Why you need to hear from miserable doctors

Why you need to hear from miserable doctors

Is being a physician a good gig, or not?

In a piece that’s gone viral, internist Daniela Drake writes a strongly-worded column in the Daily Beast about how miserable it is to be a physician:

To be sure many people with good intentions are working toward solving the healthcare crisis. But the answers they’ve come up with are driving up costs and driving out doctors.  Maybe it’s too much to ask for empathy, and maybe physician lives don’t matter to most people.

But for America’s health to be safeguarded, the wellbeing of America’s caretakers is going to have to start mattering to someone.

And she brings up many points that have been expressed here: the paperwork, the eroding respect from the public, and the increasing burdens of maintaining certification.

I’m quoted in the piece, adding, “there’s a media narrative that blames physicians for things the doctor has no control over.”  That partly comes from the tension between health policy experts and physicians that I’ve written about previously, combined with the fact that there are relatively few frontline physicians writing in, say, the New York Times.

That’s why I spend as much time as I do building KevinMD.com into a visible, influential platform where the public can hear the physicians’ voices framed from their own perspective, rather than feed the doctor-bashing narrative that pervades much of health coverage today.

Pediatrician Aaron Carroll disagrees, however, saying that being a doctor is rewarding, not many physicians are quitting, and applications to medical school are at an all-time high.  It’s a typically progressive worldview that tends to discount many of the issues that physicians face.

While “physicians complain far more, and far more publicly, than their situations warrant” according to Dr. Carroll, staying silent and taking their “beloved” public status for granted isn’t an option.  Attacking physicians is low-hanging fruit for those who have the megaphone and influence of major media platforms.  Doctors often don’t fight back: They’re either too busy with patients, or don’t have the media contacts or savvy to offer a rebuttal. And losing the ability to frame the conversation will cause our public respect to deteriorate more than it has already.

So it’s important to have the conversation on physician dissatisfaction.  It’s important to discuss the cost of medical education, physician burnout, and the myriad of paperwork and bureaucratic mandates that obstruct doctors from giving the best care they can to patients.

Left unchecked, the physician profession will become completely demoralized.  Whether you care or not, it matters.   Demoralized doctors are in no position to care for patients.

Why you need to hear from miserable doctors

Kevin Pho is an internal medicine physician and co-author of Establishing, Managing, and Protecting Your Online Reputation: A Social Media Guide for Physicians and Medical Practices. He is on the editorial board of contributors, USA Today, and is founder and editor, KevinMD.com, also on FacebookTwitterGoogle+, and LinkedIn.

Image credit: Shutterstock.com

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  • NewMexicoRam

    I went to bed last night in the most depressed and discouraged mood I’ve been in for a while. Our medical group had a meeting last night. While it was expressed by leadership that they care about our personal lives and that we need to have a life, I had just finished a day of getting to the office at 5:15 AM to finish 14 charts from the day before, only getting 7 of them done before starting the new day due to EHR crashes and slowness, having more patients added when I asked they not be added (so I could catch up), and so on and so on. Now I have to go in 3 hours early today just to finish yesterday’s charts. Yes, they really care about my life.
    Yesterday, for the first time ever, I let a patient know how bad this is becoming. At first, I was shocked with myself. But now I think, I really don’t care anymore.

    • theresabetterway

      @NewMexicoRam:disqus Could outsourcing some of your administrative functions save you time and possibly money? I’m not a physician but I am curious to know what you think could help most physicians immediately.

      • NewMexicoRam

        Better pay for the extra functions being required of us. Most businesses can negotiate with payers. There’s very little room for that when Medicare comes in and says “this is what you’re going to be paid–deal with it.”

        • LeoHolmMD

          That is the main problem. Inability to keep up with rising overhead in the face of declining reimbursement. Medicine does not work like a normal business. (Except DPC).

    • LeoHolmMD

      I think we try to shield patients from our own misery, because time in the office is their time, and we are trying to help them feel better. I think the public would be sympathetic if we had a platform to have such a discussion. Mass solidarity between physicians and patients is needed. It is the only way to deal with power.

      • DoubtfulGuest

        Agree, and I think most people would come around when they see how high the price is for keeping our heads in the sand. It would take some repetition, but should go well if you start with concrete examples that address patients’ “pain points”. Like “You know how doctors never seem to have any time for you and it looks like we’re not willing to take the time. Well, we hate that, too. What’s really happening is…”

      • http://www.idealmedicalcare.org PamelaWibleMD

        We are too nice. We keep smiling despite the pain. Many put on their “happy face” at work when caring for patients. When one local doc was found dead in the public park of a self-iflicted gunshot wound, everyone was SO surprised. We’re masters at compartmentalization and always putting others first.

    • Deceased MD

      Ridiculous. just ridiculous. Think of yourself and not the charts/EHR.

    • Suzi Q 38

      Try not to be so discouraged.
      I find your comments alarming and understandable.

      Can your employer give you some extra time for completing your charts? Is there ever a slower afternoon, morning, evening when this could be accomplished? Could this EMR-doctor relationship be improved by understanding that initially there is a learning curve and you will probably improve time-wise as each day passes? Are there other employes or intern students who want to learn that could help you with this process, then you check it over? Can you do the easier and more routine patient charting in between patients? Is there a nurse who can see the patient first type in the routine information: Chief complaint, current meds, BP, weight….I don’t know, as I have never viewed an EMR.

      Have the clinic or hospital director figure out why the computers are crashing. Asking you to do extra work is bad enough, but the computers working is vital to your work day.

      Everything I have said is easier said than done, but there has to be something that you can do.

      A friend of mine who is a physician complains about the same thing you do. She is not depressed or discouraged because her boss pays her a little more for the extra time it takes to do the unfinished charts. Is there an office worker that can assist you?

      I am sure my doctor is reticent to do this at all and is still utilizing the paper and folder method. Good for him.
      He can do this, as he is the only doctor in his busy practice.

      Maybe it is time to take a vacation, if only for a long weekend, with your family.

      • NewMexicoRam

        Everything you mention has either been thought of or tried. All in the negative. I’m saving vacation time so I can take a trip with my wife and 2 sons to India this October, to visit some old Indian friends. After that, who knows what situation I will find myself in.

        • Suzi Q 38

          I prefer to think that “One door closes and another one opens.” Look for the “opening,” and change your job somehow. If that is not possible, maybe get a new job.

          October is not that long away.
          Schedule interesting and fun things to do on the weekend…some days with your wife, others with just your sons, and then others with all of you together.
          We used to go bowling, even though I was horrible at it. We would go to concerts that the kids were in to, or go hiking. Sometimes I would take the kids to thrift stores or antique stores to look at old stuff. I used to buy my son sets of old computers that he could take apart and fix. He is now a computer engineer. Sometimes museums are cheap and interesting.
          “Vacations” don’t have to be for two weeks or so.
          You can take a vacation in a day.

          Can you at least get your mind off of work when you come home?

          • http://www.idealmedicalcare.org PamelaWibleMD

            Deep breathing, mindfulness, longer vacations will not solve this problem. Look beyond the bandaids. We need collective action – physician led. Patients by our side.

        • guest

          You are in Albuquerque, correct? I find it hard to imagine there are not other options. Best of luck to you. Enjoy India, I hope you make a nice long stay of it.

    • buzzkillerjsmith

      In my first job, at Kaiser, I was personally but (not yet) professionally dysfunctional. Quit and got back to my usual cheerful self in 2 weeks, lost a lot of weight in 6 months.

      Pull the plug. It’s the only way.

      • Suzi Q 38

        I understand why you would seriously give this advice, but he has to tread carefully because he not only has himself, but his family to consider.

        I remember sticking with a job I didn’t like until I found another one.
        How is the new job going to be different as far as his EMR dilemma?

