A "Medical Service Provider"
As I sat in my orthopedist’s exam room, the discussion quickly turned from my chief complaint to his: “I don’t know why I’m doing this anymore,” he said. “Medicine is just not what it used to be, and I don’t enjoy my work anymore. The bureaucracy and regulations are bad enough, but what really gets me is the hostility. My patients are chronically angry and mean. The only comfort I get is from talking to other doctors. Because they all feel the same way.”
Perhaps this sentiment strikes you as the spoiled musings of a physician who is lamenting his demotion from “god” to “man” – reflecting the fundamental change in the public perception of doctors that has occurred over the past ~50 years. Or maybe you wonder if this surgeon’s patients are mean because he is a bad doctor, or isn’t respectful of their time? Maybe he deserves the hostility?
I’ve found this particular surgeon to be humble, thoughtful, and thorough. He is genuinely caring and a proponent of conservative measures, truly eager to avoid surgical procedures when possible. He is exactly what one would hope for in a physician, and yet he is utterly demoralized. Not because of the hours of daily documentation drudgery required by health insurance and government regulators, but because the very souls he has been fighting to serve have now turned on him. Their attitudes are captured in social media feeds on every major health outlet:
Doctors? I no longer afford that kind of respect: I call them “medical services providers.” They and their families and the medical cabal created this mess when they got control of med schools so that the wealth of a nation would remain in the hands of a few medical elites and their families. The very notion that doctors are smarter, more productive, more anything than others is ludicrous. They are among the worst sluff-offs of our society, yet the richest at the same time. It is an unreal world they have created themselves and they are now watching the natural outcome of such a false system.
The very best physicians have always been motivated primarily by the satisfaction of making a difference in their patients’ lives. That drive to “help others” is what makes us believe that all the sacrifices are worth it – the years of training, the educational debt, the lack of sleep, the separation from family, the delay (and sometimes denial) of becoming a parent, the daily grind of administrative burden, the unspeakable emotional toll that death and disease take on your heart… All of that is offset by the joy of changing and saving lives. But when that joy is taken from you, what remains is despondency and burn out.
What patients need to realize is that they have been (and still are) the primary motivator of physician job satisfaction. Patients have the power to demoralize us like no one else – and they need to take that power very seriously. Because if negative attitudes prevail, and hostility spreads like a cancer in our broken system, the most caring among us will be the first to withdraw.
And in the end all that will be left is “medical service providers.”
How could it have happened?
He was strong; do you remember how he could get uphill? He was fit; can you ever recall seeing him out of shape? His blood pressure was perfect, low even. He bragged about his exemplary cholesterol levels.
He was lean and mean.
Wait a minute…what was that about being mean?
When an endurance athlete in middle age is felled by a sudden heart attack, these questions always arise. It’s mysterious, as the idea holds that exercise and fitness should inoculate one from heart disease. But it does not.
There is more to the story of heart attacks than just the big five: genetics, smoking, high blood pressure, diabetes and cholesterol. Read more »
*This blog post was originally published at Dr John M*
The voice at the other end of the line was angry and accusatory: “You didn’t even talk to me! You never knew my son! You didn’t talk to any of us!”
I explained to her that since she had never even met the defendant, there was no way she could have any information that would be relevant to the accused’s state of mind at the time of the crime. The victim and the defendant were total strangers and there was no apparent reason for the killing, which made the crime even more tragic. Her son was dead in a random incident, in a crime that was unquestionably motivated only by the defendant’s untreated psychiatric symptoms.
The defendant’s family was equally shocked and horrified. They were all hardworking solid citizens, with no history of criminal contacts, substance abuse or mental illness. When their daughter started getting sick Read more »
*This blog post was originally published at Shrink Rap*
“This job is killing me” is not a statement of jest. It is a desperate plea of outright sincerity.
Stress, anxiety, depression — all have been associated with an increased risk of cardiovascular disease and mortality. But can interventions to help people cope with stress positively affect longevity and decrease risk of dying? The results of a new study in the Archives of Internal Medicine would imply the answer is an encouraging “yes.”
Constructively dealing with stress is easier said than done, but it would seem logical that if we can reduce our psychological and social stressors we might live longer and delay the inevitable wear and tear on our vessels. This study proved that one such intervention, cognitive behavioral therapy (CBT) for patients who suffered a first heart attack, lowered the risk of fatal and nonfatal recurrent cardiovascular disease events by 41 percent over eight years. Nonfatal heart attacks were almost cut in half. Excitement may be dampened by the fact that all-cause mortality did not statistically differ between the intervention and control groups, but did trend towards an improvement in the eight years of follow up.
Definitely less suffering. Maybe less deaths.
The authors state that psychosocial stressors have been shown to account for an astounding 30 percent of the attributable risk of having a heart attack. Chronic stressors include low socioeconomic status, low social support, marital problems, and work distress. Emotional factors also correlated with cardiovascular disease include major depression, hostility, anger, and anxiety. Read more »
*This blog post was originally published at The Examining Room of Dr. Charles*
When we physicians don’t get our way, or don’t get the response we desire, we can be intimidating. I have seen this play out many different ways. I have been treated rudely by other physicians. I was once threatened by a very prominent one, who told me (in response to the fact that I dared question his tone): “Be careful son, you’re digging yourself a deep hole.” I don’t know what kind of hole, or where it would have taken me, but he was certain I was digging it. Oddly enough, I rather like digging holes. (Very zen.)
Physicians yell at one another, or curse. Physicians stomp around and slam down charts. I don’t like it at all. I think it suggests immaturity. I always tell students and residents that in the ER, especially, the physician is “Captain of the Ship,” and the Captain must never lose his or her cool.
But physicians, sadly, do the same to non-physicians. Nurses, in particular, earn their ire as they scream, curse, stomp and engage in all sorts of negative behaviors. It also happens to paramedics, unit secretaries, dietary workers, therapists, administrators and all manner of persons. Read more »
*This blog post was originally published at edwinleap.com*