Most physicians today feel like they are continuously under the gun

As I write this post a frail sickly patient awaits anxiously by the phone for a call from her doctor that will never come.  Every day, countless people leave their physicians office angry, confused, and feeling abandoned.  Yet when I think back to my medical school class, I feel nothing but pride.  I couldn’t imagine a more caring, conscientious group of young learners.

I remember my fellow residents working long hours.  They abandoned their families to sit at the side of a dying patient or catch up in the library.  We were entering a solemn profession, signing a covenant with humanity.  A decade later I struggle with the disconnect.  I don’t know how to integrate who we were with who we have become.

Most physicians today feel like they are continuously under the gun.  Lambasted by insurance companies, petrified by medicare regulations, we struggle to follow a vague set of proclamations that carry dyer consequences.  We cower in fear of malpractice attorneys, and bear the brunt of the emotional and physical turmoil of our patients.  We have mastered the art of duck and cover.

But the problem with always feeling like your dodging bullets, you lose the ability to help your patients do the same.  The poor swimmer who frantically treads to keep his head above water could never save the drowning man flopping in front of him.  Self preservation has ousted patient care in hierarchical primacy.

We all find different ways to deal with the stress.  Some escape in search of the next rainbow and pot of gold .  Many who remain physically in the field have left emotionally.  The covenant is broken.

I can no more blame our reality on the public, than I can on those innocent medical students who enter the hospital with such hope.  Day after day our patients are getting the short end of the stick

Our nation as a whole, or our physicians must rise together and make a stand.  Barring such an occurrence, the systemic desensitization of this mighty profession will continue.

While the doctor will be available to see you, empathy will have left the building.

Jordan Grumet is an internal medicine physician who blogs at In My Humble Opinion.

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  • John C. Key MD

    I have not ever, I am afraid, seen physicians rise together. The “herding cats” simile comes to mind. Give me mine, I don’t care about yours. For too long physicians as a group have abdicated their leadership role and deferred to the insurers, the hospitals, the government. Professional groups have too often allied themselves with the latter rather than the former.

    It is not too late. Independent practice, direct pay models, and a renewal of our oft-maligned cottage industry can occur. Physicians have a great heritage; it should not be sacrificed to the situation that medicine faces today.

    • http://onhealthtech.blogspot.com Margalit Gur-Arie

      Yes, but who is going to stand up and be counted first? I have been posing this question here for a very long time…. No takers so far…… Oh, and by the way, it is almost too late…..

    • sFord48

      I assume your call for independent direct pay models are for primary care. I have yet to see an orthopedic surgeon call for such things.

      It’s already too late. Instead of real solutions, the call is for patients to pay even more.

      It is too late.

  • http://www.thehappymd.com/ Dike Drummond MD

    Thanks for the post Dr. Grumet. What you are talking about are the survival mechanisms we use to make it through physician training and through the average week in practice. These survival mechanisms … to see danger in every patient interaction and spend our energy worrying … are major causes of Compassion Fatigue and Burnout. AND It is very important to realize that looking at the world in this way is a HABIT and a dysfunctional survival mechanism left over from your training. Physicians “rising and making a stand” has nothing to do with the solution you seek.

    FEAR is the anticipation of future pain. It does not exist in the present. We allow our attention to be dominated by FEAR in our practice … it is a habit. Research shows this can be changed – and burnout prevented – through what is commonly known as “mindfulness”. It is the conscious release of fear … and a return to what is actually going on in the present. This is a skill you can learn and practice and get really good at …

    Your entire post is a cry for mindfulness. If you are fearful and notice challenges in empathizing with your patients … you are overdue to learn this skill set.

    my two cents,

    Dike
    Dike Drummond MD
    http://www.thehappymd.com

    • http://onhealthtech.blogspot.com Margalit Gur-Arie

      Dr. Drummond,
      Perhaps some of the fear is to due anticipation of future pain, but a lot of it is due to the experience of clear and present pain. You cannot just make believe that you are not harassed by insurers and you are not subjugated by mindless regulations, and you will be ignoring all this at your own peril. Perhaps not literal or immediate peril, but things are not going well for the medical profession nowadays, and unless dealt with in the here and now, it will only get worse. My 2 cents…. :-)

      • http://www.thehappymd.com/ Dike Drummond MD

        Hey Margalit … thanks for your comment. If you are sitting in an exam room with a patient and instead of being present with what is actually going on in front of you … you are lost in feeling harassed by insurers and “in peril” … wow … wonder what the patient’s experience of that encounter is. like?

        I am talking about the ability to be present with your patients (and family) rather than stew in your feelings about “the system”. YES … THE SYSTEM SUCKS … we agree on that AND are you going to let it hijack your awareness like this? Just like patients can be in pain and not suffer … you can be in a dysfunctional system and not go crazy with fear and anxiety and paranoia and “peril”.

        If you are stuck in fear and your survival mechanisms you will feel helpless. When you are able to let go … you can see possibilities and choices. Only then can you take the most powerful and productive action to change things.

        And … FEAR is only ONE “trigger for advancement” … only one … when you are in survival mode it just looks like the only one.

