Medicine at the Crossroads

 

        “When you look for the bad in mankind expecting to find it, you surely will.”    Pollyanna

 

I try not to spend too much time on Facebook, but it’s always been a good way to keep up with “friends” in the Scottish Deerhound world.  The deerhound, being a rare breed, tends to link people across the country, and indeed the world, who have similar interests.  Lately though, the deerhound people haven’t been discussing dogs much.  Instead, they’ve been discussing their terrible experiences with the world of medicine.  One owner described being admitted through the emergency room of her local hospital for stroke-like symptoms.  By the evening of her second day of admission, she complained that she had not yet been seen by a physician.  Another complained that a family member had just been diagnosed with Type I diabetes, but was initially given an appointment with an endocrinologist in six weeks—completely unacceptable in this situation by any standard of care.  I am of course compelled by pride to speak up and defend my profession, but not without an increasing sense of embarrassment for what used to be considered a noble calling.

After I published my piece on the fatal shooting of Dr. Michael Davidson, I was contacted by Carey Goldberg, reporter and co/host of CommonHealth (http://commonhealth.wbur.org/) and asked what struck me the most about the nearly 200 comments left on the essay when it was picked up by KevinMD.com.  Here is what I replied, “There were several reasons that Dr. Davidson’s death hit me particularly hard, even though I never met him.  One reason was that I trained at the Harvard teaching hospitals, Beth Israel for Internal Medicine and MGH for Radiation Oncology, so this hit close to “home” especially with my daughter being there.  But more importantly, I come from a medical family–grandfather was a dentist, father (now 89 years old) is a world renowned plastic surgeon–and in my lifetime of 61 years, I have seen the sad decline of public affection and respect for physicians.  When I was a child, people would stop me on the street to tell me how wonderful my father was.  Now, when I sit in on conversations among people who do not know I am an MD, I hear nothing but derision if not outright hatred.  There are many, many more people, as evidenced by the response to my blog piece, who feel slighted not only by “the system” but also by their physicians.”

And why not?  Articles such as this, http://www.nytimes.com/2015/01/30/business/medicare-payments-surge-for-stents-to-unblock-blood-vessels-in-limbs.html on the front page of the New York Times continue to erode patients’ faith in their physicians to “do the right thing.”  Patients despair when they cannot get appointments to see their doctors in a timely fashion and when they are seen, that their doctors don’t spend enough time with them or explain things to them.  They despair over the cost of care in increasingly difficult economic times. But doctors are in despair also, at the ever increasing bureaucracy of medicine, the insurance conglomerate which makes documentation, authorization and billing a nightmare, the takeover of large segments of medicine by for profit corporations and the heightened expectations for positive outcomes fueled in part by misleading advertising by those same corporations.  Many have come to feel that the sacrifices, both personal and economic, that they made in order to go to medical school were just not worth it.

I do not pretend to have any answers to the multiple crises that contributed to the death of Dr. Davidson, or the current climate in which doctors and patients must function.  I wish I did. But I do have a request for both my patients and others, and my physician colleagues, as well as my Facebook friends and the media.  Let us try once again to see the good in one another again, and not just the bad.  We’re all human, and at some point we are all going to get sick.  For better or for worse, we depend on one another.

11 thoughts on “Medicine at the Crossroads

  1. You are absolutely correct that the respect for physicians is gone, from the government officials who have created irrational and unmanageable laws and regulations, to the monitoring agencies like CDC, to the hospital administrators, to the leaders of professional organizations and medical certification boards, to the patients themselves who believe they have access to all the information they need to determine diagnosis and treatment so perceive a physician as an impediment to getting what they need when they need it.

    In fact, physicians are losing respect for each other.

    The art of clinical judgement and physical examination is discounted as not evidence-based or quantifiable so no longer considered worthwhile.

    It isn’t the work we trained for, that is certain. I’m glad your essay got the coverage and attention it deserved.

  2. From the patient’s point of view, I agree wholeheartedly with Dr. Fielding and Dr. Gibson, and I believe what we’re all missing is the intimacy that once informed the doctor/patient relationship. Medicine is, or was, an intimate profession–from birth to death and at all stages of life in between. For a host of reasons–chiefly the Dickensian parsing of time spent together– intimacy we once enjoyed isn’t there anymore. Enjoyed, and mutually benefited from, because I think it serves an important function in the healing equation, and there’s almost always room for some healing to occur, even in the most hopeless cases. We can shrug and conclude that in a generation of two it won’t matter because no one will know what’s missing, and that may be accurate, but it certainly won’t be correct.

  3. Hi Helen here formerly of Bruhns Auction. I’ve recently relocated to Huntington Beach and am in need of a gynecological oncologist. Can you recommend anyone?

