My Soap Box:

Most people who go into medicine do it because they want to help people. But the system they work inside of now doesn’t reward curiosity.

It rewards speed.

Fifteen-minute appointments.

Clicking boxes.

Templates.

Billing codes.

Documentation that somehow matters more than eye contact.

Complex illness is inconvenient. It doesn’t behave nicely inside algorithmic medicine. It doesn’t wrap itself up neatly in a single visit. It requires time — time to listen, time to think, time to connect dots that aren’t sitting politely next to each other.

Time, unfortunately, is the one thing the system punishes. A lot of providers “bonuses” rely on how many patients they can see in a day. So multiple symptoms = money/time lost. Complicated patient = money/time lost.

It is sad, but it is true. Modern medicine is built around numbers. It is a business. Myself, as a provider, refuse to ever let that be a factor in my practice. Quality  will always be greater than quantity. It gets me in trouble, but the whole reason I got into medicine was to help. Not hurt.

Human bodies do not follow spreadsheets.

And unfortunately, as a patient who experienced this – you can feel the pressure from the provider. You can tell they want to get out of the room as quickly as possible. So you start preparing for appointments like you’re presenting a legal case. You rehearse your timeline so you don’t waste the fifteen minutes. You bring lab results like exhibits. You try very hard not to cry, because crying makes you look anxious, and anxiety gets coded.

You slowly realize you’re auditioning for your own diagnosis which sickens me. In so many ways.

And if you are too complicated, you start to sense something uncomfortable: you are a problem. You convince yourself you are the problem. Which could not be further from the truth.

The problem is the quiet business logic operating behind the scenes of healthcare. Administrators track productivity. Clinics track volume. Physicians are evaluated by how many patients they see, how many procedures they perform, how efficiently they move through the day.

Surgeries, biopsies, hi and bye cookie cutter appointments pay. A long conversation where a doctor sits and thinks with you? The pay is not nearly as much.

No one says this out loud in the exam room. But you feel it in the pacing.

You feel it when the provider glances at the clock.

When follow-ups get scheduled months out even though your symptoms are escalating.

When you get referred to another specialist… who then refers you to another… who then refers you back to someone else.

Each handoff fragments your story.

Each new appointment resets the clock.

Each specialist sees their slice of the puzzle: rheumatology sees antibodies, oncology sees imaging, neurology sees nerve signals. Rarely does anyone get the luxury of sitting long enough to see the entire ecosystem that is you.

So you start questioning yourself.

Maybe it’s stress.

Maybe you’re exaggerating.

Maybe your body isn’t failing… maybe you are.

Medical gaslighting rarely happens because someone wakes up intending to dismiss a patient. More often it happens because uncertainty collides with time pressure. Because insurance companies require objective findings before approving tests. Because documentation must justify every order.

If your disease is subtle instead of dramatic, you end up living in the gray zone.

And gray zones do not run efficiently on business models.

The psychological toll isn’t just fear of illness. It’s the slow erosion of trust. The realization that the system meant to protect health is also governed by spreadsheets, contracts, and cost analyses.

You don’t resent individual physicians. Actually, sometimes, I do.  But you resent the machine that compresses their humanity. The machine that teaches them to optimize rather than investigate. The machine that treats complexity like a scheduling problem.

Meanwhile, you wake up every day in a body that feels foreign. You wonder whether symptoms will spike today. You Google things at two in the morning you probably shouldn’t Google. You quietly worry that the window for catching something early might be closing while you’re being told to “watch and wait.”

Watch and wait is medically reasonable in many situations.

Emotionally, it feels like standing on train tracks listening for something you can’t see yet.

There’s also the practical side. Multiple specialists. Imaging. Labs that insurance only half covers. Time away from work. The exhausting, invisible labor of being sick in a society that equates productivity with worth.

If you look fine, people assume you are.

Chronic, complicated illness is isolating because it is often invisible right up until it becomes catastrophic.

The tragedy isn’t that healthcare involves money. That is part of it but systems need resources to function.

The tragedy is when financial incentives quietly shape care in ways that disadvantage the patients who are hardest to diagnose.

If your illness is straightforward, the system works beautifully.

If it isn’t, you fall into a gap between billing categories.

And that creates a strange psychological burden.

You feel sick.

You feel unheard.

You feel expensive.

You feel like a problem.

Over time, something inside you shrinks. You stop asking as many questions. You hesitate before scheduling another appointment. You worry you’re being labeled difficult.

But there is nothing difficult about wanting your life back.

The deepest wound may not even be physical. It may be the realization that you’re navigating not just disease, but an industry.

Healthcare in many places now runs less like a sanctuary and more like a marketplace. Systems merge. Clinics compete. Administrators talk about growth projections.

Margins matter.

And somewhere inside all of that, there you are — a person whose life has been interrupted by something confusing and frightening.

Your symptoms are real.

The exhaustion is real.

Your fear is real.

What complicated illness requires is slower medicine. Thoughtful medicine. Systems that allow clinicians to investigate without being punished for taking time.

It requires humanity over throughput.

Until that happens, patients with complex or ambiguous illness will carry two battles: fighting whatever is happening inside their bodies while also navigating a system that often requires proof before compassion.

And proof, in medicine, is expensive.

So you wait.

You research.

You advocate.

You push gently at first… and then a little harder.

You try not to burn bridges, because you still need help from the people on the other side of them.

And underneath everything is a quiet hope that someone in the machinery will slow down long enough to actually see you. Not as a billing code. Not as a productivity unit. Not as a complicated case. But as a human being whose life has been abruptly derailed by something that deserves attention.

And my hope now is that medicine remembers why it exists because I’m fairly certain the Hippocratic Oath did not include a section about productivity metrics. Medicine was never supposed to be a business model — disease has never given two shits about the quarterly earnings report.