How to respond to the despair from physicians

It seems that in the past few weeks, physicians across America have reached the breaking point.

Internist Daniela Drake wrote in the Daily Beast about how miserable it is to be a physician. She talked about the lack of respect, the lack of time to see patients due to increasing paperwork and the ever-present board certification processes.

Orthopedic surgeon Daniel Craviotto Jr. wrote “A Doctor’s Declaration of Independence” in the Wall Street Journal. In it, Dr. Craviotto states that, “In my 23 years as a practicing physician, I’ve learned that the only thing that matters is the doctor-patient relationship.” He goes on to explain that mandates for electronic health records (EHR), the burden of board recertification, and changes in Medicare and Medicaid have added to the burnout facing so many physicians today.

I don’t know about you, but I applaud these doctors for speaking out. What’s even more troubling than the degree of frustration reflected in these articles are the comments left by hundreds of non-physicians. Apparently, many people think that physicians are a wealthy, complaining, and unsympathetic bunch.

How can we respond to this overflow of despair from our fellow doctors and disdain from our patient population?

Some facts that you may want to share with your friends, family and patients:

  1. Of the total health care expenditures in the U.S., physician salaries and reimbursements account for 8.6%. This is the second lowest of the Western nations. The lowest is 8.5%.
  2. The average physician salary in the U.S. is $191,500. And the average amount of debt from medical training in the U.S. is over $150,000.
  3. There is a predicted shortage of 90,000 too few physicians by the year 2020 in the U.S.
  4. Nine out of ten physicians state that they would not recommend their profession.
  5. More than 300 doctors commit suicide every year.

There are no easy, simple answers. Connection — to each other, to our support system, and yes, to our patients — is part of the equation. I agree wholeheartedly that feeling connected to a disconnected system is, at the very least, unsettling.

Creative solutions are needed. Such as the one suggested by Art Gardner, an Atlanta patent attorney, currently running for U.S. Senate. He determined that part of the high cost of health care in the U.S. has to do with patented medicine. The price of Crestor, for example can range from $7.50 per pill in the U.S. to $1.78 in Canada. To make a profit, the drug company needs to charge $3 per pill. In America, because of the patent laws, it turns out that Americans are subsidizing artificially low prices throughout the civilized world. It makes sense to help out the impoverished in Africa, but not so much to be subsidizing the Germans, for example.

Thinking outside the box like this can provide answers to reduce medical costs that don’t add to the destruction of the doctor-patient relationship we all cherish.

As I recall, the Declaration of Independence endowed us with life, liberty and the pursuit of happiness.

Perhaps we all need to take a chapter from history and infuse a little modern day George Washington in our world to lead us across the health care divide.

Starla Fitch is an ophthalmologist, speaker and personal coach.  She blogs at Love Medicine Again and her upcoming book, Remedy for Burnout: 7 Prescriptions Doctors Use to Find Meaning in Medicine, will be available this summer. She can also be reached on Twitter @StarlaFitchMD.

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  • JR

    I’m just tired of issues being presented as something unique to the medical community.

    The middle class, across the board, is suffering. Young people graduate from from college with a four year degree and get a job as a part time retail worker or as a security officer at a mall, and they default on their student loans they have no ability to repay. Other young people are living at home with their parents with no jobs at all.

    Small companies are constantly being bought and absorbed by larger companies which have all the same problems that large medical business have. Metrics and satisfaction surveys are being applied to workers in all fields, it’s nothing unique to medicine.

    The greatest influence on national suicide rates is long-term economic trends. More people are dying from suicide than from automobile accidents because the economy is so poor.

    By focusing on how much doctors are suffering in exclusion of the rest society, it does come off as elitist and out of touch. The truth is that medical providers used to be one of the top earners in society, and now they aren’t. That’s only because the top earners in society own… 50% of the world’s wealth. The distribution of wealth is escalating quickly. http://www.forbes.com/sites/laurashin/2014/01/23/the-85-richest-people-in-the-world-have-as-much-wealth-as-the-3-5-billion-poorest/

    • Arby

      I agree with what you are saying, except to say that this is magnitudes worse to have happen to them. It isn’t so physicians get a pass on suffering, it is because it is so much more dangerous in healthcare than most other industries.

      • Lisa

        So in essence you are saying doctors should get a pass…

        • Arby

          If that is the result, yes. However my point is that as a patient you do not want this happening in medicine. I was respected in my work, but the culture I was in was cruel and heartless. We were lied to most of the time, overworked and belittled; nothing was ever good enough. A relentless grind for the meaningless pursuit of my superiors’ careers. Yet I was in banking, we weren’t killing anyone (at least not directly), even though our managers acted like every single thing was a life or death issue.

