for diseases that disproportionately affect them. Preclinical science leans the same way: in 2021, more than 80% of preclinical drug-safety studies used only male animals. Those biases carry straight into our continuing education. And when something arises to challenge them, the response is always the same: the argument's too flimsy, the evidence doesn't exist.

So now there's a feud between functional and conventional medicine. Functional doctors say conventional doctors don't do enough; conventional doctors call functional doctors "quacks" in Reddit forums. And we drive another wedge into any transparency our patients might have had — while they, frustrated, turn away from the growing number of us who can't relate to them and go looking for answers on TikTok. Which frustrates everyone even more.

Clinicians sometimes need reminding that it's okay not to know something. Lack of knowledge about one thing is not a lack of expertise about everything. Medicine is a field of lifelong learning with giant gaps in its own foundational knowledge. The doctors a hundred years from now will look back at us the way we look at leeches and the balancing of humours.

Why Direct Primary Care Has Been a Blessing

All of this is to say: the structure of Direct Primary Care has been a gift.

I'm working through a certification with the Menopause Society. I'm taking gut-biome and hormone-replacement courses with the Academy for Anti-Aging Medicine. I'm learning from colleagues who've built their own singular practices through organizations like the Direct Primary Care Alliance. And most importantly, I've built a practice that gives my patients 30, 60, or 90 minutes face-to-face to actually discuss their symptoms, their syndromes, and their concerns.

I build patient education right into the visit — sharing what I know about physiology so people can truly collaborate on their care from an informed place. That shouldn't be the exception. It should be the rule. And as this movement grows, I'm genuinely excited to share the practice.

So — what's your doctor like? If the honest answer is "I'm not sure they really know me," there's another way.

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