Doctor bashing has become a national sport: How to stop it

Doctors used to be among the most admired and respected persons in the community; now just a mention of this formerly revered title in a social setting will generate a totally different response.

Patients far too often will pour out stories of traumatic healthcare experiences, insults suffered, acts of disrespect or poor bedside manners, and disappointments in a system and in doctors who let them down. Doctor bashing has become a national sport.

The fact is the training, knowledge, skills and professionalism of physicians is just as high now, if not higher, than in the old days when everyone bragged about and loved their doctors. A major shift is that in this era of patient rights and empowerment, doctors are held much more accountable and often have not been proactive in responding to this higher standard.

As a result, many physicians today are demoralized because they have less time with patients, more demands and requirements, mounting stress and declining reimbursement, exacting public scrutiny, and a climate of negativity.

I am more than convinced that the physicians who love their work and are committed to doing the best for each and every patient outnumber by far the uncaring, money-focused minority. These physicians are valued and respected and bring all their energy to focus on their efforts to do the very best for us.

The vast majority of my fellow physicians also are striving to improve their skills and elevate their practice by engaging in improvement initiatives.  They know full well that self-development will benefit them personally:

  • They will strengthen their reputation in the community for outstanding care and service as a matter of professional pride.
  • They will attract new patients and retain a loyal patient following.
  • They will maximize reimbursement and pay based on CAHPS scores.
  • They will renew their passion for medicine and helping patients despite an atmosphere of stress and pressure.
  • They recognize that the individual physician is better served by collaborating and teaming with others than by going it on their own.

Those who feel healthcare is getting a bad rap and are tired of doctor bashing should:

  • Have the courage to speak up and promote the positives about our system, hospitals, and providers.
  • Continue to express compassion to friends and family who have suffered disappointments with their healthcare providers without joining the bash. The blameless apology works really well. “I’m so sorry you had such a painful experience.”
  • Promote empathy for the challenges physicians face. Help to educate others about the pressures on physicians in today’s turbulent environment.
  • Thank, appreciate and recognize those physicians who exemplify the Hippocratic Oath and are truly patient-centered in their approach.
  • Do your part in making your organization a caring community in which everyone, including physicians, feels supported.

Physicians need to proactively market themselves as the caring, highly-skilled professionals that we are. We can reduce the bad rap by aggressively making the truth known to patients, decision-makers and opinion-makers.

Healthcare is getting a bad rap because satisfied consumers and health professionals are silent. What we need is less noise and more truth. Truth can set us free and can free the medical profession from the burden of negative public opinion.

Carla J. Rotering is vice president, physician services, Leebov Golde Group. She is the co-author of The Language of Caring Guide for Physicians: Communication Essentials for Patient-Centered Care.

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  • DQUser

    Maybe doctors, especially the ones in the front lines, the non-specialists, should take control of the AMA instead of the AMA controlling them?

    • southerndoc1

      The AMA and the other medical societies have absolutely no “control.” They whored themselves out to the insurers and CMS years ago.

      • DQUser

        Absolutely! They’re become a propaganda machine for big pharma and the insurers. Look how they’ve demonized ” socialized medicine.” I’ve lived and worked in the UK and I can tell you categorically that one works less hours there for more money and the patients have better outcomes than here in the US.

        The lies the AMA puts out about the British National Health Service are disgraceful. Remember the “kidney patients being refused dialysis and sent home to die” story? The truth is that instead of going to hospital for dialysis patients were given dialysis machines and a nurse goes to their home and either trains the patient and family to do it or if that isn’t possible does it. It’s been a huge money saving success.

        • Alice Robertson

          They didn’t demonize socialized medicine…although I would hope they would. They jumped on board with the President to make more money off of more medical codes.

          • DQUser

            Well Alice, I can tell that you are a Brit. I can also tell that you have been well and truly brainwashed too. Can’t you see that the propaganda you are seeing and reading in the UK is because the LIB/LAB alliance want to privatize the NHS? The big money can see how much of the GNP is siphoned off in the US and they want to get their dirty fingers into it in the UK.

            Of course the UK has hospital infections. Every hospital in western industrialized countries does, especially the USA. I got MRSA in a US hospital. It’s a modern phenomena due to the over use of antibiotics both to treat patients and here in America the routine feeding of them to livestock.

            There’s little point in arguing specifics so look at four comparisons of the UK to the USA. The UK has more live births per 10,000 pregnancies and even though it has more people there from the third world, greater longevity, fewer hospitalizations and a lesser index of infectious diseases. If you want more then look up the published data.

            Again, having experienced both I can tell that when everything is taken into account the benefits are greater and the burdens fewer for both doctors and patients in the UK than in the US.

          • Alice Robertson

            Well I have a huge mistrust for the media (nice we agree on something:), but let me say it’s anecdotal not brainwashing. Too many relatives suffering there. Wait times of a year and by that time the cancer is spread all over their body. The chemo is torture without private insurance that will cover the nausea drugs, and even pain pills are held back now.

            I am speaking more from my heart because it appears to be needless suffering…while they throw money at a Royal Family….ugh….monarchies! Ha! Sorry….but that healthcare system was well intentioned but a nightmare for those with life threatening illnesses. It’s why 59% of doctors have private health insurance.

            I should share I have a daughter with cancer (oddly my second child with cancer..not genetic) and we could get free care in the UK. Even with all it’s problems I would choose the American healthcare system above any other in the world.

          • Tamara

            The British taxpayers spend less money on the Royal Family than the American taxpayers spend on Obama and his family. Sad but true.

      • Suzi Q 38

        I agree. Us patients are the losers, plus the PCP’s that are left.

      • Alice Robertson

        And they supported Obamacare? Which drove up insurance costs. And made millions in coding software. Doctors who want to distance themselves have to use their software.

    • FFP

      AMA is to American doctors as the KKK to the civil rights movement.

    • Suzi Q 38

      That is a good idea in theory, but how will it actually get done?

      • DQUser

        I understand that only 25% of doctors are actually members so I suppose it means the remainder (re) joining, going to the meetings and making their voices heard and their wishes carried out. Look at the way that little secretive group

        • Suzi Q 38

          You are right. It wasn’t fair, but life is not fair.
          Stuff happens.
          I am so concerned that my PCP will retire.
          I have been his patient for 12 years.
          Every time I go and see him, he is so busy, and looks tired.
          I think he is about 60.
          Am I going to have to go to an NP and be my own PCP if he retires?

  • Richard Jacobson

    I heard a speech last year at a medical conference where the speaker said that doctors are losing their credibility in all medical matters because of their obsolete nutrition advice. That advice is low fat, high carb, high grain and omega 6 consumption. Patients who follow that advice are getting fatter. Their diabetes is getting worse. And their overall health is suffering.

    They see 21st century nutrition research on the Internet calling for low carb, high fat, no grains or industrial seed oils. They follow it and they lose weight, get off diabetes drugs, and they feel great. Plus their blood values improve. Yet many doctors berate them for changing their diet.

    • Carla Rotering

      Thank you for sharing your perspective and bringing your voice into this important conversation.

      • Guest

        Please stop posting in this corporate politically-correct speak, that brings zero valuable information and shows about the same amount of human feeling.

    • FFP

      Nobody should give advice on matters they are not experts in. That includes BOTH doctors AND the general public.

      • rbthe4th2

        Define “expert”. I can read a medical study and come to a conclusion, whereas my doc can look at it and say he can’t figure it out. What does that tell you? Btw, it was bad enough that I’ve had 2nd and 3rd opinions and they’re all getting together with the insurance asking ‘what are we paying for’. This is not just a list of missed diagnoses, this is like, where they in the same room with the patient at the time this happened?

    • mmer

      //That advice is low fat, high carb, high grain, omega 6..//

      Uhhhh, what doctors are giving that advice? Those are possibly the worst possible nutrition guidelines. Maybe in the 80′s, but today? Most primary care docs would probably recommend something similar to the Mediterranean diet.

      • rbthe4th2

        My primary doc said he knows nothing about nutrition and can’t help me. Wonder what he’s going to do at obesity ICD code 9 time?

    • Suzi Q 38

      The news reports keep changing what is good and bad for us, from diets to vitamins and prescriptions.
      My favorite line is: “We can’t even eat anymore…”

  • Sean Harris

    Don’t worry. With the amount of Drs leaving clinical medicine there don’t be many left to bash.