          I assure you, you do not want that environment or the people struggling under it, where the sick are being treated.

          • JR

            Doctors used to be business owners. Those that weren’t had to be paid enough to keep them from striking out on their own. Being a business owner generally means a better income then being a worker.

            Now, businesses are created with the intent of selling them.

          • Arby

            Or with the intent of buying up all the competition and becoming a monopoly.

          • Ava Marie Wensko George

            JR, this is exactly the problem (besides all of America’s 99% are being hit hard). I am a university professor. I see so many residents going through MBA classes because FINALLY they recognize that they are entering a business and not a customer service type field. Unfortunately, most physicians practicing today do not have a business mindset. I understand focus on patient care is primary, but physicians also have to pay attention to the business of medicine, even if they are employed. Numbers count. Morbidity and mortality numbers play a significant roll in whether or not a physician will be able to accept certain insurance patients, which means if their numbers are not right, they will not be able to work. This is part of the business mindset that physicians must have and maintain. Medicine is a difficult business these days, but that does mean that physicians can cherry pick what they want to do and neglect the rest.

          • Arby

            I see a noble purpose in learning about business by physicians and that is to learn to recognize the business mindset and counteract it, not to embrace it.

            The last type of person I want involved in my care is an MBA. Their pseudo-humanitarian ideas wreck havoc with people, and yet they keep coming up with more ways to damage us. I saw TopTen BottomTen in action, learned a new way to communicate ever year, yet people were still going to HR over abuses, and now we have gamification. Why? So, it can be fun to manipulate people for business needs?

            It doesn’t take an MBA to keep certain patients from being neglected, all it takes is human decency. And the more that is punished, the less you will get of it.

          • Lisa

            You are correct, I do not want what is happening in medicine, but I also do not want what is happening to the rest of the middle class either. It disturbs me a great deal and as JR points out the focus on the difficulties in the medical community misses the fact that we are all affected by the economic forces in play.

          • SteveCaley

            The symptoms of despair from the doctor, and from the patients, are different symptoms of the same illness. You are all being very sharp diagnosticians; you will not discard the suffering of the middle class in general; that is likely a third symptom, a more global and systemic process to which the other two processes belong. Some diseases, like rheumatoid arthritis or extrapulmonary tuberculosis, look localized but are really systemic.
            This is not a disease that’s easy to fix, or self-limiting. The whole boat is sinking; maybe those in the stern will live 20 minutes longer than those in the bow. That’s not a great benefit in the big picture, really.

          • Patient Kit

            So, if we are all on a sinking ship, do we try to help each other or is it every man for himself? Or are we all so doomed that it doesn’t matter how we go out — drowning, sharks, freezing to death — the end result is the same. I happen to believe that it matters whether we are willing to hit each other on the heads and take each other’s life jackets rather than try to help each other.

          • SteveCaley

            Naw. Compared to the Big Messes that people have made it through – World War II in Europe, the Great Depression at home, tons and tons of disasters and famines and plagues and all that in history – this one’s a lightweight. We can do it, if we grow up and decide to.

          • Patient Kit

            I agree. Bigger fights have been fought and won in this country. Civil rights comes to mind, to name one in which the unpowerful had to put something on the line and go up against the very powerful to change things. I don’t believe things are hopeless. I believe it is possible to have a better healthcare system in this country. But I disagree that it is a lightweight fight. It won’t be easy but it can be done.

          • Arby

            Would it be so difficult to let doctors fight their own battles and let the rest of the middle class fight theirs? We can back each other up, yet no one can fight every battle. If they fight this battle correctly it will help patients and it will help them as patients too. Very few of us will be doctors, but most of us will be patients.

          • JR

            Doctor: The public doesn’t understand what we are going through, so we need to speak up so they understand. This way we can sway public opinion and generate change.

            Public: We totally understand, we’re dealing with the same stuff.

            Doctor: No you don’t understand! You’ve never dealt with bad software at your job (even though we all have). You’ve never gone from a paper system to paperless (yes, we all have). You’ve never had to worry about being sued (Oh yes we have!) You don’t have college debt you can’t afford to repay (What? Yes we do!) You’ve never been reviewed according to badly tracked metrics (Yes, they were tracking that at fast food joints in the 90′s… certainly your average joe has been subjected to it). You don’t have to deal with losing your job over an angry patient (I had a restaurant manager who was fired back in 2003 because the same customer complained too many times directly to corporate. There was no satisfying that customer, the customer was the problem not the store manager.) Bullying in the workplace happens around too… that’s what all those “hostile work environment” lawsuits tend to be about.

