5.23.2007

A Doctor's Value

Imagine this: As a junior college student, you decide "I want to help people, I think I'll be a doctor." You study hard, go into tons of debt, and sacrifice lots of life luxuries...and for "privilege" of being someone's doctor. You choose ER, because you really want to make a difference. A County ER, because that where people *really* need help.

As a medical student you notice how evil the residents seem. They call their patients "rocks" if they have extended hospital stays. They have acronyms for people, like LOL in NAD, (little old lady in no apparent distress), or CTD (circling the drain - when someone is dying). And those are the nice ones - some are
much worse.

You think "how can these docs be so jaded...so mean?" Then you see a hard working resident, sacrifice his marriage, his relationships, work 36 hours w/o food, nor sleep, working for less money per hour than poverty wages...to be shown no appreciation by his patients, his program, his hospital, nor his society."

A common response is: "well, no one forced Dr. Hardworking Resident to be a doctor? He knew what he was getting into, besides he'll make tons of money when he's out"

To that I say: There are lots of things that are...wrong in this world. And, the solution isn't "well, that's just the way it is." That may, in fact, be the way it is, but you work towards change. Medicine is no different. The process of becoming a doctor is flawed. The cost is outrageous (on multiple levels). The work hours are insane. And the sacrifice huge. Still male dominated, and by in large, female/family unfriendly. And the lifestyle, not what most people imagine. Yes, there are some good things (lots of good things) about being a doctor (I'll get to those another day)...but that doesn't eliminate the bad.

So when a surgeon complains that "the hours are too long," we should listen. Afterall, one day, you just might need a surgeon....and one that's well rested is better than one that's running on 20 minutes of sleep over the last 36 hours. It's not appropriate to say "well, you chose surgery...you knew what you were getting in to." That's like telling the police officers asking for bullet proof vests to "suck it up...you knew you'd be getting shot at, and that death is a possibility." Just because there are problems, doesn't mean that those who have the courage to speak out for positive change should be silenced, and told to "suck it up, deal with it."


Somehow doctors are expected to be...martyrs of sorts. I wonder why? Is it because society holds doctors in such high esteem? (the rate of frivolous malpractice lawsuits show that that's not the case). Is it because society helps subsidize the doctor's medical education, and therefore has a financial interest in doctors and their training? (Oh wait, they don't, actually, so that can't be the case). Is it because the doctor and his/her family are "taken care of" in *their* time of need, like the village witch-doctors of civilizations past? (Not counting on that). [hand raised high over my head, waving back and forth] I know, it's because doctors make tons of money, and people who make tons of money are held to a higher standard? (Well, 80-200,000K year is hardly a "ton"...and along this line of logic, where's society's accountability of Trump, Gates,
insurance company CEOs, Enron's CEO, Delta's CEO...and so forth and so on).

Maybe in the end, it's because there's something "inside of us" that makes us superior, ethically...??? But if that were true, doctors would have more say-so over the direction of health care, and wouldn't be undermined by everyone on the healthcare team (i.e non-physicians)...because, afterall, they'd be innately ethically superior.

***
But, as it is, everyone wears a white coat, pretending to be "doctor." (Because in polite society it's not nice to
hurt people's feelings by telling them that there may be someone else that's more valuable to the organization than they are. God forbid we call a secretary, a secretary). The doctors have allowed themselves to be side-lined (and marginalized) by this "healthcare team theory," instead of upholding the coveted 'doctor-patient relationship'. The doctors don't have a strong voice in matters pertaining to healthcare, since the AMA, CMA, and other professional organizations just sit on their asses, so it's no surprise that the non-physician, self-promoting organizations, have (almost) successfully sold this "healthcare team model" to society.

The only problem is...patients still want to see *the doctor*. Patients still *want* that sacred doctor-patient relationship. And in the end, they don't want to see a PA, or a nurse. They don't want HMOs or insurance bureaucrats coming between them and their doctor. And, I think they realize that this 'pimping the physician' isn't good for healthcare. Afterall, it has become quite apparent that one would be amiss to expect the doctor to see his/her position as anything other than *a job* if they are 'demoted' to "healthcare provider," (i.e. just one of the team members). A job that ranks lower than their family, than their relationships...and like most Americans, a job that isn't some sacred calling. A job.

This is where we are today - being a doctor is a job, not an identity. This is why you have specialists
bailing on their oncall responsibility. This is why you have 10 minutes with your primary doctor (PMD)...oh wait, it's now PCP (primary care provider), and they may not seem as interested in your health as you'd like. This is why the doctor-patient relationship...is weakening.

Practically, it can only be one way: either the doctor is team-leader (the "team" can still exist, and it's probably beneficial that it does), the valued decision maker, held in high esteem, the doctor-patient relationship the most coveted aspect of healthcare; but in turn expected to be...ethically superior, and somewhat of a martyr in exchange for the privilege of being called "doctor." OR....doctors are just a member of a 'healthcare team' with equal vote...where everyone wears a white coat, and decisions are made by the group.