    • Carla Rotering

      My hope is that we find a way to stay – and continue to do the good work that IS Medicine.

  • sml22

    Maybe you should spend less time blogging and then you’d have more time with your patients.

    • southerndoc1

      Completely agree. And think of all the time she wastes eating, sleeping, defecating. And then, on top of that, she takes time away from her practice to spend with her spouse and children. She may even waste time reading a book every now and then. A perfect example of everything that’s wrong with doctors today.

      • buzzkillerjsmith

        Def@$*%&#*.

        I’m the only one in this town who wears tight pants!

        • Alice Robertson

          Unfair to be so descriptive while fictionally faceless:)

  • DoubtfulGuest

    I think doctor bashing is frequently rooted in a sense of helplessness and intimidation. Specifically, the belief that more constructive feedback would not be taken to heart or even paid attention to.

    Re: the blameless apology, this is demeaning to anyone who was actually harmed by a doctor’s negligence. The public does need to be more aware of system errors and communication problems so we can contribute to possible solutions. Having empathy for physicians and caring about their stress are not mutually exclusive with assigning appropriate responsibility for medical errors and “bad patient experiences”. It’s actually some of us who have seen this dark side of the health care system who are most interested in making things better for all. We can celebrate the good people while taking an honest look at what’s wrong (very few bad *people*, but lots of processes, relationships and systems that need to be fixed).

    • Carla Rotering

      Thank you so much for your thoughtful response. I am in agreement that in the face of frank errors and negligence, our responses must be an appropriate reflection of these kinds of concerns in our health care delivery system – and I am an avid supporter of interventions at this level that include enhanced and appropriate communication, responsibility, process improvement, and an ever-evolving level of transparency. For those people we encounter in more casual circumstances, it is often comforting for them to hear our compassion, even when we have not been personally involved in a disappointing experience. Medicine itself – and our relationships with patients and the general public – is indeed complex, and my hope is that we will find many paths to lifting those relationships.

      • Suzi Q 38

        I don’t think I ever had a doctor that knew how to apologize. They are so fearful of litigation.
        Some think that they know everything, including how we are supposed to feel after a surgery, rather than what we are actually feeling.
        What we are actually feeling doesn’t matter, because I am supposedly making it all up to bolster a fake lawsuit.

        How about find out the cause of the problem, or go home.
        You talk about this cliche that people just “bash doctors.”
        Maybe there are some good reasons.

        Some doctors need a better attitude about how the patient must feel.

        Maybe start listening and caring rather than “running” from a difficult medical scenario that is the patient’s real life right now.

        Also, quit covering up for colleagues that don’t do their job or the right thing. Get annoyed and order the test yourself, because that is the right thing to do.

        • rbthe4th2

          AMEN. Just had a primary care doc tell me he couldn’t diagnose malapsorption or malnutrition. I have lost about 10% body weight in 2 months, with anemia, documented vitamin deficiencies, and low protein values. Guess they forgot how to read because I gave them the medical studies that said ‘here is how you do it’. Or maybe medical school no longer teaches you how to read them.
          and it is the docs who know about this and aren’t fixing the problem that are just as guilty.

          • Suzi Q 38

            Part of me is not all surprised that they don’t know every little detail of every condition.

            I had a problem after my hysterectomy.

            I was in the OR, and my surgeon was told that there was no cancer found in my uterus and ovaries that he had just removed. The plan was no cancer, no removal of lymph nodes. He didn’t take them out as per his judgment and my prior request.
            Days later, he gets another report from the head pathologist and it was disclosed that my left ovary had a borderline proliferating tumor in it.

            He kind of got annoyed, because he said that he might have taken out my lymph nodes if he had been given the information in a timely manner during my surgery as planned.

            I had to research the “Borderline proliferating tumor.” While it is what it is, a very rare tumor, sometimes they do not do anything, hence its name. It was not one of the more deadly tumors. Its action was like a sleeping animal, ready to pounce when it woke up…if it ever woke up at all.
            I told him that there was no need to go back in and get the lymph nodes, unless he could show me how this would benefit me after the fact (surgery). Who in the heck wants to have another surgery again?

            Anyway, he was kind of ruffled that I had a few studies with me with certain facts outlined.
            I left the studies with him.

            It is nice that you had some information.
            I don’t mind sharing the information with the doctors, if it involves my care.

            I guess sometimes they don’t recognize this or that in a patient or remember what the protocol is for treating it. It is a possibility that they learned it in medical school but did not get the actual clinical and patient side of it until he/she saw a real patient.

            This might have been the problem with my specialist, who is about 42 or so. This is still considered young for a gyn/oncologist, just out of his fellowship.

            My favorite publication source is “Up To Date.”
            I get some good information from that site.
            I think it is reliable…at least I hope so.

          • Suzi Q 38

            Are you feeling better? How did you become so malnourished?

      • karen3

        You missed the element of “compensation.” In serious medical error, there are costs. they are real. If I am looking at $2mil of lifetime costs with no way to pay them, transparency ain’t worth much…..And real measures to make sure that doctors and hospitals that make major errors don’t do them again is what really matters. It’s the substance, not the presentation.

    • DoubtfulGuest

      Edited to *potentially* demeaning…you are right, it depends on the context of the discussion.

  • Steve Sisko

    I’m 52 with 4 kids and have had many experiences with doctors; with the majority being very terse and rushed. I saw a urologist for literally less than 2 mins – in and out. I wanted to ask some questions and he muttered something about ‘make another appt. His office visit charge was $440! I think he became the thing he handles on a daily basis.

    More often than not, I have a better experience with the NP’s and PA’s than the MD’s. One criteria I use for de-selecting a doc is the opulence of his office and the type of car he drives. Superficial? Maybe…but I’m not sympathetic to someone who makes so much, often provides crappy service and then whines about how little he/she makes.

    A dermatologist I saw a couple years ago had two brand new S-class Mercedes parked out front: one for him and one for his bitchy wife office administer who wanted full payment up front PRIOR to services rendered. Guess what I did? Walked out. The lady was yelling after me to come back! It was hilarious. They continue to try to bill me $50 for the “missed appointment” and I continue to ignore them. I have to laugh as they must have spent twice that on pursuing me.

    Smart docs are getting with the program.

    • southerndoc1

      If your insurer’s fee schedule allows $440 for an office visit of any length, they’re a big part of the problem.

      • ninguem

        “Facility fee” perhaps?

    • Carla Rotering

      Thank you so much for bringing your stories forward and sharing your experiences. I was especially moved by your encounter with your urologist – and recognize that these kinds of encounters are exactly why I – and many of my colleagues, these days – are so deeply committed to making a difference in the lives of patients everywhere.

      • buzzkillerjsmith

        “Moved” is a strong word, Carla, better left for discussions of pediatric leukemia, unless of course you are lighter than the rest of us at this blog. How about “interested to read”?

        • Alice Robertson

          Gosh please forgive my curmudgeonish post but even Carla’s niceness is suspect. There is a female doctor who posts here. We call her Perky Pxx because she is all over patients with her supposed sympathy that quite honestly comes off sounding like platitudes. It feels like a way of drumming up more capitalism (you suddenly start to receive her Pxx posts inviting you to her retreats where she has the answer to all your ills).

          The truth is some patients see right through it and think her name is more like Pimp Pxx. Doctors have to be careful not to extend too many candy coated compliments.

          • DoubtfulGuest

            Sometimes people are really trying even if they talk funny…but I would like to see plain ol’ transparency instead of the ever-evolving kind.

          • Alice Robertson

            I definitely agree. Doctors are in a hard place, but there are a few doctors here I respect (that doesn’t mean agreement, but they add clarity because they are honest. The most honest ones are almost always anonymous). But sometimes it just seems a segment of doctors need coddled themselves and some are struggling with the school of hard knocks. A few times I have wondered….why didn’t you waiter or waitress for a while in school and get some thicker skin:) And some seem upset that you suggest a job during college (my daughter works full time in physical therapy as an assistant while perusing a degree in the field, then part time volleyball refs and fulltime college with cancer, so it’s possible)

            My point is it’s not the patients. We are no worse than complaining customers in a restaurant, but restaurants handle complaints better and the staff laughs it off. It’s other doctors that are their PR problems. It’s like teachers…there are about 1/3 rotten teachers, 1/3 average..do their job alright….then 1/3 spectacular. So it is with doctors and the 1/3 that should have chosen a different field wreck enough havoc that doctors can either spend their life feeling unappreciated or just do their job and focus on the patients who do desperately need good doctors while being more vocal about their screw up colleagues. Patients are why they exist and even with all this bureacratic peripherals the doctors focused on helping their patients and realizing complaints are part of the game handle the whole “sport” much, much better. They don’t need the accolades, they need to coddle the curmudgeons, their focus is on staying on top of the medicinal game and helping those who can be helped.