            Sure – there ARE unique things to being a doctor. But much of what they are going through is what the rest of society is also going through. It’s not a good move to sway public opinion by stating that the public doesn’t have to deal with things they deal with all time.

          • Pam Pappas MD

            JR — You might find it enlightening to shadow your physician closely for a few days or a week, and see what s/he goes through just for the privilege of providing good medical care to people like yourself. There are certain commonalities in the suffering all humans experience, but roles and pressures differ profoundly. Best wishes.

          • JR

            Pst. Most the non-doctors who regularly read this blog have a personal interest in medical topics, usually from being misdiagnosed, injured, treated shamefully by medical personnel, etc.

            Trust me: We know what it is like to suffer.

          • http://www.drpampappas.com Pam Pappas MD

            Yes, suffering abounds in the world — and I’m sorry this is happening with you. However, this does not preclude empathizing with the suffering of others — even a group of people you feel has harmed you. Doctors are still human, just like you. And I still think you might be surprised at the thousands of decisions, pressures, expectations from self and others, etc that your doctor somehow balances as s/he sees patients and deals with practice issues — trying to do the best s/he can for each person, given the extreme constraints s/he’s under. Take care.

          • JR

            I could only be surprised if I wasn’t aware of the decisions, pressures, or expectations doctors have?

          • Arby

            So, because you hold a chip on our shoulder, you don’t care that a business mindset is overtaking medicine?

            I’ve been harmed too. I used to say, it isn’t where you go, it’s who you see, that determines how well you are cared for. Well, when business and government strangles more of medicine, good luck with finding good care anywhere.

          • JR

            I support independent doctors. Even my eye doctor is privately owned. And I encourage other patients to do the same. Not all patients can do this – not all doctors can leave their horrible employement – but if enough patients and enough doctors move that will start to change things.

            I’ve seen companies take great care of their employees. I’ve seen a company that fires the bottom x% of their employees every year when they do performance reviews. I shop at company one, and boycott company two.

          • Arby

            Good on you. I wouldn’t support a company doing that either and I’d really like to let them know that is the reason, but I rarely get to connect with their management and even less that they listen to me. Perhaps, I should think about starting a social media campaign someday. I am not really the type, but I have seen some progress with a few of them.

          • Patient Kit

            Not this patient. I have no ax to grind with any of my doctors. I’ve been lucky to have some very good docs. I love, respect and recommend them to others. My issues are mainly with the profit-driven powers that control healthcare, the ever-rising cost of healthcare and the seriously eroding access to and quality of healthcare.

          • JR

            Well, if you’ve never suffered that’s awesome.

            But I still think it’s wrong to claim that all doctors are suffering, and they are all suffering more than any other person on the planet just based on the fact that they are a doctor, and imply that no one else knows what suffering is.

          • Patient Kit

            Oh, I’ve suffered. Layoff. Unemployed. Uninsured. Ovarian cancer. Eviction. A terrifying fall out of the middle class onto Medicaid. And now I’m facing the threat of losing all access to healthcare and doctors as soon as I start working again, even as I still need medical care for cancer. I didn’t willingly jump. I was pushed. And the jury is still out on whether my bungee cord will work or snap.

            I’ve suffered plenty. But not at the hands of my doctors. The source of my suffering and terror is our economy and the powers that control the money and access to healthcare.

            If you read my other comments on this thread, you’ll see that I agree that doctors are not suffering alone or the most. But I don’t have the anger that you seem to have toward doctors. My response to you was a reaction to your assertion that most patients on KMD have been misdiagnosed or mistreated by doctors. That has not been my experience.

            I consider it essential for docs and patients to remain allies and I think it’s counterproductive at best and destructive at worst for doctors and patients to compete about and compare pain. That serves no purpose but to divide us. We need to empathize with each other, not fight over whose pain is worse. It reminds me of people arguing over whether the Holocaust or slavery was worse.

          • JR

            That’s what I’m trying to argue:

            Running around saying “our suffering is unique and you can’t understand our pain…”

            and then using a bunch of examples that are the same things that everyone else in society is suffering from…

            Yes, that DOES come across as out of touch and entitled instead of bridging the gap between doctors and patients.

          • JR

            The thing that bothers me about this comment is that you are stating that “You can’t possibly understand the pressures a doctor faces.”

            I went from an office that was all paper to one that was completely paperless. I’ve been there, seen the benefits, the challenges, the bumps along the way, the paperwork that due to bad software design got thrust into a dark hole that was never reviewed… oh i’ve seen it. I GET it.

