The growing culture of hostile dependency towards doctors

Let’s start with a disclaimer: I am not complaining; I’m just stating the facts.

Honest fact: The morale of doctors in the real world is low–and sinking lower.

I know what you are thinking. “Come on Mandrola, you are nuts if you expect us to feel sympathy for doctors–of all professions.”

Well, you can think that if you wish, but I’m calling it as I see them. And here is why it matters:

Because when you are sick, an available, rested, un-rushed and talented doctor is really important.

You know this: quality health care–real quality, not spreadsheet or Internet quality–stems from basic human-to-human interaction, between patient and doctor. Healthcare reform, with its emphasis on metrics, prevention of fraud and cost-cutting measures has forgotten the basics. Namely, that humans, who have dedicated their life and committed their self-esteem, practice medicine. To take care of people well, doctors need things:

  • We need face time with the patient–not with a computer screen.
  • We need time to listen, to examine and to treat.
  • We need to feel trusted.
  • We need our self-esteem.
  • We need leeway to be human.
  • And of course, we need to be paid a fair wage for the years of training that it took to acquire these skills.

In support of this view, I’ll call your attention to four posts from real doctors:

My colleague Doctor Wes Fisher talks of the growing culture of hostile dependency towards caregivers. Wes is rightly disturbed by a sensational and one-sided book review of surgeon-author Dr. Mark Makary’s Unaccountable. Agree or not with Wes, his words come from the heart of a man who hangs a lot of his self-esteem on the doctoring peg. Wes is a guy I would want to have as a doctor. If healthcare reform keeps going in this direction, patients will have fewer Wes Fisher’s around to pull them out of fires.

Here’s a quote (via email) from an esteemed colleague — another guy you would want as your doctor:

We doctors are absolutely being demonized.  Every day something new is written pinning our healthcare crisis squarely on our shoulders.  It’s really affecting me emotionally.  I’ve actually started to think it might be a good idea to take a media holiday for a while.  I appreciate that you still have the energy to fight.  I’m getting pretty tired.

One of the most obvious unintended consequences of cutting healthcare costs on the backs of doctors is the flight of good primary care doctors to concierge medicine. One of the best posts I have read on the topic of dropping out comes from Dr. Rob Lamberts. Dr. Rob is a beautiful writer and another passionate practitioner of medicine. I’ve been reading his stuff for years, and it is clear that Dr. Rob has unequivocally mastered the obvious.

Finally, there’s me. I wrote an In the Prime post today about the two sides of the canvas of healthcare reform. It was in response to a nicely written opinion piece in the Courier-Journal. A local doctor pointed out that we must not settle for anything less than universal insurance coverage. He’s right; but there is also the important question: What good is universal coverage if there are not enough caregivers?

Doctors don’t expect sympathy. That’s not what we want. We want the people–our patients–to know the consequences of hostility towards caregivers–be it in mistrust, hyper-regulation or lower pay.

We welcome reform, but we can’t sit still and watch it destroy the practice of medicine.

John Mandrola is a cardiologist who blogs at Dr John M.

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  • Dr. Mahesh Jain

    Patient’s hostile and selfish attitude has become the order of the day. They simply want to use a doctor as puppets in their hands. Acceptance of medical advice is determined by psychological state of the patient and his relatives rather than merits. Costs are bound to escalate as a result of shift from trust and clinical acumen based practice to evidence based legally perfect medicine.

  • JPedersenB

    If you had had as many family members and friends who were harmed by the medical industry as I have, you might understand why so many no longer trust their doctors. Between the bad advice, the pushing for test/drugs/procedures and the outrageous costs, I have to question everything that any MD recommends. If I thought doctors had my best interests in mind rather than protecting themselves, I might learn to trust again!

  • drawnear

    Thank you! Next time I go to see my Doc whom I love dearly and I do give the freedom to be human and really appreciate face to face time with her…..I am going to give her a big hug and a thank her and encourage her to keep in the good fight. I have been adamantly against Obama care and believe there are better ways to handle health care for the uninsured than a government take over.