        That’s four cents ;-)

        Dike
        Dike Drummond MD
        http://www.thehappymd.com

        • http://onhealthtech.blogspot.com Margalit Gur-Arie

          Hi Dr. D. Certainly one can learn to function in a dysfunctional system, by separating and compartmentalizing things, I assume…. But wouldn’t it be more beneficial to all involved if instead of accepting the situation, those who are most affected and best suited to affect change (which is rather unusual), would take some sort of action above and beyond keeping their head down and carrying on the best they can?

          Up to six cents… :-)

          • http://www.thehappymd.com/ Dike Drummond MD

            Hey Margalit — here’s a couple more.
            I am NOT saying … lay down and accept it. I am saying don’t let your “rage against the machine” make YOU sick or make it so you can’t be present for your patients.

            There is absolutely no chance of any “rise together and make a stand”. A stand for what? This is a general rant about feeling like he is constantly dodging bullets. There is no one shooting at him.

            Take a breath and let go of that feeling since it is not real. Then look at what you can do about your circumstances and take action. AND there is no cavalry of docs coming over the hill to rise up and rescue anyone.

            Dike
            Dike Drummond MD
            http://www.thehappymd.com

  • Amy Staples

    so true, so true and I know of many doctors who do not even care that their empathy has disappeared. They care not for the patients. They only care for the money, the status, their statistics. The patient, oh that’s the human. Oh yeah, I guess I should do something for him. bahaha What a joke.

  • http://www.bryantsstatisticalconsulting.com Donald Tex Bryant

    Believe it or not, there are docs who actually enjoy meeting patients each day and enjoy being at work. I know of some local primary care providers who find enough time to spend with their patients without having a negative impact on the bottom line; in fact, their approach improved income at their site.

    I imagine most physicians at Park Nicollet Health Services or Virginia Mason Medical Center enjoy their work. You can read more about their experience in “The Toyota Way to Healthcare Excellence.”

    Lastly, my encounters with physicians and other staff at a University of Michigan “Lean Healthcare” training was very positive.

  • Janice Mancuso

    The esteemed Bernard Lown, MD posted the following essay yesterday. It speaks eloquently to this topic. Doctor as
    scientist, healer, magician, business entrepreneur, small shopkeeper, or
    assembly line worker — which is it?
    It’s very long but well worth reading.
    janice
    http://www.OslerSymposia.org

  • Sapphire Storm

    I am not a doctor, nurse or in the medical field. Yet of course I have had my my share or experiences with doctors.Most of the ones that stand out are the negative ones. Yet when I think of my primary care doctor and my obgyn I think of them positively. Mostly my negative experience is one where the doctor shows a lack of empathy. ( I am so lucky to have a primary care Dr who is actually very empathetic, most of the lack of empathy does not come from him but from the OBGYN and specialists).

    I get that this field has become drastically different from ye days of old. However, why complain about it? But do something about it. I think many MD’s might feel the same way about their patients.
    The truth is, we are in a different era of medical care. Doctor’s are not put on a pedestal anymore (and really, should they ever have been? I think not.).

    Here is the thing~ listen to, and respect your *clients* (see them that way rather than “patients”). I have experienced that subtle yet palpable condescension and patronizing from doctors when I come in with my own information (yet, I was the one who had to diagnose my son’s Diabetes Type 1, not his pediatrician, who was overweening in his complying with my request for a Diabetes test among other glandular problems). I have experienced frustration and disappointment when I am turned away from getting some kind of help and investigation towards a problem I have (embarrassing problems; hard to mention to ANYONE).

    Also, understand that the role of MD is changing. Just like for everyone; life is not as before and that could be a really good thing. There is a study that speaks to the fact that people who receive apologies from their doctors are way less likely to sue (yes, this is true; if my son’s doctor had acknowledged his ongoing mistake in neglecting to attend to my son’s health concerns rather than focusing on psych concerns; I would never think of suing. I won’t try to sue him, but I sure felt like it, because I was traumatized!).

    Another thing is that doctors can (and probably do) form organizations that support each other around insurance issues. Look if you have to lobby in Washington, then do it!

    I think that doctors tend to think they are “special” and shouldn’t have to deal with this stuff. But, you know what? We ALL have to deal with this stuff. If you are in this field, do it right. If you can’t deal, then get out, or get help. I have heard about doctors saying so many times, when a client is struggling with an issue: oh I think you should get psychological help (including my son’s Diabetes symptoms, where..umm..he could have gone into a coma if I did not figure it out!).

    Doctors~ you are people, like the rest of us. Get over yourselves. If you owned a moving company you would need insurance. If you were a lawyer, you would need malpractice insurance. Name me an industry where you would be immune to these issues? Yes you spent a lot on your education. Is that the client’s fault? I mean…figure it out! Figure out what you want and if it’s not working, work to change it.
    I think a doctor who lacks empathy (like these independent medical examiners for insurance companies) are losers, and not only that, morally corrupt.
    Why have doctors become so complain-ey? If you think insurance is hard from YOUR end…try it from the other end!