We have all heard about trying to get the “monkey off your back”. It is used in sports a lot as an overdone cliché when a guy can’t win a championship. In medicine, we need to investigate this phrase a little more closely because it has an important meaning. The “monkeys” I am talking about with patients are actually issues or problems. Patients come into our office with them all the time. They don’t have just one of them either. Many times they have a barrel of monkeys and they want the physician to take them. Here is a word of advice: do no become their zookeeper.
You may not always see these monkeys because when a patient arrives, he or she has the monkeys well hidden. Other patients in the waiting room hardly notice. The front staff is usually oblivious of them. Your nurse, however, usually gets a whiff of them. She senses that there are monkeys about. By the time you enter the room, however, the monkeys are all over the place and you realize that the place is a menagerie. What is sad and amazing is that these patients live with these monkeys all the time. They feed them. They take care of them. Now, since you are the doctor, they want to get rid of them and hand them over you. Don’t take them.
It starts with a list. Complaints of dizziness, fatigue, or headaches are just little monkeys that got the patient to come in. Pretty soon the big monkeys come out. You may know them as depression, situational anxiety, fibromyalgia, or polysubstance abuse. There are a lot more monkeys I could name but does it really make a difference. You get the point. For some reason the patient thinks that you deserve their monkeys since they don’t want to take care of them anymore. They are tired of it. Their monkeys weigh them down and since they don’t want to deal with the issues themselves they are kind enough to let you do it.
I want to be the first to say that I got enough monkeys of my own. I’ll admit it and also go on to say that I sure as heck don’t need any more. It took me awhile in private practice to realize that each time I left a patient’s room I had one, two or three monkeys on my back. The patients would say things like, “I want you to get me to quit smoking” or “I am overweight and I want YOU to address that”. Other bombshells of relationship problems, run-ins with the law or problems with money got laid on my back. These monkeys were all over me by the end of the day. I was becoming the Quasimodo of Medicine. Sure the patient felt better but I was burning out feeding all the monkeys they left with me.
My answer to this quandary is to turn the tables on the patients. You must make them take responsibility for their own monkeys. They have to kill the damn things before they make a mess everywhere. Give them assignments to fulfill. Make them jump productive hurdles that will get them to the right place and without a monkey in sight. They need to show some accountability to you because the next time they come in you will ask them if they followed through. If they say no, then you spend your time putting those monkeys back on their shoulders and you walk out monkey-free. That is how you survive. They either get rid of their own monkeys (or at least show some effort trying to) or they keep them home. In other words, just like at the zoo, don’t feed the animals!