  • Dr. J. A. Jaar

    Very well done.

    Doctors do expect sympathy.

    We are humans.

    And……we work hard and never complaint.

    • Rob Burnside

      I general, I question the motivation of today’s physicians. Did they enter medicine to heal, or for the Mercedes sedan and condo in Aruba? In the “old days” no one got rich practicing medicine, and the doctor-patient relationship was much more satisfying for both. Today’s unfortunate commercialization and requisite quantification of the healing arts make that almost impossible..

      • Dr. J. A. Jaar

        My father was a physician and worked for more than 60 years.
        I have been a physician for more than 30 years.
        We have a son who will be a physician in two years.

        It is a tradition, we love it and we have it in our blood.

        My family never got rich practicing Medicine.
        Our main concern…………….to heal and care for our fellow human being..

        And we have done that!!

  • Marc Kashinsky

    I have never been hostile towards doctors. I am hostile towards health insurance companies, the government [politicians], and numerous others, and how they’ve changed our thinking about health care in this country. No longer do we think about how health care saves lives and relieves suffering, but instead treat it as nothing more than a commodity much like having your car repaired.

    Gone is the compassion for our fellow man, and gone is the high esteem we used to hold for doctors.

    Until we change that mindset, health care in this country will continue its decline, and doctors will never receive the respect they deserve.

    Just my opinion!

  • Saleamua

    I’ve been fortunate–most of my experiences with my providers–not just doctors, but nurse practitioners, nurses, PAs, med techs–have been positive, both clinically and socially (pleasant, professional). Inherently, I realize that we all have bad days, both as patients and providers.

    However, to characterize healthcare reform’s emphasis on metrics as ‘forgetting the basics’, disregards the other areas of emphasis–actual outcomes based on care provided, and elimination of unnecessary (including redundant) care. Most of us are smart enough to understand that these errors are not the fault of doctors or any one individual in the healthcare system.

    I do agree that patients, and those who take care of them, should be the center of care. In fact, I try to assume that’s why doctors and clinical professionals entered into their fields.

  • Dennis Lee

    Patients need to change their diet in order to let their cells to repair!!! Staying on a junk diet will never give the cells a chance to recover from deficiency and toxins. Tradition medicine just cover up the symptoms with side effects requiring more medicine to work on another side effect!! Doctors can do no more till the patient change their mind set to recover with their diet adjustments!!!! It’s also the politics of the government that create the onset of hostile relations between patient and doctors!!!!Insurance companies has too much red tapes and really wants to pay themselves and not the doctors!!! Government created a mind set dependencies on to the patients and with the economy equal to the never ever recover Japan, situation will not improve! Let me know if my comments are correct.

  • Robert Young

    If you think things are bad now, “don’t stop thinking about tomorrow”.
    Ain’t it great tha from today on everyone will get “affordable medicine”, even though there aren’t enough physicians or nurses to see them all; with 4 million a year new Medicare patients and tens of millions of newly entitled Medicaid patients. Your question perhap will be how do you treage all of them and have them all believe they actually have care. But docs and hospitals know how to do it, just show they had care on the office computers, that will control medicine as it swiches to newer tecniques that most patinets will never be treated with.

    • EmilyAnon

      A little off topic but to address the concern of not enough doctors to treat all the newly insured:

      I am in California, and have just read that the first new public medical school in 40 years is almost complete and will start accepting students next year (UC Riverside). We now have a total of 10 med schools.

      But over 20 ABA accredited law schools have been built here and dozens more unaccredited.

      Why aren’t more medical schools being built in the U.S. USC Keck School of Medicine has reported they have thousands of applicants for 100 spots. That’s a lot of potential new doctors being turned away.

      • johnathan blaze

        Law schools are cheap to build and run. They don’t require much equipment besides lecture halls, libraries, and internet connections.