            I’ve gone from working at a small family oriented company that decided “Let’s be corporate!” with an HR that prevents any kind of employee displine which kills moral because “John gets away with doing x, so why should I bother trying to be better? It doesn’t seem to matter how I perform, there are no consequences.”

            I’ve been there when metrics are pulled from systems and applied to individual employee performance – metrics that don’t actually correspond to the work the employees due because the systems recording it are completely unreliable.

            Yet, you are INSISTING that the public “CAN’T UNDERSTAND!”

            Maybe stop assuming we’re so different. Maybe realize that other groups have gone through the SAME problems and found ways to solve them. Maybe you don’t need to reinvent the wheel after all. Maybe – we can help you.

            In my case, leaving that environment was the best decision I ever made. Techies have been leaving corporate america and starting their own companies with Techie-leadership – and people fight to work for them. Having tech people in high management roles is a huge selling point to employees.

            What if doctors starting leaving these corporate medical systems and created their own doctor-driven ones?

          • http://www.drpampappas.com Pam Pappas MD

            JR — I’m not “insisting” that the public “can’t understand” physicians.In fact, I’m saying that all of us are human.

            I AM suggesting that physicians are dealing with things that go far beyond the tech issues you keep mentioning that you can solve (and I hope you’re offering your proposed solutions in that sphere also). These issues include what it means for a person to be alive, dead, suffering, healthy, or somewhere in between. It includes what it takes for a given person to heal from whatever currently ails him or her, and how you as a physician can support that. A stroke of a pen, a check of a box, can impact all that. How to convey hope in the midst of all this is another issue. Shadowing your physician closely might expand your awareness and human compassion. From what you write, you’ve been through some processes of your own and I’m sorry for this suffering. Take care.

          • JR

            You’re clearly arguing against something I’m not arguing for, but you’re being so vague I have no idea what you THINK I’m arguing. In fact, I can’t even tell what you think you’re arguing either, and instead you’re using personal attacks.

            Why would you think I lack compassion? How do you know the sum of my knowledge? You don’t know anything – I’m a random stranger to you on the internet, yet you make some bold assumptions.

            Isn’t it obvious I’m playing devils advocate? Are you not catching on? I’m not being subtle about it.

            This article itself ignores all the facets of suffering that doctors deal with and instead focuses on money, money, money, money. If you think that’s a way to motivate the public, go ahead and continue. But hint: it’s not motivating the public.

          • Arby

            What would you have them say to the public?

            And, for whatever business you are in, why should physicians fight your battles?

            You’ve touched a raw nerve in me in that your perspective is the same as corporate America’s.
            “Everyone else is dealing with the same issues, and they come to work everyday, so suck it up and deal with it.”

          • Lisa

            I wouldn’t say JRs perspective is the same as corporate America’s. Rather he is saying that you are taking the wrong tack to sway public opinion.

            You know what really got me in about this article is the author made one suggestion that would chip around the edge of medical costs (the bit about the cost of patented medicines) and gave some data for doctors to share. Yet she didn’t touch on the real cause of the problems in medicine – the take over by Corporate America.

          • JR

            If you want to paint a picture that the suffering of person A is greater than person B, and get mad when person B doesn’t immediately agree – maybe you should realize that person B also suffers and you have more in common than you originally thought.

          • Arby

            I haven’t addressed this subject directly because I never got the sense that the article writer or the doctors that comment here (with the exception of one) were ever saying their suffering was worse. I don’t even know how the discussion got framed this way.

            I’ve been responding to the claws that came out in the comments. When MDs are finally speaking up, maybe showing a little fire in their belly to change things then they get shut down with a conversation about why their suffering is no worse than the rest of the middle class, that is discouraging. Your intention may not have been to say your suffering is no worse than anyone else’s so suck it up and deal with it, but that is the what they are going to be beat over the head with by their managers. I know, I have seen it this played out too often.

            I appreciate you giving them advice on how to reach the public, I just wish it had been with a little more understanding.

          • JR

            This article is responding to the fact that even though doctors have come out about the challenges they fact, the general public is still not getting it.

            My response is the way it’s being framed makes doctors seem completely out of touch with the experiences of the public.

            I’m not arguing at all that doctors don’t have pain points or they shouldn’t work to improve them, but if “swaying the public to gain support for policy change” is the method being chosen, then complaining about the fact that doctors graduating today have an average of 150k in college debt and make 190k a year isn’t going to sway all the people with 45k in college debt and incomes of 35k… a situation very common to 25 – 35 year olds right now. Instead it just comes off as out of touch.