          • DoubtfulGuest

            Mostly agree, yes. :) I don’t know any really fancy doctors. From what I can see, mine range from comfortably middle-class to ramen noodle-level, perpetual grad student type poverty.

            I will concede that many patients I know, are really resistant to learning much about how the health care system works, or giving up their preconceived notions about doctors (e.g. that they’re all rich). So, there’s that, and the corporate interests take advantage of it. It seems particularly prevalent in people who are scared, because they suddenly need a doctor, some injury or illness has reared its head, when they were never previous heavy utilizers of medical care.

            Us seasoned folks, who have a serious ongoing illness or family member with same, have quite the eye-opening experience.

            What drives me nuts, is the way doctors get upset with us for all the things we don’t understand, but they won’t really let us understand, either. In the case of a serious medical error, it’s a black box, no one will talk, no one will let patients understand the facts about what went wrong. At least that’s my experience. I love facts! I want to understand.

          • DoubtfulGuest

            Also…the reason I want the facts is so that hopefully my and my doctor’s version of reality will come to match up as closely as possible. I have taken a mostly fact-based approach in trying to communicate with this doctor’s office about the mistake (I did mention the emotional effects on me but I kept this secondary to trying to resolve factual misunderstandings).

            Unfortunately they seem to think if anyone wants facts there must be a lawyer involved. Well, there’s not, not on my end. It’s just funny how we hear about patients being too emotional in response to mistakes, but a different approach isn’t welcome either.

        • Suzi Q 38

          BuzzKiller.
          You are a buzzkiller.
          If she wants to use the word “moved,” so be it.
          Do you have the “remote control” when choosing her words?
          LOL.

    • Suzi Q 38

      Tell her to save the stamp and the paper to bill you.

      I have specialists that routinely bill my insurance company $400.00 for an office visit of less than 15 minutes.
      They then write in the EMR report for the visit that they stayed and examined me for an hour. If it was 45 minutes I can see them claiming it was an hour….but 15 minutes??? You go figure.

      The insurance companies need to wise up with some of these visits.
      If they are follow-up, not let them charge as much.
      To be honest, I haven’t looked at the bills from the insurance company.
      I will now.

      • Cyndee Malowitz

        When you review your insurance information, remember that there’s a huge difference between what is billed to the insurance and what is actually reimbursed. For initial visits, I generally bill insurance companies $185. However, I get reimbursed less than half that. I don’t know anyone, including specialists, who are getting reimbursed at $400/visit.

        As far as the physicians documenting a 1 hour visit, but spending less than 15 minutes with you, well that’s fraud.

        • Suzi Q 38

          Thanks for your comments.
          I am going to pay a closer look on what was charged and why.

    • buzzkillerjsmith

      “One criterion I use for de-selecting a doc is the opulence of his office and the type of car he drives.”

      Even though you are 52 you are wise beyond your years.

      • Steve Sisko

        Thanks for the compliment!

        There are plenty of docs out there and I don’t need to finance ostentatious consumption and grandiosity and then turn around and hear how friggin’ poor these doctors are.

      • Alice Robertson

        Hmmm…..that’s insider info? So how would a groveling little layman find out what kind of car a doc drives? Okay…can’t resist and I like that you have a sense of humor…should patients check out the parking lot…the Bureau of Motor Vehicles? Ha!

        You know I really appreciate your honesty (and posts), but doesn’t that sort of mindset just feed the divide from patients who squawk about doctors earning so much more than them? Is it really a litmus test? I am completely sincere because you know I struggle with a daughter with cancer and quite frankly some of her doctors terrify me. I asked her specialist what he would do and he gave me an honest answer (this guy is blatantly honest to the point you sometimes you can’t breath). I responded, “But that’s insider info.” He told me I was right and that doctors and their families get better care. Fair enough…but I want in on that info…I want to crack that code.

        I am surrounded in opulence at Cleveland Clinic, yet, it’s not the doctors it’s conglomerated medicine in all it’s vain glory and blood sucking and absolutely glorious results at times. The best doctor I ever had (the one who became my friend) went skiing in the Swiss Alps, had his daughter in a $20,000 a year school (I think private schools are a great choice), and bought a gorgeous home from a big publisher in California. Yet, he was down to earth, would admit when he was wrong, brilliant. I miss him terribly.

        Yet, he may have been an exception. His wife is a doctor and with all they sacrificed they deserve to have money to blow?? I know I wasn’t willing to give up 14 years of my life for a specialty.

        • buzzkillerjsmith

          Nice cars are OK. I’m not talking Ferrari here, but the usual stuff that the semi-comatose lemmings (bless their hearts) who comprise the upper middle class drive, whatever that is. (I drive a 1999 Corolla–and love it!).

          Office opulence is more problematic and generally indicates too much money and not enough brains, or, as Ignatius J. Reilly would put it, no sense of geometry or theology. A rich inner life might also be missing.

          • Alice Robertson

            Nice things doctors own is a really bad litmus test. It may just mean they don’t mind having a debt load or like to pamper themselves, or have a huge mortgage. It’s just another choice we mere mortals make. We did a game once and looked up the doctors I hated and compared it to the doctors I liked. It was with an IT tech and I and we used the auditor’s office public online system. It was a real hodge podge of houses (with the docs married to docs living high on the hog….sorry….I don’t know how else to say it:)

            The really opulent offices are the plastic surgeons and you can sorta see why. The huge majority of their patients are vain (and often rich. They are a cash only payment system and tell you to show up ready to pay. My daughter had keloids after her plastic surgeon sewed up her neck twice, so the lasering was all on my tab). . But I used to keep my eye on the secret side door where the monied gals would supposedly sneak in.

            A doctor may just be a greedy bugger and drive a piece of crap….so it’s just not a good way to tell. I drive a Flex so I am driving a nicer car than some of the doctors here own up to and with three kids in college on my tab I figure it all comes out in the wash:)

          • buzzkillerjsmith

            We’re getting into deep waters here, Alice, but I would submit that a doctor (or another type of human) who doesn’t mind having a big debt load or who likes self-pampering or who has a big mortgage–I would submit that a person like that is ipso facto a deluded semi-comatose lemming whose preferences will not result in long-term happiness at all but whose foolish ways contribute in no small measure to the cultural, intellectual, and even environmental degradation that we see all around us every day.

            I of course exclude persons who take on debt for such things as education or to pay medical bills.

            As you might surmise, I don’t expect to be climbing the corporate ladder in the near future.

          • Alice Robertson

            Well….I don’t find debt to be a personal indictment of capability. Now that said…(watch Alice get in trouble here) when my daughter became a nurse a teacher out-of-the-blue asked the class who had filed for bankruptcy or had plans to. It was incredible that only my daughter and another gal didn’t raise their hands.

            So is that a condemnation on nurses too?

            And we know historically doctors have a poor track record of repaying student loans (remember the shows where they would track them down and ask why they were earning all that money and not paying back their loans?) My one doctor friend said it was the talk of medical school who had no plans of paying back or how to get out of it. She claims only she and another doctor weren’t in it for the money. Yet, she bought a million dollar home recently (and she is a patient favorite and a great doctor).

            I have a frugal living orthodontist and his equipment is old, his office old, and his skills are old. I really do think it was his old xray equipment that caused my daughter’s cancer. I remember with horror after her diagnosis going in for my youngest daughter’s braces being removed. I saw that old Pac Man sticker that had been there over 15 years before when my son got his braces there. My heart sank. The guy is a proud cheapskate.

            Hope that sums up why I am unimpressed with frugality among doctors. I don’t care what year the car is they are driving, or where they take vacations. I care that they take the time to keep up on research, that they listen to their patients, and aren’t going to scrimp on important medical needs of their patients.

          • buzzkillerjsmith

            I did not know about the poor track records of docs. If you have comparative data on how that varies among professions, I would be interested to see it.