        Medical schools require more equipment and they also need to work w/ local hospitals.

        Of course medical lobbying groups try to limit the number of schools that open & residency positions (which are all funded by govt money). There is a huge movement to keep the doctor (and specialist in particular) supply lowered. It all comes down to money.

  • petromccrum

    I admit that I am one of those hostile patients. The entire healthcare system is soooo dysfunctional its amazing that anyone seriously ill ever recuperates. My husband passed away this year due to
    incompetent medical care. His last days were made more insufferable by a hospital that provided substandard care. Where is the accountability? Where is the compassion? Where is the medical/emotional/financial help? So excuse me if I seem hostile. Patients are getting fed up with the treatment we are receiving; at a huge cost.

  • meyati

    11/09/12 My blood pressure was way up. My Dr. of about 15 months wanted to give me BP med. I told him that I don’t need it. I was scared that he was mad at me, and he is the only reason I’m sticking with this HMO.
    The pharmacy gave me the wrong med-who saved me? I asked the HMO if they had a pharmaceutical bill of rights 4 patients-no-but it was all my Dr.’s fault.

    I had to go 2 an urgent care-They don’t have any on this end of town. I asked them if they would consider one here. They sent me a letter that they made a file on him because he was incompetent and didn’t advise me the system doesn’t have Urgent care here.

    The system tried to keep him from writing a script for a stomach med that I’ve been taking since 1992, and it keeps me out of the ER. I have severe IBS, which he understands. I have hypothyroid, which he understands.
    There are other things out there, but the Dr. before him told me to quit eating donuts (sugar is a food trigger that sets off cramps and severe diarrhea). She also wanted to give meds for the symptoms of hyperthyroid, but refused to adjust my thyroid dose, even after reading bad thyroid screens. I went out of range, took the lab work and camped in the office of an administrator. The next day I was assigned my current doctor. TG

    Do I trust and appreciate my doctor? YES. Do I like the American medical system? NO. I told my doctor that the reps are doing busy work, trying to make their selves look important to get a raise or keep a job. I asked 2 binary questions-yes or no-and they had nothing to do with him. But people in administration spent our medicare money on doing investigations, when I wanted a yes or no answer. Is it illegal to make a suggestion? This is supposed 2 B America.

    This money should go to me and other patients. This money should go to good doctors that care for me-not busy work that worries me about if my doctor thinks that I’m a problem patient. Perhaps this is part of the patient-doctor problem- Unproductive twits trying to look and feel important by making up problems. Then you know what? Before I saw him, I had to sign a paper that if he abused me-even verbally-that I’d report him-I was a F***ing math teacher- HS. I’ve even seen the school on 2 television “FBI Files” because of the gang activity there. I occasionally dealt with armed students. I’m wondering if my doctor is on a sh*** list. I’m not scared of him- I’m scared the system wants 2 get rid of him. The system scares me- I hate the FDA and the American medical system, but I trust and really like my doctor.

  • johnathan blaze

    Maybe it’s because the American people are finally waking up and realizing that doctors are no more trustworthy than car mechanics. That doctors are making insane salaries by gaming the system and financially raping the sick. That doctors are not our friends, nor are they concerned about our health. Instead they are increasingly dismissive and greedy. That doctors still have the nerve to complain about their lives despite their huge salaries and job security while the rest of America suffers. That overly-inflated Medicare payouts to doctors are sending America off the fiscal cliff. That medical lobbying groups composed of doctors actively try to limit the doctor supply. That “do no harm” is a complete crock unless it refers to a doctor’s bank account.

    I wouldn’t call it hostile dependency. I’d call it waking up and seeing reality. There’s not a big difference between the swindlers on Wall Street and the swindlers in the white coats.

    It aint the 80s anymore. We have the internet now. There is an open exchange of information and the whole medical scam is getting exposed. The cloud of arrogance and secrecy is getting dispersed. The pure distilled greed and trickery of doctors is ever more apparent, and yes, the people are mad as hell.