Seems to me, that if decisions are to be made by the "healthcare team," (with everyone possessing the same clout as the doctor) then the team should have malpractice insurance...and when someone fucks-up and kills someone, it's the *team* who takes the hit (not the physician). The team should have patient care ratios. If one member on the team gets a raise, we should all get raises. We should be compensated for the amount of time we spend training, with consideration of the average cost of obtaining that education (both time value, and actual dollars). A *true* team, is a team when lives are being saved...and when someone foolishly cleans the surgical equipment with hydraulic fluid. And, finally, it should be all the members on the healthcare team that are taxed 2% to pay for universal healthcare...or none of us.

So the doctors had better get a clue, organize, speak up, and hold these professional organizations accountable....or watch healthcare completely fall apart...and pay a 2% tax to boot!!
***

Here's an interesting excerpt adding perspective:
(advice to a pre-med)

The first thing you need to do is to cool your jets. Medicine is a good career but it’s just a job. I’m sure you will meet some zealots who seemingly breathe, eat, and live medicine but for the most part, by the time you get into residency you will find that most of your colleagues want pretty much what other working people want, namely a useful job with good pay and decent hours. In this regard, maybe the years of working long hours for little of no pay like you’re going to do in medical school and residency beats the idealism out of people but I prefer to think it teaches them the difference between professionalism and fanaticism. Naturally you have to pretend to be driven to get into medical school as showing passion is a de facto requirement. Your real reasons for wanting to be a physician, while perfectly legitimate, would sound trite and self-serving if you even dared breathe them aloud. Just between me and you I didn’t want to save the world either and just applied to medical school because I thought being a doctor would be kind of cool.

Suppose you need to borrow $40,000 per year. That's $160,000 in debt added to the $240,000 opportunity cost of medical school plus the $60,000 dollar opportunity cost of a three-year residency where you will make about forty thousand a year. That’s almost half a million bucks, not even considering the time value of money which is not working in your favor. if you match into pediatrics and make $90,000 per year, your net benefit from all of those long years will be $30,000 a year which, again ignoring the time value of money, puts your break-even point sometime in 2031. This explains perfectly why American medical school graduates eschew the lower-paying primary care specialties. They are fairly intelligent and can do the math.

Because medicine is a high risk profession that deals primarily with an unhealthy and irresponsible public, the simple act of plying your trade will routinely place your home, your livelihood, and your savings in jeopardy. Think about how you’ll feel having your wages garnished to pay the widow of a crack dealer on whose discharge instructions you forgot to write, “Follow up in the Emergency Department if your chest pain returns.”


7 comments:

Petri said...

It seems from all the discontent rampid on the internet that Medical Doctors are the pinnacle of medicine, the face of it perhaps. People don't see nurses, administrators, and entrepreneurs when they think of medicine they see a doctor. In a way, doctors then have been besieged on all sides because they are the figure-head, they bear the brunt of what's wrong with medicine, not because they are necessarily causing it, but because they are the only thing people have to direct their anger at.

Physicians nowadays seem beset upon by insurance companies trying to make a buck, patients trying to save a buck but still recieve fast efficient McHealthcare, Drug companies trying to sell, associations trying to keep up membership, government agencies trying to regulate, and even their own hospitals and administrators trying to streamline. The fact is, everyone still believes in the "doctor knows best" ideal, but when it comes down to it the primary motivation for everyone involved is to save money. Since the only way any of the aforementioned events happens in medicine is through doctors, they become the battle ground. Each individual party wants the doctor fighting for their interests, but who fights for the doctors' interests? It's so easy for all these parties to minimalize or idolize the doctor and as such disregard their fundamental humanity. I completely agree with you on this one, doctors need to stick up for themselves or all these competing interests will destroy their livelyhood.

Anonymous said...

From what I've seen medical care in this country gets a much greater percentage of the GNP than any other country in the world. So why are doctors getting less and less of this largesse? I think it's because clever people have decided they want a bigger share for themselves and they are politically more savvy about getting it. Doctors are seen as politically and financially naive, focused on their 'do-gooding' and so are easily divested of increasing pieces of income and status while shouldering greater and greater financial burdens (low pay, lawsuits and malpractice insurance).

In not too distant history doctors had little more to offer than the 'bedside manner' and it was invaluable. Now, doctors seem mostly the dispensers of miracle pills and apparatuses; his expertise primarily deciding which is needed and when.

I don't think docs should unionize; that would further demean them and their training. What's needed is for docs to take control of the medical organizations and make those actually work FOR them. That would really be a revolution in 'health care'.

Jenny Blair said...

Dear God, it is so refreshing not to be the only one pointing out the madness of the medical training process -- the hours, the exhaustion, the effect on one's personal life -- and the idiocy of the martyrdom that we residents are expected to affect. See my article, "When Young Doctors are On Call," for a description of the unadulterated miseries that await those who brave residency training. strangeviolin.com.

Gristlee said...

always go with good and registered doctors...and if you are going to take prescription drugs like viagra, cialis or levitra then you must carefull beofre taking drugs from pharmacy...must consult with doctors before taking any kind of medication..

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Anna said...

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