            Money management is hard. It involves both math and controlling one’s emotions. I realize that.

            Perhaps you are familiar with the academic literature on consumption and happiness? The psychologists and economists have done quite a bit of work on this, and the upshot is that consumption gives a shot of satisfaction in the short term and this satisfaction wanes quickly and folks get pretty much back to baseline. Most people gain longer term satisfaction from personal relationships and more free time and experiences. If you Google “happiness and materialism” you’ll find lots of info on this. People are often on what is called the “hedonic treadmill,” meaning they must consume more and more to regain the happiness that has waned since the last consumption episode. I have seen this in myself, which is why I try not to buy much expensive stuff.

            Another factor, here is that people want status in this society and consumption is a marker of status. But we docs have instant status. All the docs here have experienced this. So why buy all the extra stuff. I don’t get it.

            It is certainly not my place to tell people how to lives their lives. I would submit, however, that docs, at least the ones I know, like to live large and are very liable to the consumption-happiness trap, perhaps even more so than non-docs.

          • Alice Robertson

            I agree that materialism doesn’t bring happiness. My six kids make me deliriously happy:) And I gave up having a lucrative career based sheerly on the fact you mention….that money wasn’t our objective in life. But the consumption and happiness data just changed. It was in TIME magazine a few weeks ago (wasn’t it around the quarter mil mark the happiness factor ended? That’s what changed).. I will search around because years ago doctors defaulting on student loans was a big issue. Now I think about half of students are defaulting so it clearly is something across all professions and the government has gotten a bit more pro-active in pursuing them (I am sure the digital era has made it much easier to track people’s financials).

          • Alice Robertson

            I went to google and put in “Doctors defaulting on student loans” and because links cause moderation I will leave you to go to google but the thread said doctors were at one time some of the worst offenders (but the article shows they are doing much, much better, and one has to differentiate between a complete default and a temporary one). The first article that pops up goes into deadbeat doctors and that really means the ones that have quit practice and can never pay back the $116 million they owe [and that's for a bit less than 1,000 deadbeat docs]. Thankfully they are a minority, but in fairness teachers and others owe tons of money they defaulted on (their student debt would probably be much less?). It says the government had to start banning Medicaid and Medicare payments of deadbeat doctors with a public shaming list (which is a bit unfair for some). Anyhoo…..it’s interesting and another one of those items where your colleagues are hurting the doctors who are doing their job and paying back their debt.

            “Payback can be a bitter pill for the nation’s deadbeat doctors.

            The government has seized tax refunds and unemployment checks,
            claimed judgments against them in federal court, banned them from
            billing Medicare and Medicaid, even posted their names on a public
            shaming list”

          • Alice Robertson

            Here is the TIME mag if you are interested. It was interesting to see the data (and disappointing on some levels because I really do think wealth is just wallpaper on life. I put a discouraging quote from the article (I mean 11% of 18 year olds depressed?)

            The Happiness of Pursuit” [July 8 / July 15]

            Americans are free to pursue happiness, but
            there’s no guarantee we’ll achieve it. The secret is knowing how — and
            where — to look

            By
            Jeffrey Kluger
            Monday, July 08, 2013

            snippet: Since 1972, only about one-third of Americans have described themselves
            as “very happy,” according to surveys funded by the National Science
            Foundation. Just since 2004, the share of Americans who identify
            themselves as optimists has plummeted from 79% to 50%, according to a
            new Time poll. Meanwhile, more than 20% of us will suffer from a mood
            disorder at some point in our lifetimes and more than 30% from an
            anxiety disorder. By the time we’re 18 years old, 11% of us have been
            diagnosed with depression.

          • Alice Robertson

            Oh yes, I forgot to say thank God you aren’t climbing the corporate ladder. I think it’s doctors with the AMA, administrators, docs working with AARP, etc. who are the real problem with doctors. The compromises and money hounding these doctors use have done more harm than good. I am all for capitalism (not the Ayn Rand type though…gosh I hate that gal:) but the tactics of a percentage of physicians is abysmal and a scourge on your professionalism.

            So, I say….clap, clap, clap….you will do far more benefit to mankind to stay put and keep talking because it’s the top of the corporate ladder that is a type of prostitution of physicians good name.

          • Tamara

            Any doctor who’s a friend of Ignatius J. Reilly is a friend of mine! What state do you practice in?? :)

    • Yale Lewis

      Who are you kidding.You must have know the billing policy of the office before you wnet for your appointment! Why are there more examples of Dr bashing in the comments?!?!? WTF!!

      • Steve Sisko

        Are you serious?

        1. How many docs offices will share their rates before the visit?
        2. How would you even know what to ask for before a visit?

        Like you so eloquently state; WTF?!

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

    It may be a tad too late for saying please and thank you, or marketing oneself as a caring professional (sounds a bit weird anyway).

    The bashing of physicians is not occurring because “consumers” gained access to the Internet. This is a relentless, well-coordinated and well-financed public relations effort to transfer control of the trillion dollars health care industry from individual professionals to corporations.
    The first step is to convince patients that they are “consumers” and doctors that they are “providers”, and buyers naturally should never trust sellers, and the transition of power/trust (and profit) is then complete.

    • ninguem

      Well said Margalit.

    • DoubtfulGuest

      Agree…there’s an insidious spread of “consumer” language when patients talk to one another. It’s kind of creepy.

    • Suzi Q 38

      You make a good point. It is so true.

    • ComplexNumbers

      The “Parent/Child” relationship in medicine is dead…let me repeat..D..E..A..D.
      We demand to be called ‘customers’ and not patient. We will call you ‘providers’. As long as We are all engaged in a capitalist for profit system then that is the reality.
      Anything else is allowing doctors to play both sides of the fence.
      Your profession can flatter itself with titles all day long after we are done with the ‘transaction’.

      • Kaya5255

        You have hit the nail on the head!!!
        I am a customer, of healthcare!!! I see a “provider” of healthcare services. As a customer, I want to hear all of my options and then I will decide what’s best for me.
        Last time I looked I didn’t give up my right of selfl-determination!!

    • Noni

      As usual, spot on. As a patient, I can navigate this awful system. As a parent, I am concerned and terrified.

  • ninguem

    Ambrose Bierce (1842 – 1914) From “The Devil’s Dictionary”, first published 1906 as “The Cynic’s Wordbook”, and re-titled “The Devil’s Dictionary” in 1911.

    Physician-bashing has a long pedigree.

    PHYSICIAN, n. One upon whom we set our hopes when ill and our dogs when well.

  • buzzkillerjsmith

    I agree that the level of professionalism is higher now than it used to be. Good, yet inadequate. Here’s the thing: doctors are not in control of their professional lives. CorpMed and the government are.

    Recall the squeeze theorem from elementary calculus. If CorpMed and the feds go to ground and we are under them, we go to ground too.

    It’s da system, baby, not its factors of production.

  • karen3

    I am a bit puzzled. Once again, the doctor bashing is viewed as a “communication” or “perception” problem. How about addressing the real cause of patient skepticism. The death toll. Medical error, if reported in CDC statistics, would be the third leading cause of death. 180,000 Medicare patients die each year due to preventable medical error. Millions are injured — per HHS OIG – with physician reviewer based data. The medical profession exercises virtually no oversight over its members, allowing people like Kermit Gosnell to practice decades with no problem. Instead of being happy shiny, why not focus on the substance?

    The “blameless apology” does not work; accountability does.

    • ninguem

      Kermit Gosnell has absolutely NOTHING, ZERO, to do with any physician “conspiracy of silence” and the usual stories.

      It has EVERYTHING to do with abortion politics.

      It was made abundantly clear in the grand jury report, doctors at nearby hospitals treated Gosnell’s disasters, and reported the cases as complication of abortion procedure, pursuant to Pennsylvania law.

      They were ignored.

      Go after an abortion clinic or abortion practitioner, all that happens is you get mau-maued, a wardrobe full of coathangers waved in your face. You’re the evil Taliban mysoginist male Republican for wanting to regulate abortion in any way. And Casey, the Democrat governor, was pro-life, and Ridge, the Republican governor, was pro-choice. Go figure.

      So the state ignored the physician reports.

      • VanessaObRN

        So the doctors treating Gosnell’s patients downgraded his disasters as “complications” to the medical board? Talk about soft pedaling. After all, aren’t all patients warned of the possibility of “complications” in any kind of surgery. No wonder the complaints were dismissed.