  4. This is spot-on. When I go to the doctor now I see so many people like an army of ants trying to process paperwork and forms and there is always a frantic atmosphere (even though the doctors and nurses are very nice). I also used to think Concierge Medicine was an unnecessary frill but my husband and I have recently signed up with our Internist (who is converting to this type of practice) because we are both at an age when if we need attention we don’t have time to wait for his time – we need it now and that’s a luxury we have to pay for.

    I don’t know what the answer is – truly – but I feel badly for the doctors who are making medical decisions with one hand on their auto-dial to their attorneys in case things don’t go perfectly (and how can all things in medicine go perfectly?) and for patients everywhere who are confused and scared and are overwhelmed at the way the systems works now.

  5. A thoughtful post, and I surely agree to look for the good in one another. People respond to that. It’s simply a better, easier, more friendly way to live.
    –Amrita

    • Amrita, Pollyanna called this “The Glad Game”–finding something to be glad about in every situation. Tough to do in healthcare, but worth trying.

  6. Interesting post. The events you mention are shocking and nobody should have to let their health deteriorate while waiting for care. Yet it happens, and is a sign that things are out of control. I live in Canada, and have been quite fortunate with my family doctors, and health care in genera, but wait times here are a huge issue when it comes to surgery, and mistakes and terrible things happen as well.
    I happen to work in a service job which affords me good basic health care, and some extensive care if needed. My point really is, though, that it seems a lot more people are very quick to jump to anger and misinformed judgement and have expectations, a sense of entitlement steeped in selfishness, no matter what the service. They will usually keep their thoughts to themselves unless under the relative anonymity of the internet and then it is usually shocking and can make me want to go live in a cave away from humanity. Not an option right now, unfortunately, ha, so I try to dish out the love and kindness and hopefully, usually get some of that back.

  7. After nearly 26 years in healthcare, not as a Dr. nor RN, but an RT. I have seen and continue to observe how we are now forced to deliver care. We tug around to every room a computer on wheels (COW) This system is meant to cut down on med error’s, and allow the care giver to give report, and optimal care. Much of it is cookie cutter, all of it has become the care givers television, which basically has the same story, but different patient..And if the patient is lucky enough to have a practicioner who truly fills in the blanks with accurate info, and gets it right, the “COW’ actually does its job..That’s the point..the “COW” does most of the job, and who is benefiting?. When one is engulfed in watching a screen, just like TV, you become glued to just that. I’ve watched patients being questioned, with very little contact. We have become programed in many ways to deliver artificial care. Fill in the blanks so medicare, or your boss, or JACHO can see we have done our jobs properly, when in fact we have failed, or will fail when we lose the capacity to realize patients aren’t just fill in the blanks..Healthcare is a business, it must make $$, but when we focus more on that, bad things can happen. Doctor’s aren’t allowed to call the shots. They too are forced to perform under the boiler plate system designed to quickly and efficiently make decisions that won’t cost more $$. When $$, ego, greed motivates.. how is that safe?.. We all enter or at least most enter the field of medicine, to make a difference, just like Dr. Michael Davidson..Are family members noticing the way in which we deliver care now, because it is noticible..The world we live in is constantly changing, some of these changes are good and beneficial. Yet, not all reap these benefits. Yet, those that do, may not even be on the front line of delivering care. I often think of health care as a cash cow of some sort..Such a tragedy, such a loss to lose someone so compassionate, so dedicated, so talented….because…….? Let Doctor’s do what they are trained to do, without any more added demands, and pressure..No more worry Dr. Davidson…PEACE…

    • I recently had an anterior approach hip replacement. There are few orthopedic surgeons in MI who perform this particular surgery. The one I chose on the west coast of MI has performed over 2000 of them. He has developed a very efficient team that covers all aspects of the procedure. There is also a portal available to the patient to see some, but not all, of their medical records.

      I availed myself of this portal about 2 weeks after my initial visit. As I was looking around at what was available to me, I found the Dr’s summary of the exam. So I opened it up. It seemed to be fairly accurate, even if seeming to be a bit stiff or formal, until I came to the first he/she and then him/her. It became painfully obvious that they used a template that simply included all the obvious things that the Dr would cover on a first visit regarding a hip replacement. Nothing personalized, nothing specific to me, and those he/she’s and him/her’s.

      I wrote a rather scathing email to the team that I was a she, not a he/she. I went on that I was very aware of what proper medical records were and this was not an acceptable one. If they were going to use a template, they needed one for each gender. That was when I was informed that I did not see the entire medical records. I replied that it did not matter if that “template” was different in my “real” medical records, it should never have been used in my, or anyone else’s, portal.

      Just an example of the records that have to be used in today’s medical offices. And how they can be inappropriate at the same time. It is so time consuming ing to write up a proper medical record. Most physicians don’t have the time to be dealing with all this paperwork and still have time to do the medicine they have been trained to do. It’s such an unfortunate occurrence.

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