    The jig is up.

  • beadie

    The message of the customer service model employed by hospitals has helped to create demanding, rude, hostile patients and family members. Patients also seem to think they can do whatever they want including eating fat and sugar laden foods, soft drinks and milk shakes and forego exercise. Then they blame the doctor; sometimes it is their own doctor but it is usually a hospitalist. I have heard doctors cruelly cursed by patients. I am a nurse; most doctors I work with are dedicated, compassionate people who are amazingly courteous to everyone, including the patients that curse them. I have been cursed, punched, kicked, and so forth. I note that it seems crazy for patients to not have to comply to any standard of care for themselves while physicians and nurses have to comply with ever-increasing standards of care, core measures, standards of practice, whatever you want to call it. Why should the entire burden be on providers and none on “consumers?”

  • MatzM

    I’m only hostile when my doctor sits behind a desk typing or looking at his I-phone instead of listening to my symptoms when I have my blessed 15 minutes after waiting ever so patiently to get into his office and withstanding the abuse of his front office staff for six months to get into see him when I have a chronic condition. Blame it on whomever you want, but I’m not asking for much but a little compassion and some attention. And don’t start me on insurance companies. They are not providers any more. They just make it harder for people like me to get serviced. I paid a lot for my two Masters degrees and if I don’t treat people like this. It’s called common courtesy.

  • Gangnam Djumv Stylee

    While I have what is known as “common decency” and “respect for my fellow man”, I am extremely unhappy with the quality of healthcare right now. As it’s becoming close to European style health care.

    This is my problem, and Doctors, try to understand this. When you need repairs to your car, does the mechanic require you to fill out an application, drop it by his office, and at HIS convenience, he will contact you back whether or not to “ACCEPT YOU AS A CUSTOMER”? No, but a Doctor does this. When your computer is broken, and you take it to a computer technician to have it fixed, and the computer technician states that it is fixed, when the problem still exists, so you must take it back to him 10 times before the problem is finally resolved correctly, and pay him the full amount for his services regardless of whether or not he fixed the problem? No, but a doctor does this. When you hire an electrician to come fix your electrical service in your house, and you have a question about the electrical work that he’s done, and you call him to seek an answer to your question, does he simply refuse to take your call, and demand that you meet with him in person so that he can charge you a fee for after-action consultation? No, but a doctor does this.

    The worst part about this is that we’re not talking about something like a car, a computer, or an electrical system. Yes, these are important objects that need to work correctly to function with ease in our modern society, however, a human body needs to function correctly in order for someone to live. Doctors seem to have forgotten this. Sometimes, you people act like you don’t give a damn because hell, it isn’t you that’s suffering, right? To the rest of us, you appear as if you are only there to pick up a check, and if I’m still suffering by the end of the day, meh, no big freaking deal.

    Maybe if other professions that you depend on started treating you the way you treat them, you might understand, but this is simply not going to happen, because these loose standards are only acceptable in your field. When I was in the military, when I got sick, I went to sick call, and they fixed the problem. Why can’t you do the same?

    And why am I ranting? Because I find the double standard unacceptable. I needed to see a doctor in my area this week because I’m in some severe pain and all i get told is “do you have insurance?” to which my answer is yes, but I will pay you in cash if you see me tomorrow, and the reply? “come by and grab an application, fill it out, and doctor ________ will call you back if he wants to accept you as a patient” Seriously? After I offered to pay you in cash?

    Is Obamacare screwing this up? Yeah, probably, but I didn’t vote for that shit. In fact, I called my congressmen and senators and told them not to vote for it. Are the insurers part of the problem? Yes, but I have insurance because the cost of a Doctor’s service is disproportionate to the any other aspect of cost of living. Are frivolous malpractice suits part of the problem? Yes. But that doesn’t give you any excuse to treat people the way that you treat them. Shape the hell up or get out of the business.

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