        Perhaps the good follow-up doctors just didn’t want to get into the messy arena of testifying against this butcher.

        • southerndoc1

          Complications include everything up to and including death. There is no “downgrading” in using that term. The doctors at nearby hospitals would have had no knowledge of the killing of viable infants at Gosnell’s clinic. Direct your outrage more appropriately.

          • Alice Robertson

            Yes, the mothers are culpable too. And maybe society.

          • DoubtfulGuest

            Points taken. However, I’ve noticed whenever we bring up medical errors on this blog it seems like patients tend to get corrected, downvoted
            or ignored by the physicians. Any idea why? Or…maybe I’m wrong? ;)

          • VanessaObRN

            So the results of willful disregard for a patient’s wellbeing resulting in predictable harm or death is called a complication. Nice and neat. No blood on anybody’s hands.

          • ninguem

            This is really great. Try to regulate abortion in any way and you’re mau-mau’ed as evil mysogynists, coathangers waved in the face, and I can see all the pithy sayings now “if you don’t like an abortion doc’t have one”, on and on.

            Apparently, because I haven’t tried to bomb an abortion clinic, personally shoot Kermit Gosnell, or use inflammatory language instead of medical terms, I’m Josef Mengele or a little Eichmann.

        • ninguem

          Are you really a OB nurse?

          • Guest

            Probably. They spend so much time in labor rooms they often can’t see the forest for the trees. Forgive her.

      • Alice Robertson

        Yes and because of these complications he decided to deliver the babies and just kill them after birth. And saved their body parts.

    • karen3

      Ninguem — Gosnell’s treatment by the medical board was “nothing special’ and “business as usual”. The going viewpoint is that doctors are emotionally fragile and it ruins team spirit if we actually address patient harm and hold people accountable. Instead, the vogue is to talk about “systems” and “processes” as if there are no incompetent doctors out there – which any patient could tell you there are.

      Mention an error that is obviously not a “system” error, you will get a long screed about how we should feel sorry for the poor person who spent so much money on medical school (violins playing) without a word about the impact, personal and financial, on a patient with serious harm. The person facing millions in costs due to serious medical harm will be labeled as greedy and worse. In fact, many such people have difficulty getting care because other physicians won’t acknowledge the harm.

      If the system wants to be “patient centered” it needs to address patient harm in a way that has much more meat that ‘blameless apology.” :Accountable apology is more appropriate. And accountable profession is what builds credibility.

      The plain fact is that if the third leading cause of death is medical error (not bad outcomes, but error) people will not trust the medical profession until it cleans up its act.

      • DoubtfulGuest

        Well, sometimes it’s both…from what I can see about the medical error I suffered – (wait, I mean, received? does that sound better and less confrontational? ;)) there was a combination of a bunch of system errors and some personal doctor error (things that went wrong during our communications, e.g. history-taking with the doctor not giving me a chance to explain and getting really mad at me for something I did not do).

        I found out through my own research (no one will talk to me) that this doctor IS suffering, too, is in a very bad place financially, and probably was at the time made the mistake. I do feel sympathetic to many doctors because they have the same symptoms and troubles for which they try to treat us (e.g. chronic pain, severe fatigue) but there’s no help for them. Particularly with mental health problems, they suffer alone.

        However, it bothered me yesterday that they piled on about your Gosnell example without addressing your main point about medical errors and patients who are harmed. I’m under the impression that you also suffered from a doctor’s mistake? We can’t just keep going around and around about who has it worse. It’s as though patients who are harmed by errors should just keep quiet if we also care about our doctors…as a sort of pressure valve on an impossible situation? Surely we can come up with something better?

  • drll

    I think I will take a hallucinogen and go to sleep. Hopefully I will wake up in the 1970′s and can start thinking about my career choices all over again.

  • Alice Robertson

    I agree and tend to think the AARP needs to get their hands out of the cookie jar. They are too powerful and using that power in a way to suit themselves is like our reps and their secretive meetings with insider info where they can invest or sell to hedgefunders and make millions. Then they acted like they would support legislation to end the practice, but I read recently that may be a farce and they overhauled it.

  • pmanner

    Amazing. A column on doctor bashing turns into a forum for, yes, doctor bashing!

    Allow me to retort.

    With respect to nutrition, which seems to be a favorite topic for the worried well: we simply don’t know what diets work best for a given person. Some people can scarf down pancakes and cheetos their entire lives. Some subsist on eggs and bacon. Some eat rabbit food. Frankly, I don’t care what you eat. I’m not your mother.

    With respect to you being able to read a medical study better than your doctor: no, you can’t. We read them all the time, and the sad fact is that studies are like subways – there’s another coming along in a few minutes going in the other direction. This morning, there are 453 new articles on Pubmed. After 20 years, you develop a healthy BS detector. Sorry if that offends.

    With respect to deciding whether your doctor is good or bad depending on the car he drives, and the condition of his office: the depth of your shallowness is miraculous. I suppose I could do the same, and treat you differently depending on your zip code or whether you drive a Lexus versus a Chevy, but I try not to. And yes, you should pay for your appointment.

    The short answer is that you should be responsible and care of yourself. Eat less, exercise more, don’t drink too much, don’t smoke at all, and read a good book every now and then. If you don’t, there’s not much a doctor can do for you.

    • BettyL

      Your tone is antithetical to the medical notion of good bedside manner and confirmation that some doctors have become disgruntled to the point of being a detriment to the profession. Have you considered plumbing? (Not me! Ha, ha!)

    • Alice Robertson

      While I agreed with some of what you shared but I have to share you are wrong on medical studies…well you are outdated in your thoughts. I know this saddens doctors (at least those commenting on the new practice) but the Wall Street Journal reported on peer reviewed papers wrote by…..oh no…..real people (is there a difference? Ha! Teasing alert!) Anyhoo…..I am sorry but just as you were trained to write or read research so can a layman learn (no they aren’t tested because they aren’t practicing medicine, they are reporting on research and that’s quite learnable). And who better than a mom of an injured child, or a person looking for a cure for cancer? It’s still peer reviewed (and that’s problematic….like juries….but a good litmus test…usually…unless pharmaceutical eejets are involved:)

      Just so you know a specialist didn’t read my daughter’s lab report. He was trained well….works at Cleveland Clinic…but he simply didn’t care (he did it twice and cancer spread and went to a stage three in the eight months he was negligent).

      I am on a pediatric cancer list and the moms there are much better at explaining blood test results than my doctor. There is a place for both at the table.

  • Karen Steward

    Carla has a great point-and one worth putting in motion. When these “satisfied customers” begin speaking out, both sides of the patient-doctor relationship will benefit.

    Doctor bashing would go by the way of the dinosaur if only the medical profession had an ear to hear. The power, I believe, is in your own hands. I know this posting won’t get off the ground, as I can already feel the HIPPA hand encircling my throat, but I am going to post it anyway.

    Nothing helps an ill patient more than the ability to read someone else’s good experience with a doctor. Rather than blindly searching for a doctor and being at a disadvantage during a stressful time, (illness) the system should be reversed. Whether the medical profession likes it or not, today, most people google their symptoms. If an ill person feels he or she has been misdiagnosed, not heard by the physician, etc., google becomes the next doctor in line (and many times the first). With doctors rushing through appointments these days and sending the patient out to specialists for the dissection process (instead of seeing the patient and his or her symptoms as a whole) those who are ill simply do not have the energy or finances! to endure the doctor hopping required in order to find a doctor who will get to the bottom of an illness.

    My oldest daughter suddenly became ill at age 13. The first year of her illness was all consuming-and we were just trying to get a proper diagnosis! During that year, she was wasting away before over very eyes. It was a terrifying ordeal for her-for our entire family. Finally, we were told she had Crohn’s disease. Prednisone to the rescue. Ahhhh, she could finally eat without vomiting. Well, for the first two weeks, anyway.

    We had barely heaved that sigh of relief when the monster reared its ugly head again. Doubled over in pain, nausea, vomiting, ER runs, bouts of pain so severe she was screaming, beads of perspiration on her forehead, yet my husband and I were often treated as “hysterical” parents by the gastroenterologist. We were told, “This is typical of Crohn’s disease-and you must accept this illness.” How comforting.