        Does changing jobs mean doing the same work or changing his job title and duties as well?

        The core of your message makes sense.
        A person does not need to be deliriously happy at his/her job, but h/she shouldn’t hate it.
        If you hate it, it may be time to reinvent yourself and do something else.

        It is not easy, but you are never to old to change your life.

  • Anne-Marie

    You need to enlist the public as your ally. How do you make that happen? How do you frame the conversation so it doesn’t come off as negativity or feelings of being victimized?

    I’ve seen enough discussions here at Kevin MD to recognize that many, if not most, physicians feel frustrated, demoralized and hopeless. I can empathize with workplace frustration because I deal with it myself, every single day, although it comes from different sources and manifests itself in different ways. So I can see the need for us, the public, to do something… but what??

    Speaking as someone who is willing to be your ally in the cause, my concern is that too much focus on the negative will not help you as much as you think. For people who are firm in their belief that doctors are whiny, arrogant and self-entitled, it’ll only give them more ammunition. For those who are inclined to be sympathetic, the message could be discouraging and might ultimately backfire if patients start to feel perceived as an imposition on the doctor’s time and energy.

    It depresses me that NewMexicoRam feels depressed and discouraged, and it makes me wonder if the mere presence of my appointment on his calendar is adding to his burden, even though I might really need the doctor’s help on that particular day.

    You’ve gotta find a way to frame the conversation so it really resonates with the public instead of turning them off. Good luck.

    • http://www.kevinmd.com kevinmd

      Completely agree — doctors need the public on their side. What I try to do is frame the issues so that everyone can realize what affects doctors also affects patients.

      True, there are those who will be antagonistic to physicians no matter what I say. But there will always be some who are willing to listen.

      Too often, especially if you read the New York Times’ progressive framing of health issues, the finger is pointed at physicians, pitting them against patients.

      Doctors and patients are on the same side. No patient wants to be treated by a burnt out doctor, for instance.

      Articulating what doctors go through — and, conversely, doctors also need to understand what patients go through as well — hopefully can bring doctors and patients closer together and is the primary goal of my site.

      Kevin

      • NewMexicoRam

        Interesting that you mention Dr. Aaron Carroll and his blog. I’ve followed him off and on over the last several years. He seems to get his opinion and has very little desire to see other points of view. I wonder how much his being an “academic” at Indiana University has to do with it? I went to IU for med school, and it seemed to me that the attendings sure had a lot of time on their hands.

      • Deceased MD

        Any idea why the NY Times and the media perhaps in general are not getting an accurate message across? Perhaps a complex question but just wondered if you had any brief thoughts.

        • Anne-Marie

          Not to speak for Kevin, but I think doctors in general often are not very good at shaping their own message. They’re too busy taking care of their patients for this to even register on their radar screen, let alone become somewhat of a priority. Ever notice how many of the print quotes and sound bites come from academic medicine, researchers or physician administrators? and not from the rank and file?

          • Deceased MD

            You may be right. I have a lot to say ( as many here do) but am not familiar with who would listen. In this era, the individual does not get traction. it’s the lobbyists o/w does not get traction. I give Kevin a lot of credit for his site but sadly it only goes so far.

          • LeoHolmMD

            Is there a reason it could not go further?

          • Deceased MD

            Well it would certainly be welcomed. In my pessimism after reading in JAMA about 50 percent of the public having at least one medical conspiracy theory frankly I began to wonder. As far as MD’s we know the organizations that “represent” us are not.

            Where would you start?

          • LeoHolmMD

            Heck, I would start there. I am loaded with conspiracy theory. Patients feel there is a lot of gaming in the system. Why not help them understand that? Transparency would help a lot. There is a lot of talk about perverse incentives, but if patients knew the particulars, things would change much faster. As far as other medical organizations…they can certainly sign on if they clean up their act, but I would go third rail on it. Establishment is obviously not the path.

          • Deceased MD

            I actually just did write a blog on KMD 4/12 “Why so many Americans believe in health care conspiracy theories” and the key was the mistrust of the HC system.
            Only went so far though. I do agree with you Dr. Holm. I suppose there are a group of people that we can educate but I am realizing a large group that hold onto mistrust in a misguided way. That group is harder than one realizes. The problem is people are divided. Even MD’s are divided.

            But the fundamental things you bring up are really about the system being gamed and mistrust. Very accurate. Will not work with passive dependent types or misguided that watch FOX news but could work with others. At the moment, the only way to get things done is lobbying. So from here I am lost other than to try to educate as much as I can.

          • http://www.kevinmd.com kevinmd

            True again. Physicians in general don’t get a lot of (if any) PR or media training. And, as you say, there’s patients to take care of.

            That’s why attacking doctors is low-hanging fruit. Most can’t, or don’t know how, to fight back.

            K

          • Anne-Marie

            Most doctors just won’t fight back either. They just don’t want to step into the swamp, and I don’t blame them.

            One best-practice recommendation for telling your story is to cultivate someone in your local media who is friendly or at least open to listening to you. Make it your mission to develop a good working relationship with them and to share information and perspective that educates them, raises their awareness and demonstrates your value as a source. Ask them for constructive advice on how you, the physician, can work effectively with the media.

            Ignore the big-name media personalities. They live in a rarefied world that does not reflect the day-to-day reality of most working journalists, anymore than Dr. Oz or Sanjay Gupta reflect the life of the average primary care doctor.

            A lot of this frankly comes down to one-on-one conversations and your time and willingness to develop good relationships with others who are in a position to help you.

          • LeoHolmMD

            Many doctors can’t because they are employed and fear reprisal. The indie voices are shut out by the advertising based censorship of the larger systems. The media seem to be preoccupied with hot topics like swine flu and other methods of soft advertising. Either that or you get some unanswerable question like: “Do you support Obamacare?”. Trying to have a discussion about the jeopardy patients are in these days is not something that fits in between commercials very well.

          • Anne-Marie

            You are thinking primarily of the broadcast media, yes?

            There seems to be more room in the print media for thoughtful stories that convey more information and nuance. Most newspapers also post their print content on their websites, making it fairly easy for a good story to spread via social media sharing.

            For docs who are employed, is there a doc leader who can be the lightning rod? I’m not sure why the independent groups can’t develop their own voice and wield it effectively – most print newsrooms make their coverage decisions independently of advertising.

            I’ll go back to my original advice: set the agenda yourselves. Answer the question about swine flu but then work in additional comments about the overload this poses to a system that’s already overwhelmed and docs’ concerns about being able to continue providing good care.

            There isn’t a blockbuster solution to getting your voice heard, but there are ways, if you’re willing to start small, be persistent and look for solutions rather than obstacles.

        • Patient Kit

          For starters, the big hospital systems, health insurance companies and pharmaceuticals are big advertisers in the media. And advertising is media’s main revenue source. I’m not saying that’s the whole answer to a complex question. But it’s an undeniable part of the dynamic.

          • Deceased MD

            yes they really do control media more than most realize. We think there is free speech but not anymore.

          • Patient Kit

            I wouldn’t go that far. We do still have free speech in this country. And the best way to protect that right is to use it. But when it comes to mainstream media, money does talk.

    • NewMexicoRam

      I’m not upset at patients–they are the only thing I enjoy about my job anymore. It’s “all those out there” who think I can can do more with less. And it leads to less time for me and my family, with less pay.

      • Anne-Marie

        People should hear that, then.

        Who’s the real enemy here? Maybe doctors need to articulate this more clearly.

  • NewMexicoRam

    I don’t get migraines, thank God. But I am starting to investigate other options. The problem is, I’m not sure it’s much better anywhere else.

    • toolate

      You could be having a migraine. I get them, for real. They’re incapacitating. No one can force you to go to work if you’re having a migraine. Stress triggers migraines. They can start at any age.

