Issues with Medicine

On the white coat.
Everyone wears one. I wonder why. I think patients are starting to realize that it’s actually those of us *without* a white coat that are the doctors.

On Customer Service.
How stressful would it be if you actually gave a damn about patient satisfaction scores. Not because it’s not a worthy goal to be customer friendly; but because these scores are derived from so many factors that you, as a doctor, have absolutely no control over. Wait times, parking, whether or not you have access to old medical records. Think about it, if a patient in the ED waits 8 hours, cannot tell the difference between a doctor and a nurse manager (because everyone is wearing a white coat), gets a CNA that treats them shitty, and then goes out to their car and finds a parking ticket on the windshield….you can bet that when a survey is sent to them asking them to rate their ED doc…they’re going to use this only opportunity, to show how frustrating it was for them. And when that patient decides to go elsewhere next time, it’s the MDs who are spanked.

On Complaints.
All complaints don’t deserve a ‘full investigation.’ The drug seeker who’s pissed off because I wouldn’t use my medical license, and my medical education/professional decision making capacity, to give him the drugs he seeks (i.e. I decide my job isn’t to serve as his drug dealer), he complains. Subsequently the wheels start rolling…and eventually I get to ‘respond’ to this complaint. Frankly, I don’t need to know about it…and the complaint should be discarded. The patient has the right to get a second opinion. I have a right (a responsibility) to do what I believe is correct/safe. Woe is the doctor who gets bullied by Anna Nicole Smith, and when she ends up dead…all eyes on doc drug dispenser. Customer service gone too far!!

I remember there was one case in particular. The patient wanted something that wasn’t medically indicated. Had I given it to her, and something bad happened, no one would have given me a pass because I was doing what she wanted. It would be like “but you’re the professional; you’re the one licensed to practice medicine; she didn’t know, but you knew better.” So, she went to administration and threw a tantrum. Some nurse administrator (in a white coat, no doubt) thought it was a good idea to walk the patient back over to the clinic, and question my decision. Needless to say, I felt very disrespected, undermined, and angry. “Why don’t you give her blah blah blah?” She asks.

“Because, in my professional opinion as a physician licensed to practice in this state, it’s not indicated, and potentially harmful.”

Her: “It’s not a big deal just this once to give her this or that….”

“If *you* think she should have it….*you* give it to her. You go to medical school, do a residency, apply for state license, a DEA number, and get a job somewhere…then you can give her anything you want. But, I’ve made my decision.”

Why did I have to go there?

On Joint commissions.
I wonder who appointed them, this private entity, God. Why are we closing hospitals, and compromising patient care, jumping thru impossible/impractical hoops trying to comply with various, random, and irrelevant ‘regulations’ that they pull out their asses. It’s easy to have a ‘new regulation’ on paper, but in practice, if it’s not practical to implement, it only distracts from what we’re actually able to do right. Also, what about when they’re just wrong, harmful to patients well-being. Like the 4 hour timeframe to antibiotic administration in pneumonia patients. I’ve seen more people with c.diff colitis violently ill, who received antibiotics to treat ‘possible pneumonia’, for the CXR to be clear. Passing out levaquin like candy in triage to meet some random joint commissions regulation is causing lots of undue sh*t (literally) both for the c.diff patient, and society in general as our antibiotic resistance rates rise. I think doctors need to take more responsibility, and *regulate joint commissions*. Afterall, who regulates them?

On universal health care.
When this happens…because it will…these groups that import doctors and nurses…who cut costs with cheaper mid-level practitioners in environments that should have physicians…who have unhappy doctors…had better watch out. CEOs need to understand: patients have health insurance to see me. Everyone else is supporting cast. Everyone else is there to allow me to do what I do.

On diversity.
You can’t advertise that you have a ‘diverse’ staff as a medical group/institution, if you’re counting foreign doctors/nurses, and minority/immigrant housekeeping and cafeteria workers as “medical staff.” When an Asian American, Mexican American, or African American patient seeks a diverse insurance company (i.e. anyone on staff that looks like them), they’re actually hoping for American doctors with various ethnic roots. The racial makeup of support staff…is very much less significant. And it is misleading to tout diversity in a medical group when the diversity you speak of doesn’t include the physicians…the very reason one seeks the services of a medical group/insurance plan.

On a Doctors Bill of Rights.
Doctors need a bill of rights. The right to do what they deem appropriate for the patients under their care. To prescribe the best medications, perform the necessary procedures. To refer to specialists as needed, and feel free to do the best they can without fear of friveouls malpractice suits. Doctors need legislative protection from insurance companies, CEOs, and other non-physicians hindering their ability to provide the very best care for their individual patients. Compensation needs to be fair. Medicare/cal, and insurance companies should not be allowed to short-change doctors for their own profit. Likewise, doctors should not be punished for providing medical care in the way of additional taxes. Tax the insurance companies who are making a profit (and those who are not). What sense does it make to tax the doctors? Why not the nurses as well?

I think we need to unionize….


wealthandtaste said...


i'm a paramedic and come fall 08, an M1. I enjoy your blog most days, but this post struck a nerve. i bemoan the uppity nurse managers ten years removed from clinical practice giving orders as well... but try not to sound so resoundingly pompous with the "without doctors you'd all be doomed.. DOOMED!" Give me veteran support staff and a shitty doctor over a great doctor and a squad of janitors any day. Perhaps I'll change my mind 4 years from now, but I hope not.


Anonymous said...

Doctors are the most important. If I could only choose one member of the medical team to help cure my appendicitis...it would be a doctor, no doubt.

Actually...to cure my 'anything' I'd choose a doctor over anyone else. Unless the lab tech is this guy,

or the janitor is this guy.

Anonymous 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..

TwinWithbabies said...

You say it so well. I hope changes come soon. After investing $300 k plus in medical education and years studying to come to the point of the health care is being control by insurance is a shame.

Dora Ali said...

always go with good and registered doctors..http://www.afu.ac.ae/en/policies-and-procedures-manual/

Emma Joy said...

Lot of peoples have Issues with Medicine,so always follow the doctor's advise. meet and greet gatwick
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