    Several things caused me to believe our daughter had been misdiagnosed. I began to ask questions, then more questions. (Anyone hear a loud buzzer?) All hell broke loose. How dare I question if my own child had been properly diagnosed.

    The doctor saw her 10-15 minutes, informed us of her current sed rate, prescribed more prednisone, and told us to live with it. We would return home, oftentimes with her lying in the back seat dry heaving in a trash can, and continue to deal with these constant “attacks” of abdominal pain. I couldn’t help my daughter-and the medical world said she had to live this way.

    Fourteen years later-and only because of our own determination- our daughter became totally and completely well once again. Just as well as she was before her life was turned upside down the summer of 1988.

    From age 13, until age 27, she needlessly suffered, yet a mere 4-hour surgery in Europe made her well. She is well today only because our family refused to give up the fight to find out what had really gone awry in her body.

    Back then, when I was googling symptoms, how nice it would have been to be able to read some OUTSTANDING-get-to-the-bottom-of-the-illness physician names pop up alongside my search terms “abdominal pain, nausea, vomiting, misdiagnosis.” etc. Yes, I could find doctors with those search terms, but nothing actually linking specific symptoms>illnesses>doctors who treat>highly recommended>……..You get the idea. Instead, it was a blind, random, pin-the-tail-on-the-doctor attempt each and every time we tried one more doctor, to no avail. We spent a small fortune going in and out of doctor’s offices; our poor child enduring the agonizing drive, misery, repeated tests, as we went along.

    Lastly, it would be nice if the USA medical profession would stop the adhesions coverup. Of course, that is just an opinion from a hysterical mom who almost lost her child.

  • BettyL

    I don’t consider myself a “doctor basher,” but I am a patient who has come to speak out about a multitude of health care experiences that range from inconsiderate to criminal. As a researcher, I have found corroborative evidence – much of it from within the global medical community – that there is a health care crisis in American society today. Healthcare is drastically different from the care the average person used to received when we considered doctors among the “most admired and respected persons in the community.” In the last generation of medical training and healthcare models, several things have changed from those “good old days” that have physicians on the defensive. 1. Decentralization of healthcare in favor of the specialty model. A patient used to go to one doctor for care and expect it to be managed by one physician who knew the family. Now a patient is apportioned out by body part to a litany of “specialists” with little to no coordination or oversight. The family doctor position is actually an endangered species as one of the LOWEST paid positions in the health care pecking order. The specialty model has driven up the costs of health care and has too often left patients without an advocate to coordinate disparate treatments, tests and diagnoses. 2. “Managed care” has placed control of medicine in the hands of profit-focused business people and out of the hands of compassionate medical professionals. That’s the reason why doctors today are “demoralized because they have less time with patients, more demands and requirements, and mounting stress” 3. Some stressed-out, demoralized physicians who expected to be deified post-MD are angry and vindictive. I actually had one doctor advise me to beware of doctor bashing because here in the midwest where I live, doctors have a kind of inbred community where they go to the local medical schools and then hire into the local medical centers (none here rates above a 3 on a 5-scale compared to facilities nationwide; 80% are rated one). These doctors know each other and have a sort of network in which they will brand a patient a problem and will coldly and cruelly refuse care to the danger and detriment of a patient’s health. 4. The combined trifecta just described has resulted in some just plain bad doctors practicing medicine under a defensive healthcare system. Too many doctors today lack the conscientiousness and compassion that once commanded respect. I had the experience of one bad doctor who I found was notorious amongst his peers. “Are they still letting HIM practice?” I heard from more than one physician subsequent to firing that doctor. No…YOU’re still letting him practice and be counted in your number. Ultimately the way to stop bad doctor bashing is to do a better job of policing yourselves and your colleagues – refusing to allow the bad apples to spoil your hard work and reputation. Other solutions? Increase PCP salaries; decrease specialist “rock star” rates; and cap profits on medical institutions. We don’t want to bash doctors, we’re just dying to be treated well.

    • Mike

      +100

  • Melvinbrand

    Doctors aren’t so bad, it’s HMOs that are pure evil. My goal is to have twice as many doctors as we have now and exactly zero HMOs. My goal is to destroy the HMOs’ ability to sue people for stating the truth about them by initiating medical-free-speech laws with regards to huge medical institutions. This would not apply to individual doctors working as sole practitioners or in small groups. But rather, I want to create a set of laws that allow us to verbally rip the HMOs to shreds with no fear of lawsuits from them. Once we can publish books full of nothing but the horror stories HMOs produce, we can get the public will up to break down all the laws that shield HMOs from accountability. (And that means getting Binding Arbitration laws, at the Federal and State level, off the books entirely. No more of the Arbitrator hacks. We want real courts. I’d like to see each of these HMOs blasted in the press, in books and in court till everyone working in those buildings wants to flee. And, I’d pay my life savings to be the one in the seat of the wrecking ball that eventually takes down the HMO’s world headquarters.

    • Steve Sisko

      Tell us how you really feel about HMO’s.

    • Guest.

      Medicare and Medicaid are no Saints either!

      • Melvinbrand

        True. But, I have the unique advantages of having five-year or ten year tours of all three models. And here is the main difference I find. With Medicare and Medicaid, although they’re evil too, there’s tons and tons of recourse for the activist. They are public entities, and, as such are owned, partly by me, and you. What does this mean in terms of patient activism. It means that you can first complain to your doctor; if that does work, the hospital; if that doesn’t work, to the county administrators of those plans; if that doesn’t work, to your congress woman; if that fails, your Senator; if that fails, the Federal HHS Secretary; if that fails, the Vice President of the United States; if that fails, the President of the United States. Using this route, combined with available charities, media outlets, and generous doctors, I have never failed to get hat I needed, no matter how expensive, no matter how much expertise and equipment and facilities and/or money was required. Kaiser was able to shut down all recourses in about a week: Here’s now it went: 1. Complain to doctor. The doctor doesn’t even speak English, hates even being in California and only became a doctor in another country because he heard a rumor you could get rich being a doctor here, which, increasingly, is false anyway . . . which means this poor woman came all the way from Pakistan to find out the US is a bunch of wankers, just like her country. Okay, so she doesn’t give a hoot. 2. Go to patient Ombudman who is paid by Kaiser to see if she wants to oppose Kaiser? Um, what? So, unless she’s insane, she’ll rule against you too. 3. Try to go to court. The court rules that ERISA trumps all State and Local legislation and regulations, and hence, per ERISA, 99% of the time, you are summarily denied access to any further legal discussion, period. All recourse now over, forever. Good bye. So, I’ve done far, far, far better under a system where I am, in essence, as a tax-payer, viewed as the owner and boss, as opposed to a pleading patient with zero rights, zero standing, zero ownership and zero recourse. So yea, all insurances are evil; but Kaiser is the ZERO RECOURSE zone, and so, while they are all initially just as evil and greedy, Kaiser is the one that is the best in the world at blocking any further input from you. Of course, since we’re all hoping Kaiser will save us from really having to pay for a really real healthcare system with REAL DOCTORS, which Kaiser doctors are the most hollow shadows of on earth, then, I really can’t hang with them existing at all, which is why, in fact, in my lifetime, I intend to see them shut down.

  • Carla Rotering

    What an amazing diversity of perspectives and responses! Thank you all for placing your voice into this important conversation – for sharing your experiences both harsh and hopeful – in a way that invites each of us to consider the incredible complexity of today’s Medicine. As we learn to “see” through one another’s eyes – the more enlarged our vision actually becomes – and we develop more clarity around a future path that grants dignity and fulfillment for patients and health care providers alike. I’m grateful that every response to this post has served to nudge my mind toward an expanded way of thinking. Thank you!

  • Christian John Lillis

    With all due respect to Dr. Rotering, her article completely misses the reason why so much “doctor” bashing is occurring. First, let me stipulate that I have three doctors and several nurses in my family and I think the world of them, as I do the doctors that I entrust my own care to. That said, millions of Americans are unnecessarily harmed by medical errors and preventable infections every year in the US, causing untold deaths and trauma – both physical and emotional – and costing our country hundreds of billions in excess healthcare costs. Sadly, the majority of doctors remain silent about these issues and in too many cases medical boards lobbying against any meaningful accountability.