      • NewMexicoRam

        Excuse me. I don’t get migraines. Let’s not derail the conversation, please.

      • Anne-Marie

        I sympathize with the desire to walk out and I recognize that sometimes you just need to save yourself. But be aware that by doing so, your actions have immediately made life a little bit harder for everyone who remains, and the downward spiral will continue.

        • Patient Kit

          Excellent point. This is why walking out is always a last resort once all other avenues and attempts to remedy the situation have failed. But if you are going to walk out, do it in a way that has a chance of accomplishing something. Because, you are right, people will be hurt.

  • LeoHolmMD

    Overhead can only go down so far before regulation starts raising it again. One of the reasons Direct Primary Care can make it is that most of the regulatory nonsense is shed. To clarify: much of the struggle is not “maintaining income”. In rural Primary Care it is frankly staying open, or not.

    • betsynicoletti

      In fact, more staff support can increase the physician’s ability to see patients. We are asking physicians to perform too many functions that don’t require physician expertise.

  • Patient Kit

    Chiming in to say that, as a patient, I care about doctors and support you in this fight. And I thank you for including us patients in the conversation here at KMD. I agree with those who have said that doctors and patients must be allies and fight this fight together.

    There are very powerful profit driven forces whose mission is to divide and conquer and turn patients and docs against each other. We need to understand that that is a very calculated strategy on their part and we need to resist it and start building a strong doctor-patient coalition.

    There are a lot of patients out here who are already on your side. Initially, dont’t waste time and energy trying to convert those who have already bought into our enemies’ party line. Also don’t waste too much time preaching to the choir of unhappy docs (although venting and getting in touch with and harnessing your anger is definitely part of the process of getting mobilized). Instead of trying to convince those who are against you, spend all of your effort mobilizing and organizing and building a relationship with those who are already with you.

    I can tell you from experience that it is never easy to get people to stand up and fight. But it can be done. And bigger battles than this have been won in the history of this country. You seem to be very in touch with your misery. Now find your fight. And some good leadership to lead us.

    And can we please try to do this sometime before I end up dead in this so-called healthcare system.

  • betsynicoletti

    I talk with a doctors every week, and this is what I hear makes them unhappy.
    1) Their EMRs. As NewMexicoRam says, using an EMR means less family time, personal time, sleep, time to see patients. In some systems, there are multiple sign ins and passwords to view images or get labs. One in 100 doctor with whom I speak likes their EMR, and says it is easier and more efficient than paper.
    2) Loss of control over work lives. Some is just day to day hassle, and some issues have a negative impact on patient care. In some systems, it’s just hard to get something done, and the doctor is the face of healthcare. No one says, “My health care team didn’t get the right lab order.”
    3) Who works for whom? It’s upside down. We used to work for the doctor. Now, we want the doctor to make our work lives easier. Do this for the coder, this for the lab tech, this for the insurance company. Of course, doctors do and want to work in a team but ….
    I don’t have a suggestion about fixing this. I don’t think resigning en masse will solve the problem. Being employed by a health system helps physicians in some ways (don’t have to worry about payroll) but can contribute to a sense of loss of control. More physicians in leadership positions? The physician leaders can’t change the economics and forces that are causing many of today’s problems. Of course, Dr. Carroll is right, physicians are privileged in many ways. But their day-to-day work lives can be miserable.

    • NewMexicoRam

      We have to enter our mini-cognition exams by clicks so “the computer can see it” for insurance measures. It takes 19 clicks to enter “mini-cog normal.”

      • betsynicoletti

        There’s no additional payment for a mini-status exam. It’s part of the E/M service. The most “bullets” you could get with the 1997 multi specialty exam is four, and for the psych exam six. Painful.

        • NewMexicoRam

          I’m talking about putting it into the Medicare Wellness visit template. I’m not talking about bullets. It actually takes 19 clicks on the computer screen to get the mini-cog entered correctly so the EHR survaillence system can recognize it to tell the insurance trackers you actually did that part of the exam.

          • betsynicoletti

            The Medicare Wellness visit *only* requires that the clinician assess the patient’s cognitive function through observation, report, family or medical records. The CMS Medicare Claims Processing Manual says, “Detection of any cognitive impairment that the individual may have.” I read the original Fee Schedule rule and it does not require a mini mental status exam. Some programmer ran amok. CMS’s own brochure about it states only, “Assess the beneficiary’s cognitive function by direct observation, with due consideration of information obtained by way of patient reports and concerns raised by family members, friends, caretakers, or others.” Feel free to call me. I’m easy to find if you search my name.

            Link below.

            But this is an example of making the doctor work harder for no reason whatsoever.

            http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/AWV_Chart_ICN905706.pdf

            Detection of any cognitive impairment that the individual may have,

            Detection of any cognitive impairment that the individual may have,

          • NewMexicoRam

            Yes, you are right, but it’s the way our group has determined cognitive function needs to be assessed.
            Like I said, I’m starting to make some plans.

    • buzzkillerjsmith

      Well said. The EHR are absolutely soul-crushing, and, as we have discussed ad nauseam here, they don’t save money or improve pt care. Yet we have to use them. Potent symbols of our powerlessness and humiliation.

  • Patient Kit

    I think if doctors are going to “walk out”, they need to be confrontational and make their good reasons for doing so very clear. Just staying home sick as a passive, kind of gutless, form of protest might feel good briefly but won’t get this job done and would probably even be counterproductive to your goals.. When teachers or nurses go out on strike, they express their reasons loud and clear.

  • NewMexicoRam

    Sorry. Before I walk out, a solid plan will need to be in place, which can’t happen for another 6 months (restrictive contract). I have a wife and 4 kids at home to feed. Things take time. I’m just trying to keep my sanity until then.

    • JR

      My physician (family physician) takes “all insurance” – if you have it, he takes it. He uses a billing company to process the bills and uses two medical assistants. He spends 30 minutes with his patients regularly. He does his own blood draws every Friday. He only works four days a week. He also manages a lot of patients with chronic conditions, so he sees them 3 – 4 times a year.

      Reading on here makes me wonder how he does it, but he seems pretty happy. So it is possible.

    • B Viner

      Been there too my friend, 6 kids. Hang in there and keep looking for a better option. Get rid of debt and make yourself more mobile. I have the same feeling as one of the other posters that things may get worse before they improve. I think we docs on the front lines need to rewrite the playbook next time though.

  • Patient Kit

    Doctors “can’t” be confrontational? It’s best to retreat quietly? If you insist on doing the right thing, you’re a marked person?

    With all due respect, every exploited person who has ever stood up and fought the powers that exploited them, has done so with great personal risk — sometimes risk of livelihood, sometimes even risk of life.

    If everyone had your attitude, where would coal miners, factory workers and actual slaves be today? American doctors are far from the most powerless creatures on earth. I understand that you have a lot to lose. But what I hear you saying is that you don’t want to risk anything.

    When, for example, coal miners fight for safer working conditions, they risk their jobs and the ability to feed their families. But if they don’t fight for better conditions, they risk their lives. Exploitation of employees by the profit
    driven powers that be is
    not a new phenomena just because docs are feeling it.

    You should have more power in our healthcare system than you do because, despite what they want us to believe, you are very much needed and not easily replaceable. You can minimize the risk to individual doctors by fighting together collectively (a dirty word, I know) with other docs and with patients.

    If I was a campaign strategist for the doctor-patient revolution, I’m sorry but, I would have to veto the use of “Lower your head, smile, nod — and quit” as a slogan. I wouldn’t want to see that on any bumper stickers or t-shirts.

    I do sincerely empathize with your sense powerlessness. But you should be in my soon to be without insurance cancer patient boots right
    now if you want to really feel powerless and vulnerable.

