The new standard of an exceptional physician

There are so many changes in medicine these days, but it takes a bit of time away from the keyboard to appreciate them.

So glued have I become to looking at computer screens, it’s been hard to pull my head from them any more.  Doctors lives are spent staring at these damn screens now.  I wonder how many of my youngest colleagues know how to start an IV, a foley, place a central line, or safely pass an nasogastric tube, let alone examine a patient.  Now we just click an order and things magically happen by a team of technicians.  Doctors are now the masters of click.  Clicks are now how doctors are measured, quantified, and sadly, actually valued.  If it wasn’t clicked, it didn’t happen.

The environment for doctors continues to change, too.  But it’s even more evident now if we stop and look for a moment.  There used to be the doctor’s lounge, a sacred inner sanctum in a hospital where doctors could congregate, get a small bit to eat –maybe an fresh apple — and find a few colleagues exhausted from the night before catching up on the news.

Now, there might be a coffee pot that dispenses come hot-water-concocted chemistry experiment it labels as “coffee” but takes like Drano.  Our space called the doctors lounge has become an antiquated mail room with long-forgotten names lying askew on a wall of drawers.  No one checks these boxes any more; we’re too busy emptying our electronic in-boxes on the screens that replaced the chairs there.  And of course, the same thing’s happening to the doctor’s dining room — if such a dining room exists at all any more.  Doctors rarely have a meal together to re-group and share our medical concerns with each other there.  Instead, most now eat in the employee dining room if they have time to eat at all between patients.

But there is an upside.  The hospital has never looked better.  We smile more and watch the Bears on big screen TV’s with our patient-customers on weekend rounds to improve patient satisfaction scores.  Hospitals are officially in the hospitality business.  This is how those of us in the “business” are getting paid and measured now.

And finally, there’s our new dress code.  The once heralded white coat donned as a medical student that later gives way to the once-heralded grey lab coat of an attending physician has lost its respected value, too.  Instead, the grey lab coat of the attending as been relegated to nothing more than a sign of the responsible physician.  Far grander now is the Brooks Brothers suit. Or maybe a really nice sport coat and tie.  Or maybe, for the real movers and shakers, just a designer shirt, polished shoes, and tie.  These doctors are the new leaders now.

Funny.

There used to be a time where doctors rose above the administrative fray for the good of our patients.   Now, the new standard of “exceptional physician” is that of a keyboard operator and administrator.

Now, excuse me while I get back to clicking.

Wes Fisher is a cardiologist who blogs at Dr. Wes.

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

    Ah … yes … the good old days. It is amazing how rose colored those glasses can become. You must have had a country club of a doctor’s lounge back in the day.

    The real question is how do we – each as individuals – adapt to the changes that have already happened and the ones we will see in the next 40 years? How do we remain nimble and adaptable?

    Pining for what is gone and not coming back we are around our peers and simply reminiscing … is fine for a while — AND to the extent that nostalgia keeps you from adapting and adds to the resistance to change it is a real stressor for many doctors. Yes I remember back when Foxglove (lanoxin) was accepted Rx for CHF and at the same time I am a whiz with the keyboard and I didn’t learn that until I was 45.

    One thing that I sincerely do not believe will change is the magic that happens when we are face to face with a patient with whom we have a history and a relationship. We care. They know it. We each appreciate and respect the other. That will never go out of style.

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

  • Suziq38

    You are so right, Dr. Fisher.

    I have to fight the urge to knock on my doctor’s five-head…”Hey, it is me that you are seeing today! I am the one that needs your attention, not the computer screen.”
    I worked really hard on my questions, my summary of my ailments and concerns.
    I know I have only 15 or at best, 20 minutes. Please give me your undivided time.

    The last time this happened, the results were disastrous. I had been experiencing escalating neuropathies and lower leg pain. I could tell that when I explained these symptoms and mentioned that now I was also experiencing a bitlateral nerve pull under BOTH arms when I bent over and urinary urge incontinence which was also new, I realized that you weren’t hearing me. Kind of like tuning out an EX. You dismissed me and my ailments as if I was a hypochondriac and was making S#it up. You said, “Have a nice day Mrs.L, “and walked out.

    I was so unnerved that I went home and wrote you a 5 page letter (which I had never done before), listing all of my pre-existing conditions and present concerns. At the end of the letter, I apologized and asked for your help with my concerns about my health that had steadily declined the last year and a half.

    You ignored the letter. I then wrote to your nurse asking her if you received the letter.
    she said that you did. I felt sad and depressed, but I vowed to deal with you when I returned.

    Thank goodness one of your colleagues had a “heart.” He said the problem was in my “upper spine.” Even though he was the colon doctor, he diagnosed what the neuro and gyn doctor should have.

    When I went on my vacation, my neuropathies and leg weakness got far worse. At night, I experienced extreme pain in both legs and did not have heavy-duty pain meds.

    I could not walk on all of the excursions.

    To make a long story short, I had a severe spinal stenosis in my cervical spine, and other spinal problems in my lumbar spine. I may also have M.S.

    I thought of all of the pain, how many times I tried to tell you what the problem was, the resistance to my request for a specialist, the rudeness of not answering my letter when my symptoms escalated.

    When I finally got to the spine surgeon and explained why I hated my gyn, he called you for me.
    This was the first time that I have ever gotten your full attention, even though I almost diagnosed my own future. I was not enough to get your attention. It took another doctor to tell you that you were a complete and not very intelligent jerk.

    The surgeon tells me that he may not be able to get the function that I have lost in the last year and a half. That when my symptoms escalated a 4 months ago, my legs were continuing to paralyze.

    I need surgery now to stop the paralysis, but why? If it is MS, a laminectomy may not help much. I could have used this time for diagnosis a year ago, when my symptoms were simpler and minor.

    Now this is a huge deal, and although I am not the suing type, I feel like consulting a lawyer, or at least report you to your famous teaching hospital board. Maybe also report you to the state Medical Board.

    Thank you all for listening. I just wanted to vent.
    I will try not to complain about you, but oh well. My health is more important than your reputation and computer screen.

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