    Doctors can regain the public’s esteem by doing three simple but courageous things:

    1) Speak publicly about the depth and breadth of patient harm, it’s causes and how we can collectively make healthcare safer. If you work at a hospital with lax sanitation, insist on better instead of chalking up preventable infections to an unavoidable side effect of treatment.

    2) Call out the doctors in your midst who are genuinely bad actors. Those with substance abuse problems, those who perform medically unnecessary surgeries, those whose bad outcomes are unreasonably high, and those who are unethical. Insist on forceful application of existing laws and disciplinary actions by your licensing boards for those who are doing wrong.

    3) Disclose and insist on disclosure of any potential conflicts of interests that can occur when taking money from industry.

    I’m sure others have additional ideas and thoughts but those three would go a long way to restoring public trust.

    • karen3

      I would add that address the genuinely bad actors — both facilities and individuals — is a critical step in protecting reimbursement rates. It is not an unlimited pie. So when doctors run up huge bills through misdiagnosis or as the results of harm, which can run into the millions, it’s less for everyone. The 5-10% who are genuinely incompetent are the ones to blame for the current litigation system and the costs of premiums. If it takes five doctors, with thousand of dollars in fees, to get a diagnosis, there is less for doctor six, who gets things right. Rates should have a relationship to value. If physicians in general are a poor value due to poor diagnostic skills and poor reliability, the rates go down for everyone.

  • cannotsay

    Not to mention that there is a whole so called “specialty” of medicine that is a quackery, ie, psychiatry, which keeps destroying people’s lives with its drugs. One of the sad effects from keeping this quackery under the protection of the AMA is that its corrupted practices are corrupting the rest of medicine. Practices such as disease mongering, ghost writing, Big Pharma bribing of doctors, prescription “for life” of poisonous drugs that have no efficacy, etc which were once confined to psychiatry are now beginning to pop up elsewhere (the prime example is hormone replacement in menopausal women that was shown later to increase the risk of cancer). So as long as the AMA continues to protect the APA, doctors will continue to become increasingly quacks and doctor bashing will continue to be increasingly popular.

    • Christian John Lillis

      I don’t think it’s fair to label all of psychiatry as quackery. There are many proven, non-drug methods for treating a variety of mental illnesses (like OCD, PTSD, etc.) and many mental illnesses that do respond to drug treatment (schizophrenia, bipolar disorder). It is sadly very true that Big Pharma and the insurance companies have bastardized much of psychiatry and reduced it to “pop this pill”, but there remain excellent doctors and therapists helping lots of Americans.

      • cannotsay

        Not a quackery? What do you call a specialty that keeps promoting scientifically unproven mantras of “chemical imbalances” when the only thing they do is to create labels for behaviors the DSM committee members do not like. That psychiatry is nothing more than a bunch of biased self appointed mind guardians generators of labels was made even explicit recently by the director of the NIMH. In May this year he said,

        “While DSM has been described as a “Bible” for the field, it is, at best,
        a dictionary, creating a set of labels and defining each. The strength
        of each of the editions of DSM has been “reliability” – each edition has
        ensured that clinicians use the same terms in the same ways. The
        weakness is its lack of validity. Unlike our definitions of ischemic
        heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a
        consensus about clusters of clinical symptoms, not any objective
        laboratory measure.”

        There you have a very explicit characterization of psychiatry as a quackery. It might be as well the case that those behaviors that DSM people pathologize because they say so are caused by unicorns in Mars when they are sexually aroused (said unicorns could generate very strong electromagnetic waves that interfere with some humans’ brains causing them to behave in ways that DSM people do not like). Nobody has seen these unicorns just as nobody has produced a single biomarker for any of the DSM invented labels. From where I stand, I take the unicorn theory as valid as the current psychiatric paradigm.

        • Alice Robertson

          Won’t it grand when MRI’s can diagnose what is currently the intangible (way too much guesswork going on). You brought up the DSM …Psychology Today has had some great writings from Leonard Sax, MD (his books and writings are honest…realizing he is not a favorite of the psychiatric world). His one article, in particular, was worth reading…and unfortunately the title may ring true with some in the psychiatric community: It feels like that old Dylan song, Everybody Must Get Stoned! :)

          Now You too Can Be Diagnosed with Schizophrenia! It’s at the Psychology Today site. Just put the docs name in the search bar.

          • cannotsay

            It made laugh :D. Or you can be declared mentally ill for stopping taking your latte :D. Truly, if it weren’t because of the thousands of lives ruined by psychiatry, this would be just a bad joke. Psychiatry has never found a lie it didn’t like nor a drug it didn’t like to prescribe to please Big Pharma :D.

        • Christian John Lillis

          I’ve read those same critiques and there is some validity to them, particularly the social control or normalizing effects. And I’ve been very outspoken about the horrors of the new DSM. That said, bipolar disorder, schizophrenia and many other illnesses are incredibly disruptive to people’s lives and there are non-drug therapies that are very effective in helping sufferers to cope and have healthy lives. You’re also not taking into account that just because we haven’t identified a physical cause for schizophrenia or bipolar disorder doesn’t mean we won’t. We just discovered what the spleen actually does!

          • cannotsay

            Again, just because nobody has seen those unicorns, it doesn’t mean that
            they are not real or that their waves do not cause what people here
            call “mental illness”! Really, I hope you realize how silly you sound.
            The only thing that neuroleptic drugs have brought to those people is a
            shortening of 25 years in their lifespans together with all sorts of
            secondary effects. People do recover from extreme mental states . In
            fact, rejecting DSM labeling can be the first step towards a very
            fulfilling life www dot openparadigmproject dot com . Psychiatry is an
            unscientific quackery that has ruined more lives than we can count.
            Among other things, psychiatric drugging is responsible for a 30%
            increase in the rate of suicide (CDC data).

      • f. lusu

        yes,i feel that psychologists are extremely helpful. they provide support when their client is falling apart from anxiety/situational depression. they teach skills and techniques to get them past their issues, which helps them with self- confidence,it might take some time,but it’s better than toxic chemicals. so… why don’t psychiatrists refer patients over to a psychologist, before drug treatment is started so they can see if there is any improvement in their anxiety/depression?

        -$-

        -there is a corrupt alliance between psychiatrists/drug manufactures-

  • overdoneputaforkinit

    The author’s solution to “doctor bashing” is to have the patients with successful treatment counter the patients with poor treatment outcomes. It goes to show that medical culture knows little about free-market forces, because medicine has always been insulated from the consequences of the free market. What is changing is that people are applying free-market rules to the medical industry whether it likes it or not. Secrecy and information hiding no longer prevent patients from the information they need to judge care. The Internet lets patients talk to each other about their experiences. Third party research and reporting disclose ratings about costs, quality of care, and outcomes so people have standards to base their experience on. The medical industry is losing it’s long enjoyed monopoly of control over the information about itself.

    • cannotsay

      Exactly! Doctors in the UIS and elsewhere just got too used to be treated as “gods”. Every time a monopoly or oligopoly has been broken there have been doomsday predictions by those who had the most to lose from the new regime. In this case, it is doctors who are predicting the end of the world; the only thing that is coming to an end is having doctors making outrageous amounts of money because they suppress competition. Doctors: welcome to reality!

  • Anthony D

    With the media and many in society that thinks negative to doctors, is it theoretically possible to stop such a thing?!

  • Guest.

    I think it has a lot to do with jealousy and envy. It takes a lot of time, energy and resources to become a healthcare worker like a physician. So seeing there is a certain amount that are practicing today, many feel it was a “shoulda,woulda,kinda” for them or they couldn’t find it feasible to be one!

  • Guest.

    No mention of the American Medical Association and its hundred year embargo on the supply of physicians? It wasn’t until a few years ago that the AMA stopped preaching about a future physician surplus and finally admitted that a physician shortage was on the horizon. Also, last I checked, the Federal Reserve does little to determine the interest rate on student loans, that would be Sallie Mae. While the interest on a secured loan for something like a home might be less than
    5%, student loans for tuition purposes are closer to 8%. Absurdly low interest rates aren’t driving increases in medical school tuition – it’s the fact that schools do not have to compete for students because of the large availability of loan money, regardless of interest rate, and the fact that there are 45,000 medical school applicants for something like 18,000 seats..