    Patients and docs sticking together is our only hope. The powers that be can’t make any money without doctors and patients. But nobody can go up against this alone.

  • DoubtfulGuest

    What PK says. Lots of you, disruptive and confrontational all at once. I’m not criticizing any one doctor for quitting if you need to for your own health. But think of what you could accomplish in large numbers!

    • LeoHolmMD

      Treat people for free in the streets. On the D.C. mall. There are lots of actions we could take as one. Get patients educated and together. Show them how they are being manipulated, divided and lied to. Tell patients the truth about what is happening to them.

      • DoubtfulGuest

        I like it. I think, deep down, most people want to know what’s going on, even if they react negatively at first. You know how they say a little knowledge is a dangerous thing? I think the net effect of doctors trusting patients with the whole story will be very productive.

        My personal take on doctors choosing a “positive” vs. “negative” message is that doctors need to make sure patients hear that doctors care about patients. AND patients need to see that doctors are human, complete with their own emotional, health, family, and money concerns.

        As a semi-informed patient and citizen, I’d love to volunteer for any kind of effort you all organize. I work full-time but this would be a high priority in my free time as I already read and talk about it for hours each week.

        Doctors would be the best folks to tell patients the best ways we can help, but I have a few thoughts…if we could bring our own doctors on board, if we could help prepare publications and such to educate patients, something like that? You have several of us offering assistance. We have a major stake in your success. Surely there are ways we could help things run smoothly and save you time? doubtful975@gmail.com

        • LeoHolmMD

          Encouraging. It seems like when I look for a channel for collective action, there is not one. A lot of what is deemed “organized medicine” has become part of the problem. But I am inspired now. I will do more looking inward.

          • DoubtfulGuest

            Excellent. Let’s make a channel. Margalit is right that patients need to do some of the heavy lifting for our docs. At least an arm or a leg of the whole monster. I can’t blame you all for feeling overwhelmed, when mostly the best you hear is “Good luck with that!”. And a lot of what makes patients so mad at you all is our feeling of powerlessness. We’re actually in the same boat with that, so maybe we can turn it around.

            Two ideas being bandied about now are 1) some sort of patient-led non profit group to inform people and support our docs and 2) a doctors’ union. I hope more people will jump in and keep this going. I really want this to succeed.

          • LeoHolmMD

            I like #1. Although I think a doctors union is a great idea, I think it sends the wrong message. Even though working conditions for us are actually conditions for patients. It may get confused with the AMA, which is perceived as a doctors union, but is not. Don’t get me started on them. Patients are the answer.

          • DoubtfulGuest

            Ah, okay. I see your points. Just a thought, people might learn the truth about the AMA if there was an actual union to make itself visible. Especially if the acronyms and logos looked nothing alike. But that’s for you all to sort out.

            On to the patients’ part. What would you like to see from us?

          • LeoHolmMD

            Really, only solidarity. So many things depend on just showing up. A few years ago I screened Escape Fire for my community. A lot of people came out and after the show there were a lot of good conversations. People came out and said things I would have never expected. Ideas were tossed around and I think there was a renewed sense of mission. I would begin there. Dialogue. This post has completely exploded today. This is what is supposed to be happening, just scaled up. More momentum. More influence.

          • DoubtfulGuest

            I didn’t even know about this film. I’d better check it out, thanks.

      • Suzi Q 38

        I think that is a good idea.
        We need to know the truth so that we can beware of the “system.”

    • buzzkillerjsmith

      Won’t work without a union and the threat of many docs at once to withhold labor. Almost all serf uprisings are crushed. The only chance for CorpMed docs is unionization.

      • DoubtfulGuest

        I’m in favor of docs unionizing. So, there would need to be some tough discussions about what patients would have to give up in the short term, so that can happen (e.g. if there’s a major strike). We already give up a lot, just not by informed choice, so again if we can get people to see that the net effect on them would be very positive…

        I don’t know the best way to handle this, though. I already “got mine” in terms of diagnosis and now only need to see doctors 5 or 6 times a year. Those are all scheduled visits that could wait weeks or months if need be. Let’s see, I do have prescriptions that need refilled, to keep me alive. I have never been in really dire straits (yet), medically, so I don’t want to be throwing other patients under the bus.

        But please tell us more about docs unionizing, any of you. Has this been tried before? Any sense of how many of you want to? What are the barriers and logistics issues? Other aspects that haven’t been covered here?

        • Patient Kit

          I’d support doctors unionizing. But organizing a union is never an easy task for anyone and it wouldn’t be a simple solution to all the problems doctors are experiencing. It takes time and effort and leadership to organize into a union. It’s not like you just set one up and docs join if they want to and don’t join if they don’t want to.

          There are labor laws to contend with and our country, in general, is not particulary union friendly. And some states are rabidly anti-union. It’s usually done workplace by workplace (or employer by employer). Airline pilots, for example, might be union at one airline but nonunion at another airline.

          Most employers are going to be very anti-union and willing to go to great lengths to stop a union from forming. Legal delay tactics will be deployed. Organizing leaders will be targeted. It’s not just docs. This happens to almost any workforce who try to organize.

          Anyone interested in doing this should research different union models to see what might work best for docs. Look at how teachers, nurses, airline pilots, actors and MLB players are organized, for example. And then you have the different groups of docs like employed docs, private practice docs and residents. Are you going to organize by specialty or all together?

          • DoubtfulGuest

            Great advice, PK. I hope some nurses will jump in here, as they deal with many of the same issues.

            http://nurses.3cdn.net/1d1e00cd8cc7b03592_jy8m6v5hd.pdf

          • RenegadeRN

            See my reply above to Buzzkillersmith.

            In Texas nurses started getting info from the California Nurses union and no one wanted to be caught dead mentioning any interest or contact for fear of management getting wind and targeting those nurses. Board of nursing was not taking any stand or even mentioning it- as far as I know.

        • Dr. Ivo Robotnik

          I believe the last time docs tried to unionize we got busted by anti-trust laws. But I don’t know enough about law to know if there’s a way around that. I’m sure there are loopholes — major corporations and banks seem to find them all the time.

          • DoubtfulGuest

            Dr. Wall has an interesting suggestion (the Screen Actors Guild model). A very quick Google search suggested there’d have to be three different types of doctor unions: for employed docs (maybe the most straightforward, legally), docs-in-training, and independent practitioners. This is perhaps a no-brainer for some, but not for me. :) Also, there appears to be a doctor’s union of some sort out there already? I haven’t yet had time to really digest or look into this stuff, I just want to help with brainstorming and keeping the discussion going…

      • Patient Kit

        How would you form a union and then use that union to pursue the changes you seek, without being confrontational?

        • buzzkillerjsmith

          Oh, we’d be confrontational all right. Businessoverlord’s job satisfaction would deteriorate quickly.

          • Patient Kit

            That’s the spirit! Reverse the misery. Give the whipcracking overlords a taste of their own medicine!

          • RenegadeRN

            Why PK- I had no idea you were such a rebel rouser ! Love it.

      • RenegadeRN

        This is how nursing unions came about.

        My state doesn’t have them, and I never thought I would be for one , but NOW I GET IT!
        Corporations push and push, till employees ( nurses and hopefully docs) get fed up and either quit or unionize.

        If I hadn’t gotten fed up and quit working as an RN and made a lateral move to clinical nutritionist – I would have moved to a state with a nurses union. My health , license, and well being is not worth their ever increasing bottom line!

  • DoubtfulGuest

    It could be fun! I’ll help.

  • buzzkillerjsmith

    This is about family doctors and general internists. I’ll let subspecialists speak for themselves.

    Abandon hope, you primary care physicians.