  • Sara Stein MD

    I love this post. Well said

  • morebuzzkills

    Eh, the tidbits in this article could definitely help improve the image of physicians. But the reality is that the problem is much deeper than the superficial points raised in this piece. There are societal factors and intrinsic characteristics of the profession that have driven much of change in how physicians are viewed by the public. Furthermore, it’s not unique to physicians. Walk into any public school and look at how teachers are treated. Professionals are not respected as they once were. Try telling teachers that their path to polishing their public image is by improving their quality metrics and being more empathetic…

    • Rita Chobanian Swisher

      Spot on. I was just going to say that teachers, police officers, fire fighters etc. are treated with the same disrespect and disdain as doctors are. We have become such a whiney, spoiled, entitled, snotty “me me me” society with zero regard for anyone else’s well being.

  • Tom Eleson

    Marketing ones self as a caring highly skilled professional? Where does the breakdown occur? I think the breakdown occurs while the patient is in your office so marketing has little to do with it. You either are or you aren’t perceived by the patient as a caring highly skilled professional measured by the care they receive and the results of it.

    Health care is all about marketing. Medical care is what I receive from a provider while I’m in a providers office. Because of my situation it does not make me healthy. What it does do is help me get through another day, week, month or year. So why is it called Health Care? Perhaps it’s because you want me to believe you can make me healthy? The truth is? You can’t.

    Methotrexate is frequently prescribed for an autoimmune disorder that I have. It was developed in the late 1940′s. It is reasonably priced and in my case and for the case of many it is the most effective treatment. 25mg a week costs about $1200 per year. I have been on it for 20 years. I have also been on Prednisone during this period of time, daily for the first 5.5 years, then a five year period using bursts for flares and daily again for the most recent 7 years..

    Several biologic treatments ranging from $16,000 to over $70,000 a year have been developed in the last fifteen years.They are very costly. If used early in the disease they can help achieve remission. Remission is not cure. The long term effects are relatively unknown. By patient testimony when they do work it’s usually for 2-3 years. In my case and the case of many they did not work at all. In most cases the patient is left on Methotrexate. How well would the biologic treatments work without Methotrexate?

    The truth is the truth. The perceived truth? That’s a completely
    different animal! Is that all your attempting to do? Regulate the truth?
    Modify it? Is it all about appearances? That’s marketing.

    Is it about Medical care?

    That’s all I want. Reasonable Medical care.

    Ask your patient!

  • Ronnie Dean

    Unfortunately the problem is not going away and growing
    steadily in our internet-healthcare environment. Patient = Consumer; they WILL
    define your online medical identity.

    A potential solution is setting the proper expectations
    between Doctor AND Patient. As you point out 99.9% of doctors are great people
    who definitely try. Trying takes (1) acknowledging a problem (and its severity)
    and (2) communication. I’ve learned patients are more understanding if they
    know what to expect ahead of time. e.g.
    will you be 10mins late? 20mins late? an hour? will the patient spend another
    20min once in the waiting room? If any of those scenarios are true then be
    honest and tell them! Don’t be afraid to go deep too. If a patient’s time in
    the waiting room is “long”, and your further delayed, pop your head
    in telling them how much longer. You’re reaffirming expectations. Finally, be
    creatively caring to a point you proactively call ahead of an appointment
    encouraging the patient to reschedule (would be challenging in an urgent care).
    And don’t forget to have that next available appointment in hand!

    To my severity comment, we use a point of service iPad in
    the office capturing patient feedback and then, with their permission, upload
    to various medical review sites. Its one part marketing and one part learning.
    Something learned is with the question “time spent waiting once in a
    room” with multiple-choice answers. Its interesting most all of the
    patients surveyed choose “0-10min” but gave a low rating. I doubt a
    doctor or staff could do better than that! Although we’d try!! The point is
    that the severity of that “bad” patient experience — time spent in the waiting
    room — isn’t really “bad”. Although “point and click medicine” could
    be a trend for the future. hmmmmm

  • Guest

    I had bad experiences with doctors some time ago and I tend to avoid meeting them. I am aware that sometime I will need them someday. But it’s good that doctors use their tie by providing a quality service. This will improve the relationship and the closeness of the physicians and patients that can make the treatment process more quickly.

  • http://sportsandorthocenter.com/ Clark-Sportsandorthocenter.com

    I agree that health physicians should provide better services to customers. It should be just like in other business where customers are kings. Spending more time with their patients, listening carefully to what they said/feel and their symptoms, and providing the best fitting solutions/diagnosis to their problems. There are many doctors who forget about this core nowadays, but there are still many who don’t. We should all ‘test’ the doctors in our first visits and/or read what others are saying. How comfortable we are and how good we feel when talking to the doctor can say a lot.

  • sandyvc

    I could fill a blog with stories about doctors and the way they stick up for their abusive clerical staff against patients and refuse to include the damage done by other doctors bad behaviour in the analysis. I used a drug 13 years ago in the US that helped my anxiety. In Canada 2 different doctor’s refused to use it because they were not familiar with it. Unlike me, they were apparently incapable of doing some Googling to find out about it. It took me 13 years to get a doctor to provide it and I was better within days. I was so ill during those years that I kept having to stop working. I could have been well and not had to take early retirement. They stole 13 years of my life and any hope I had of getting my child a good education and a good start in life. Because of their arrogance. During that 13 years I was poisoned by other drugs, in the hospital, in programs, unemployed and only when it was too late did I get the drug I knew helped. I only got it because my psychiatrist freaked out because she was making me worse and bolted from me without even trying to find a new doctor for me. I am very well educated and intelligent but doctor’s don’t like that in a patient. My GP gave it to me, hesitantly.

    My adult son has a sleeping disorder that has trashed our lives. We had to wait 19 months for an appointment. They claim the most you wait is 16. How is this acceptable? It is a dangerous disorder.

    I called the provincial health nurse 2 years ago because I believed I had pertussis. All she did was go through her smart program on her computer. The upshot? I did not have the flu. I told her I did not have the flu but she insisted on going through all the little questions on her program that led nowhere. So, I was told “You don’t have the flu.” What do I have? Not the flu. My GP didn’t know either. But not the flu. I knew but… And it turns out that, yes, there are outbreaks of Pertussis and all they had to do was Google it. A walk in clinic was my next choice. He forced antibiotics on me but could not tell me what I had. It was classic Pertussis symptoms. I dry coughed so hard for 6 weeks that I barely got any sleep. My whole body hurt. Imagine if a baby gets it and the parents are sent home with “We don’t know.”

    If only this was all. It is the tip of they iceberg. I could, literally, fill a book with just my stories. On my last visit my GP missed two things that need lab work and did not provide a prescription to a drug I take and two few refills of another. The last time I went she nearly bolted from the room when I tried to explain how the pharmacist and the intern she had used instead of seeing me herself had messed up my prescriptions.

    Then there is all the job time lost when the receptionists delete appointments and then you get nailed with paying them when they did not bother to tell you you had an appointment. My son and I have both sat in offices for hours, not the same one, when the doctor is not in and been told the doctor will be in shortly. One doctor I had was ALWAYS at least half an hour late but she treated me like a 12 year old boy caught beating off in the school yard. Half a days pay shot for you but they cannot be called on anything or they will stop seeing you. Apparently the Hippocratic Oath now covers the backs of doctors and their clerical staff against their patients.

    We are not customers. We are patients. And the clerical staff is not always right. To take abuse from some little snot when you are ill and then have the doctor claim you were abusive is just a bit too much. I am going to tell my doctor, the next time I see her, to Google herself and find out it is not just me and my son who are outraged at being abused by anyone. In a doctor’s office!

  • Richard Willner

    When the Doctor Bashing is done by the Hospital ( Sham Peer Review ) or by the State Medical Board, it is time to get help and fast !!!

    The career you save is yours!!

    Richard Willner
    The Center for Peer Review Justice
    info@PeerReview.org

  • MakeThisLookAwesome

    Is it that doctor bashing is in vogue? Or is it that with the advent of the Internet, stories on doctors aren’t strictly covered by the Press and now patients have a real voice? Because I can tell you, the jokes about doctors aren’t new.

    I think it’s that the patient has finally gotten ahold of the microphone and now doctors are finally forced to pay attention….

  • Mellanie True Hills

    Could doctors maybe start this process by not bashing each other? All the various opinions on George W. Bush’s angioplasty and stent amounted to second-guessing of his doctors without all the facts. When doctors bash each other, what role-modeling message does that send to patients about how to treat their doctors?