    I am very skeptical about getting the public on our side. The public is divided and distracted, and, as we all know, a lot of them think we are scumbags. As some of us are. Not most, but some.

    Perhaps more important, the public has very little power, at least in the short term. Moneyed interests and politicians rule this country and the unorganized citizens don’t have much say. Everyone here knows this.

    In the longer term, the public might wake up and flex its muscles and make everything right for us and our pts. Yeah, and I might pitch a no-hitter the last game of the World Series, but don’t bet your IRA on it, if you are lucky enough to have one.

    In the shorter term CorpMed is in the driver’s seat–productivity, not being disruptive, kissing up to “customers.” You know the story.

    So, young doc, what to do?

    First, don’t go into primary care, you lunkhead! I can’t believe the number of med students who still make this elementary mistake. They’re even dumber than I am ( and that says a lot) because I went into it 25 years ago when it was much better.

    Some starry-eyed romantics think that moral persuasion, merely being right, will be enough. Uh, maybe you ought to pick a history book–or even a newspaper. I’ve been in the ballgame 25 years and things have gotten worse and worse. It is not going to get better.

    If you are foolish enough to go into PC, live on lentils and rice to pay back your loans immediately and then go part-time. Don’t buy anything, don’t marry anyone who makes less than you do, don’t reproduce. Remember, this is life during wartime.

    If you can wean yourself off the heroin, I mean money, then your life will be better. Primary care is characterized by by a wicked dose-toxicity effect. Of course, trying to avoid doing what you have dedicated 11 years after high school to learning how to do might induce some sad head-shaking or bemused smirking among your friends and family who went into some other line of work.

    And it does indeed beg the question of why the heck you, who coulda been a contenda, went into this sorry profession in the first place. But hey, dumb@^%, that’s your fault, not mine.

    • B Viner

      Where were you when I was making my decisions 20 years ago?;) Good advice to get out/stay out of debt to make yourself more mobile. PC docs will soon be replaced by NPs and PAs (or FMGs), then they can enjoy the media spotlight. Perhaps a good first step would be to get a petition going to allow us to have a doctor’s union with the sole purpose of prioritising our concerns, then systematically fixing them.

      • buzzkillerjsmith

        Doctors’ unions, at least in primary care, are absolutely critical for employed docs being able to make the best of their sorry lot in medicine. Unions would make the world better for them, even if just to protect “disruptive physicians” from arbitrary abuse.

        Of course, avoiding CorpMed is better but not possible for all or maybe even most.

        As regards your decision, I hear you, man.

        Punting to NPs and PAs is great idea for us but probably not for them. They’ll learn. Most already have.

    • Deceased MD

      Agree. We need strong lobbyists and I don’t have any. Do you? In fact there is no organization supporting MD’s in general except endo ( according To Drake). These days only billionaires have a voice as far as i can see.
      And the POV that MD’s are rich??-well not sure what planet they live on? Everyone who even listens to FOX news knows that the Corporations of America rule and govern. I recently briefly spoke with a vetinarian involved in the horse racing industry. Those horses get better medical care than anyone else in the country minus politicians. When I asked how much the vet bills are, he said-”You don’t understand. These horses are worth millions and millions and are insured for that much as well.” So there was my answer. Thankfully I have never been to a horse race. Then there is the 50 percent of the public that believe in at least one medical conspiracy theory according to recent JAMA. So am realizing that it is worse than i thought. A culture where winning horses are worth more than people and half are not fighting for better care likely due to mistrust and misguided thoughts.

      • buzzkillerjsmith

        Heck yeah I have a strong lobbyist–Dr. Reid Blackwelder, head of the AAFP. He was on On Point on NPR yesterday. His comments were basically world salad. I challenge you to listen and try to understand him–if you dare.

  • DoubtfulGuest

    Where’s Margalit?

    • Patient Kit

      Wondering the same thing. It was her posts that initially drew me to KevinMD and inspired me to jump in and participate in the discussions.

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

        Thanks, Kit. I am here guys. I am reading and I don’t really know what else I can say. I feel like I’ve said it all….
        I am grateful for this forum that Kevin is providing all of us, and is probably the only visible and respectable place for airing these opinions, but we need to do more, much more, because if we don’t Buzz will end up being right.
        For the longest time I thought that a grassroots effort to preserve doctors must be led by doctors. I think I am changing my mind…. I am starting to think that it may be better, or at least more feasible, to have patients start some sort of Foundation to Save the Doctors…. like for whales or baby seals….. Thoughts?

        • DoubtfulGuest

          Sorry to jump in, but I’m glad to help. Yes, you have done so much already, Margalit. I just wanted to make sure you weren’t missing out this time. After your January post, you were, or were going to be, in personal contact with some docs to try to get organized. A few of us patients were interested but kind of out of the loop on that. Did nothing come of it?

          I can see why patients might need to take charge here. I’m a bit nervous because there’s this perception in medicine, I don’t know how else to say it, but that patients are stupid and will tend to screw things up. So I feel like we’d still need advice and input. I prefer to do stuff instead of just talking, though. Git ‘er done, as they say. :) Would like more input from folks either here or by e-mail: doubtful975@gmail.com.

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

            Nothing came of it…. nothing ever does….

            I don’t think there is a perception like that, or at least I haven’t met any docs that hold that generalized opinion….
            The best thing would probably be to have a group of docs and patients putting this together. It won’t be easy…. but could be rewarding… :-)

          • DoubtfulGuest

            Works for me. I spend so much time feeling bad and complaining, that would be better directed to getting things done. Around 10 hours per week would be feasible for me, most weeks. Did you get anything out of those discussions that could inform our efforts now?

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

            There were no discussions… plain nothing :-)

          • DoubtfulGuest

            :/ :/ :/ Alrighty then! :/ And here I was for the last few months, eagerly waiting in the wings for deployment. LOL.

            Okay, so another thing to consider is, what resources are already out there, besides this blog, that pull some of this information together for the public? The Vanishing Oath (film) is really good, for example. I donated my copy to the public library, but I thought about asking for it to be shown at my university. I could buy another copy, no problem. And I’d need to check on the copyright issue, for educational showings. But to think first about what else we already have, what work has already been done, and go from there?

            It might help to interview local docs to hear their thoughts? Particularly about how the private practices are being crushed out of existence. Some teaching hospital docs look beyond the ivory tower and would have good ideas, too. But the time issue, who’d have time to talk with patients who want to do this? How best to approach, do you think?

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

            OK…. here we go again :-)
            1) Need to define the goal of this effort
            2) Need to brainstorm on a strategy and several tactical things that can be initiated right away
            2) Need a website because that’s how stuff is done today (plus Twitter and all that)
            3) Yes, do some research to see if there are potential partnerships, but nobody will talk to us as long as we are unknown, so… maybe better wait on this. There may be problems here because many organization have a political bend, or are funded by special interests.
            4) It’s fine to have patients do it, but I still think that it would help to have some docs collaborate on the message, and imperative that they participate. Besides, doctors are patients too.
            5) Need to find a way to make this grow quickly because we don’t have much time, and herein lays the problem.

            I don’t know how people manage to go from nothing to enough power to affect national change without impropriety, and I can’t think of any true grassroots effort that was successful in recent times.

            You need to be aware that sooner or later this will have to raise funds and engage the political system and the media, because I don’t think pitchforks are effective anymore. So it will eventually get ugly… and it will take a lot of hard work and an immense amount of sheer luck.

          • DoubtfulGuest

            1) Start with something almost everyone agrees on? e.g. Doctors don’t have enough time with their patients and that’s a problem? And why? And what would need to change to give them enough time? Docs’ poor working conditions could also be addressed as part of that.
            2) No experience with web design here but glad to help with content.
            3) I’m somewhat ignorant about the different players, yes. I’m fine with waiting to go talk to anyone and honestly prefer behind-the-scenes work. I’m willing to be a bit more public if the need arises.
            4) Agree. I’d need a lot of advice. I still don’t know that much.
            5) I have written a successful grant proposal before. And a couple of unsuccessful ones. I’m cool with hard work.

          • LeoHolmMD

            You sound like you have been down this road before. Revolution is fun to talk about, difficult to plan.
            1) First goal may just be to establish a collective. Agree or disagree with them: groups like the Tea Party and Occupy gained some ground, got some attention and still have some influence to this day. The conversations are started and there are people in elected positions who continue alliance with these groups.
            2) We have patients: give them a voice. Be their advocate and move those ideas into the legislative arena. We already have the allegence, we just need the mechanism. The AAFP may have tried something like this with MeAndMyDoctor, but It didn’t have the edge or direction it needed. And again, AAFP is part of the problem.
            3) Website is important. Documentary may be more important.
            Unfortunately, nothing will happen quickly. But nothing will happen at all if no one ever starts.

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

            Sure, it needs to start somewhere. My problem is how to find the “somewhere”… For years, I have been suggesting (on this blog too) that this needs to be started. We lost lots of time already. Things are getting progressively worse and they are on a trajectory of unabated deterioration.
            At what point will a handful of doctors decide that the time has come to put on a good fight? Sure patients, or citizens in general can help a lot, but as I wrote here back in January, in order for common folks to join the cause, they need to see you guys fighting for their cause….. This is not a chicken and egg type of thing.
            Doctors have to stand up first and declare that they are willing to take on the system on behalf of their patients, and that they are asking for Help…..
            Frankly, I find it strange that I am willing to volunteer my time, but not one physician has ever stepped up to the plate…. and let’s not go the “too busy” route here… this is not a huge time commitment for most, although a few may want to pour their heart into it eventually…

          • DoubtfulGuest

            “Frankly, I find it strange that I am willing to volunteer my time, but not one physician has ever stepped up to the plate…”

            This. You’ve contributed way more than I have, but I’m concerned already about expecting a bunch of sick people to lead the charge. I DO think we should help. The average person has a few more spare hours than pretty much any physician. But I’m pretty disheartened to get no specific input in 24 hours on the “baby seal foundation” issue. My only “collaborator” thus far was a spammer from Hong Kong, whose e-mail address I blocked straightaway. Is this discussion just going to fade out again once the physicians have blown off steam yet again? There’s a bit of progress on the union issue, so maybe that should be explored more thoroughly in a future post?

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

            Honestly, I don’t think the time is right just yet. There has to be much more pain inflicted on both doctors and patients. A lot more.
            We have to reach a place where enough people can’t maneuver their little personal interests anymore, and then and only then, activism becomes a viable option.
            Revolutions are not started by futurists or prophets of gloom. They are started by people who are physically hungry in the here and now…
            So we wait…..

          • DoubtfulGuest

            Yep. It must not hurt that bad yet. Thanks for trying so many times.

          • Suzi Q 38

            I agree, Margalit.

            The physicians say that it is atrocious that they are paid so little for Medicare and Medical, yet there is no one to protest and refuse to treat these patient because of the little they are paid. Ditto for the insurance companies.

            It has to get so bad that physicians have gone to medical school and given up their youth to do what they are good at, only to find that the “bottom line” pay is not what they expected, nor what they can comfortably pay their bills with.

            The uprising will have to come from the general and family practice physicians, as well as the pediatric specialists.

            The hospital based physician specialists won’t be joining the fight, because they like their pay. They also do not want to risk losing their high paying jobs.

          • Patient Kit

            As I’m sure you know all too well, Margalit, (because it sounds like we have some similar experience in organizing people to fight for social justice), it is much easier to get people to vent and express frustration and anger than it is to get them to commit to taking action that carries considerable risk.

            I will acknowledge that docs have a lot to lose. They have sacrificed and invested a lot of time, money and effort to become doctors. And there is real risk in sticking your neck out and rocking the boat. But every worker who has ever fought his employer for justice has rocked that boat and taken that risk. Docs can’t expect someone else to do this FOR them. We can, however, do it WITH them. And it’s important to keep in mind that there is risk too in doing nothing. If doctors are as miserable as they say they are, they risk being miserable for the rest of their lives if they are unwilling to risk anything to change that.

            In the wise words of my GYN oncologist: There are no guarantees.

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

            You’re right, the risk is enormous, and worse than that, with all the misery, most docs are correctly calculating that the brunt of it will fall on the next generation, or even the one after that.
            But here is one thought I’ve been toying with…
            Physicians in small private practice, who have no desire to practice elsewhere, are not really facing that much risk, if any. Primary care ones in particular because they don’t need referrals.
            Insurance companies, which is where the money is coming from, are not going to retaliate against a bunch of doctors that cost them about half as much as the ones in big systems (may need to fine tune the initial message so as not to make too many enemies, and maybe get support…).
            Patients are going to love doctors that stand up for patients (make some sort of badge or public directory or something), and I bet their phones will be ringing off the hook with new patients….
            The employed guys are in no position to do anything, I don’t think, except the ones that work in Community Health Centers and are already inclined by and large towards social justice….
            Just thinking out loud here, Kit….

          • LeoHolmMD

            It does seem like Indies are the key…but they are also being absorbed quickly. You would think academics would take some liberty, but they are too busy trying to play nice as well, for reasons you mention. Ultimately, I think it would help to have Primary Care untethered and unified to the end of being a powerful patient advocacy group. I think Primary Care had a chance to do this, but ended up consolidating in the wrong direction. Now it’s going to take a lot of energy to invert the funnel. I am going to keep trying. The DPC movement gives me some hope.

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

            I agree Primary Care is the natural candidate for spearheading this. Unfortunately they are also the least likely to stand up for themselves, hence the low pay and unappealing status.
            I am also hopeful about DPC, but you have to be cautious here as well. For example, I realized a while ago that MDVIP is just a division of Procter & Gamble… from the fire to the frying pan….
            Just curious, how are you going about trying? Are you organizing anything, or just doing your part to stay independent, which is no small feat either these days?

          • LeoHolmMD

            I am in academics, so I rally and teach FM residents. Morally supporting local Primary Care Indie group (and a little more than that). I need to open more patient channels. Start some media contacts. I screen documentaries locally, and need to do more of that. I have hosted some forums for DPC and alternative practice models. I like getting ideas going like on KMD, but it is going to take a lot more than that. Need to do more on the legislative front, but that is a tough arena to crack.

          • Patient Kit

            I think a patient-doctor movement can happen. Doctors and Patients for a Humane US Heathcare System! But it will take time, hard work, commitment and a willingness to take some risks. I’m kinda getting a sense that lots of docs want this to happen, but they want someone else to do it for them.

            I agree that the unemployed docs — I mean, the independent primary care docs — have less to risk and probably should be in the forefront of this movement. I also wonder whether some retired or quitting docs care enough about the future of our healthcare system to get involved. Initially, the most vulnerable employed docs could still be secretly involved behind the scenes, contributing in various ways, including providing inside info about their employers. There is a lot to do and room for everyone to do something.

            I agree that it will be important to mobilize strong patient support for the docs who are willing to step up, stick their necks out for patients and get involved/lead in this kind of movement. Are there any organized patient advocate groups that could help build doc-patient coalitions?

            But first, do doctors really want to work for this kind of change in our system — or does it just feel good to vent?

          • DoubtfulGuest

            Look what they’re doing in Hawaii! Did you know about this?

            http://saveourdoctorshawaii.org/

            saveourdoctors.org redirects to them. I saw the domain name was taken and got curious. :)

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

            I knew about it. Read carefully…. This is a lobbying group for addressing malpractice laws in the state.

          • DoubtfulGuest

            Indeed, I have been reading more there and I see what you’re saying. I need to curb my enthusiasm. I actually wondered about that when I first saw it, but then it’s a major issue of concern for doctors here. This is where I’m naive, I know, but I was stopped cold in a discussion about this very issue on another recent post by a bunch of docs. It came across as, until we get the tort reforms we want, there’s nothing to discuss. That happens quite a bit here. It’s stressful stuff…kind of gets in the way of information literacy.

            That is why it will be hard for patients to lead. I have initiative, but how are we to explain doctors’ side of things to the public when hardly anyone will give us straight answers?

          • DoubtfulGuest

            A gmail spammer from HK wants to join the doctor revolution, LOL. She has a “project” for me. First step would be to deposit funds into my bank account. ;) Sigh…

          • Patient Kit

            I certainly hope most doctors don’t, in general, think most patients are stupid. For starters, every single human being who lives in a flesh and blood body, is a potential patient. That means that patients run the full range on all human characteristics, including intelligence. For another thing, there are different kinds of smart. There is book smart and there is street smart. There is specialized smart (such as medicine) and there is general smart (life experience).

          • DoubtfulGuest

            Right again, PK, and well said. Some of my frustration is with myself. I’m smart enough in my field, but I’m not “general smart”, in many ways. Anything to do with politics and the economy, I’m more like grade-school level. I have some cognitive impairment on my bad days, but there’s no medical help for it beyond the “mito cocktail” I take every day.

            I feel like I could make a contribution here, and I really want to, but I don’t feel qualified to lead. Overall, you’re much more “with it” than I am on these blog topics. Your life experience is much more relatable for large numbers of people. Every now and then I throw in some weird item that people find useful, and I’m glad to continue to do so. :)

            There’s just so much that doctors aren’t telling us, so patients are supposed to head up a movement *how*? and with what information?

          • Suzi Q 38

            It is probably not going to happen unless patients are denied care.

          • DoubtfulGuest

            Indeed, the wind has been knocked out of my sails for now. But aren’t patients already being denied care?

          • Patient Kit

            DG, I’m sure you have much to contribute to a doctor-patient movement. Your enthusiasm is wonderful. Try not to get discouraged so easily though. Change like we’re talking about doesn’t happen easily or overnight. Activists, like doctors, have to guard against burnout so that they can sustain their enthusiasm and energy for what they are doing over time. If this was easy, it would already be done. It can be fun at times, but mostly it is very hard work.

            I’m certainly not trying to claim a leadership role here myself, but I do have experience in activism and I care enough about this to get very involved. My dream job would be a full time staffer position devoted to trying to make our healthcare system more humane for both patients and doctors. There is no way to avoid the political/economic dynamics of the US healthcare system while attempting to make changes in it.

            I think you were just getting a little ahead of yourself and expecting too much too fast. It takes a lot of effort to get people involved in something like this and to sustain their involvement. Unfortunately, there will be no insta doc-patient movement.

          • DoubtfulGuest

            Thanks, PK. I like your idea for your own involvement in this, and I do think you’d make an excellent leader if you were so inclined. I think I did a poor job explaining where I’m coming from, I do understand things take time. The way I get things done (or don’t) with my medical/lack of energy situation is I’m either in 1) turbo-charged intense mode for short periods or 2) sleeping. :/ In my work life, this is how I’ve managed and I’m trying to learn to pace myself more. There’s a lot of strong coffee involved in my posting patterns.

            I was offering help for a time that I felt up to it if others were ready. But I have plenty of stuff to keep busy with and I’ll make the offer again next time there are definite stirrings of unrest. I don’t give up easily, at least not permanently. I just wanted doctors here to feel some sustained encouragement from patients and to think of the light at the end of the tunnel. I realize it would mostly not be fun.

        • LeoHolmMD

          That is pure gold. It would let patients drive the agenda. That is the way it should be.

          • Suzi Q 38

            So patients are supposed to be the “driving force,” while the doctors not do anything? Really?

          • LeoHolmMD

            Not even close. Just the agenda should be patient driven. Trust me, if I ever see a patient driven grass roots movement for changing our system, I will be front line doing everything I can.

        • Patient Kit

          First, I don’t want Buzz to be right. :-p

          Talking about a doctor-patient movement, with or without unionization as one of the goals, I think patients can do this WITH doctors, but we can’t do it FOR doctors. Doctors are going to have to be involved.

          I think I’d prefer the cause to be framed with some duality. Maybe something like “Save the Doctors = Save the Patients”. I also think that good leadership needs to be developed from both bases to form a solid dual leadership role. Docs and patients share a lot of common ground and goals, but we have different experiences, perspectives, strengths and weaknesses. We need to tap into both.

          I would also seek out doctors who have personal experience being patients themselves with serious illness or injury. I might even explore reaching out to rogue insurance, Pharma, hospital Corp admin employees who became disillusioned with our healthcare system when they or someone they love became patients and felt failed by the system. They could provide valuable inside info on those industries.

          • buzzkillerjsmith

            I’m shocking and hurt you would say such a thing about me.

          • Suzi Q 38

            I am sure you are over it by now.

          • Patient Kit

            I feel your frustration and pain, Doc Buzz..I’m just not ready to abandon all hope yet.

          • buzzkillerjsmith

            I’m in less pain than you might think. I will admit to some frustration.

          • DoubtfulGuest

            Good ideas. I was talking with my husband last night and he said “Wait — so explain to me again how this is supposed to work? Because it sounds like patients are supposed to somehow bail the doctors out by themselves?” We had a good discussion about how it needs to be a multi-pronged solution, and patients need to be a substantial part of it, but…yeah…

  • Patient Kit

    I agree with much of what you say about trust, transparency, honesty and accountability. But, personally, I hate being called a healthcare customer or consumer. It just connotes a cold business transaction to me. I don’t mind being called a patient, maybe because it connotes an actual relationship with doctors that goes beyond an exchange of money for services. I don’t find patient disrespectful or patronizing. But being called a consumer or customer makes me feel like a wallet. It doesn’t feel empowering to me.

    • DoubtfulGuest

      Exactly.

  • DoubtfulGuest

    I want to see them organize, partly because they’re trying to do something about patients getting screwed by the system. I haven’t seen a single doc try to make this all about themselves.

    I do think those personal relationships and discussions are important. Like Dr. NewMexicoRam just had with his patient. It’s ultimately better for both him and his patient for the patient to hear what’s going on.

    Good point that they can’t please everyone. They shouldn’t worry about that. I think many of those people would come around eventually, anyway. In any life situation, people often react differently than they did initially, as more information comes to light and they have a chance to process their emotions.

    Regarding what you say about a false choice, I think there are a few individuals who may need to leave medicine because they’re too burned out. It’s not for me to say who those people are, or to judge them either way. I want to see docs organize in large numbers, and see what I can do to support that,

  • DoubtfulGuest

    I’m not into the customer thing, either. But we could start with points of agreement and work together even so. What I think I see happening, is doctors have been afraid to inform the public about what they’re going through. Their alternate line of defense has been to refuse to apologize, refuse to be transparent. Lawyers are a big part of the problem here.

    Also, there are quite a few patients, particularly elderly folks, who dump all responsibility for outcomes in doctors’ laps, they just want to be told what to do and don’t want to learn about side effects, risks, or anything else to do with medicine. Doctors are trying hard to keep those patients happy through the remainder of their lives, while also adjusting to the newer “e-patient” type who wants information and choices.

    In agreement with you, one thing I find endlessly amusing yet frustrating, is how doctors LOVE to invoke personal responsibility — for everyone else! But many of them are slacking off in the ethics department themselves. The only viable alternative is for them to maintain their principles and at the same time, level with us about all the external pressures that make it so hard for them to do so. Not as an excuse, but as a problem to solve in collaboration with one another.

  • DoubtfulGuest

    Doctors: What would your ideal foundation to save you look like? Think like a baby seal, please. ;) What are the top three things you want the public to learn about what you’re going through?

    What skills do people here have that could get this going? Who wants to help? I don’t have social media expertise, really. That’s a weakness. My participation here is my only real gig online, but I’m willing to learn. Also would use my real name if kept separate from these blog discussions e.g. by e-mail or on a “Foundation to Save Doctors” Facebook page or whatever. I’m okay at writing and publishing. I have a history of volunteer work, social activism, and service learning projects. I’ve filed paperwork for a not-for-profit organization in the past. I have some experience communicating with the public about science. I’m connected with a major university so that could be a resource? I’m taking any and all suggestions…

  • buzzkillerjsmith

    Well said. Confrontation is self-destructive. Plus your businessoverlords love it, just love it. You’re playing into their hands.

    Smile and nod, then quit. They hate it when you do that.

  • DoubtfulGuest
  • DoubtfulGuest

    Yes, the recent spate of media misinformation needs to be addressed and corrected early on. That story was such a crock, the downplaying way they said oh btw those payments “may include overhead” or something like that. People need to see what the real take-home pay is for many docs. For months at a time, that may be nothing at all. People need to see some more representative numbers.

  • LeoHolmMD

    Notice the media said nothing about how in the world rural small town docs make it on how little they got from Medicare. They did exactly what was expected with this data. Exactly.

  • toolate

    I think people don’t understand the trap you’re in. If you want to practice good medicine, you will be hounded by admin. Your arm will be bent till you’re forced to compromise. If you don’t compromise, you will be terminated and reported to the NPDB. If you bend your head and go along, you can only pray that nothing bad will happen to the patients. And the patients? Instead of appreciating this, they will complain. Trust me. I have, sadly, lots of experience with this. You fight for the good of another and you get bashed from all sides including the people you’re fighting for. It’s an impossible situation. If you’re not getting depressed, there’s something wrong with you.

    Here’s an article about the insane profits and the corruption of the business people who run HCA. The article touches on the topic of how physicians are forced into unethical practice (discharging patients instead of treating). It hints at their misery though doesn’t detail it. It’s clear, though, that the doctors are the good guys. It describes one whistleblower who was fired (and when you’re fired as a doc, in most cases you’re done for, everywhere and for all time). It describes one nurse who quit after all her pleas to improve staffing were ignored. It’s all about the evils of the corporation and the INSANE profit these biz people make, at the expense of patients, doctors and nurses. Also, after HCA was charged with medicare fraud, the CEO walked away unscathed and MEGA rich.

    http://www.nytimes.com/2012/08/15/business/hca-giant-hospital-chain-creates-a-windfall-for-private-equity.html?_r=0&adxnnl=1&pagewanted=1&adxnnlx=1397757968-WsvRX0s8NvBBcc4wBDbmXQ

    I started reading the comments. here ya go.

    “Yes, doctors deserve worthwhile compensation but NOT by making a mess of the healthcare system &/or endangering patient health with unnecessary surgeries !!!”

    “In the USA the 1st diagnosis made by many hospitals and physicians, is that of the pocketbook, and not the illness”

  • Arby

    With everything that is not working in healthcare these days, what is working?

    I mean besides physicians working harder and longer.

  • buzzkillerjsmith

    Very interesting unionization idea.

  • LeoHolmMD

    This is a great idea. Time with your physician is a unification issue. Patients don’t feel like they are getting enough time and neither do the doctors. We could start there. We need a payment system to support that. Get rid of the corrupted Relative Value Committee and allow cognitive physicians to be able to have a sustainable practice.

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

    Thank you…thank you…. timely for my next blog rant (I needed a grand finale….:-)
    I have no idea what he was saying… I think the goal was to not step on anybody’s toes… Sort of like, health care sucks and retail clinics don’t suck that much more, so yeah, it’s all good.
    Honestly, the one that managed to grind my nerves was “Dr.” Hwang, as all the “disruptors” invariably do….

    • buzzkillerjsmith

      Disruptive. Beautiful. Too bad we don’t seem to hear as much about synergy and win-win as we used to.

  • LeoHolmMD

    Wow. That was painful. There is no way to reconcile what patients want, with the direction medicine is going right now. Poor guy sounded lost. Thanks for the alert.

  • Patient Kit

    I agree with everything you say in your first point.

    Regarding unionization, I think SAG is a good model to look at first. But I don’t think it will be as easy as you make it sound. Organizing a union never is. A few questions:

    1). What percentage of docs are independent practioners now? You say “most” are but I keep reading that more than 50% of docs are employed now. I imagine that these two different groups of docs, employed and independent, have many common issues but also may have some different priorities. Are you all going to be in the same union?

    2). Most SAG members are based in CA and NY. How is this union thing going to play with doctors in less “union friendly” states? I’m in NYC and it’s not easy to organize a union here. How will this work in TX and AL?

    3). Do you have any sense about what percentage of doctors in the US are open to the idea of unionizing? It’s not going to work if the majority are against the idea. You have to lay the groundwork first of getting a majority of docs to, at least, be open to a union.

    4). Are you willing to be confrontational and take some risks? I can’t think of a single union that was ever formed by people who were unwilling to stick their necks out and be confrontational.

    I support the idea of a doctors union, but I wouldn’t want anyone to start this ball rolling without their eyes wide open. It won’t be easy. It will help to have patients/the public on your side. But it is essential to have good support and leadership from your own rank and file docs.

  • DoubtfulGuest

    Dr. Pho, I surely have no idea how much work it takes to start and maintain a thread like this, or your site in general. I just wish there was some way to organize the comments so things don’t get missed. Like, all the “doctors’ union” stuff in one place? Then it could be more of a “virtual whiteboard/workroom”? Maybe it’s just too early for that…something for a future post? I wish I knew how to provide something like that myself instead of asking you. Thanks for a great post, in any case, and giving us this opportunity to connect with one another. Just thinking aloud here…

  • Dr. Cap

    Agree on all points with one amendment.
    1b. Stop calling me “provider.” Doctor, physician, surgeon or D. All of the above.
    “Provider” makes me feel crappy and diminishes what I’ve done to become something which has a name. “Provider” reeks of “Aren’t you ashamed of yourself, Doctor?”

  • rational2012

    The comments here break my heart. Having recently been on the receiving end of what seems to me to have been excellent serious medical care I am struggling with how to express my gratitude to my two doctors without sounding like a hopeless airhead. I will be forever grateful to them and want them to know it. Not only have they fixed my problem but they bolstered me with a kind of hope and confidence I have never experienced before and sort of didn’t even feel like I deserved. Maybe I should just say that. I can’t speak for anyone else, but caring physicians who help people both physically and emotionally during severely stressful times are brilliant, precious critters. So, since at least some of us love at least some of you at least some of the time, keep up the good work, please.

  • Rchobani

    Very interesting thoughts. Yes, I would agree that a union-like support would be preferential to just quitting medicine, as many are opting currently. Now, to overcome the legal battles and insurance company threats for any and all collusion among doctors…

  • http://www.idealmedicalcare.org PamelaWibleMD

    Yes. The solution is called disintermediation: remove the middlemen. Here;s how: http://www.youtube.com/watch?v=5cvHgGM-cRI

  • John_Barleycorn

    I read Daniela Drake’s article and left a couple of comments. I can say right now that after 26 years of medical practice, I was definitely ready to bail out. Fortunately, I applied to serve with the armed forces and was approved. Military service isn’t for everyone, but I strongly recommend federal service (DOD, VA, PHS) to anyone who isn’t ready to retire yet. No insurance, no malpractice.