          • Arby

            i don’t agree with the communications offered by the author either, yet I also didn’t perceive it as saying doctors have it worse than others. That people have jumped to that conclusion says a lot about how well the divide and conquer strategy is working for the true elitists.

            I think society is wrong here in underestimating how workplace pressures on doctors (and all healthcare personnel) will affect them. But, it doesn’t really surprise me that they don’t. I am sure most are more worried about how the Comcast merger is going affect their cable bill than how being a checkbox metric on a form who is being given 10 minutes with a doctor that spends half their time trying to find their lab results and input what they say into a computer, is going to.

            To your most recent point, you’re right, the public isn’t going to be swayed by the arguments in this article. I’ve never thought that swaying their opinion is where doctors would get the most traction anyway. Even a proposed Change.org petition is not going to reach the general public, only a certain demographic.

            I think it best that doctors work with the patient population. They’re the ones who are feeling the effects of this mess of system and they are much more visible to administrators (if they can be in their faces; which I know is a hard thing to do if you are sick).

          • FEDUP MD

            The difference is the stakes. If a restaurant manager is burned out and does a crummy job because of it, my meal will suck. If a physician is burned out and make a mistake, then my health and possibly life is on the line.

            If you can’t see the stakes are very different, then I am not sure what to tell you. Generally when other workers are suffering, it affects just them and maybe their families. As much as that sucks, when a doctor is really suffering, then many of his/her patients will bear the brunt of it as well. Patients should have a selfish interest in the mental health of their physician.

          • Lisa

            The stakes are high for everyone. When workers are suffering it affect society as a whole, just as when doctors are suffering it affects society. I don’t see why I should care more about my doctor than anyone else.

            Medical error causes harm, sometimes a lot, sometimes not so much. But I can think of many cases where an error causes hard. If a bus driver is or truck driver is burned out and causes an accident, people are usually injured and some may die.

          • FEDUP MD

            I think the experiences and anger of many commentators here who have received bad medical care, probably in many cases due to burned out physicians, should be an example of how suffering could affect you.

          • Arby

            You don’t have to care about their suffering at all to be concerned about their work environment. I don’t think we disagree on the systemic effects of business in medicine. Yet, I am unclear on how being told repeatably that their suffering is no worse than anyone else’s helps physicians resist it.

            Personally, if MDs were able to get to see 2 less patients an hour because they fought the current demanding schedules on the grounds of their own emotional issues vs it is bad patient care (although I wish they would fight it on that), I would be happy to get that, because the end result would be they’d have more time to spend with the patients they did see.

            So, with that said, if anyone here has good insight into the dynamics of this, and is a good writer, I’d be glad to put up what they wrote as a petition on Change.org as a call for a limit to the number of patients a doctor can see in an hour when they work for an employer of say over X number of medical staff to be delivered to healthcare organizations

            Physicians please correct me if I am wrong here, as I am no grass-roots activist, and I honestly don’t know what small step would make your workplace even a little easier to deal with.

          • JR

            Sure. But doctors suffer because they are traumatized by med school, banned from getting mental health care, and the economy sucks too.

            Just giving doctors a 5% raise won’t make them happy or solve their problems.

          • FEDUP MD

            I don’t think anyone has suggested that as a solution. We are looking for less interference with our decision making and less running of health care like it’s a Cheesecake Factory and more like a system where doctors and patients work together to treat disease. And we would like to stop being the scapegoat for rising health care costs when insurance and hospital administrators provide no direct benefit to patients,but make crazy money, more than any MD, off their premiums. This is the source of our suffering, not med school trauma, and all the counsellong and meds in the world doesn’t fix how we feel when
            we are not able to provide proper care to our patients.

          • JR

            You know every doctor in the planet, and they all are suffering, but not a one from watching people die, and bad EMRs and 10 minute visit requirements are the cause of doctor suicide.

            I’m not quite buying that. Sure, I get that some doctors are working under these restrictions, but it seems to me these restrictions are being required by… employers.

            So why not out the employers? Why not ask patients to start going to the businesses where doctors are happy and better able to take care of their patients?

            Everyone’s job has challenges, but when it’s to the point you can’t live another day or see the light at the end of the tunnel, it’s time to leave. That doesn’t have to mean leaving medicine entirely, because… there are happy docs out there.

          • FEDUP MD

            Because the media has latched onto salaried, employed docs as the way to save health care costs. There was just another article in the NY Times decrying private OBs and pushing OB hospitalists as the answer to all that ails delivery costs. No one mentions that those employed docs are employed by a big corporation and answerable to them. Private practice docs are painted as greedy and obsessed with money, rather than independent and being able to consider the patient’s best interest. But it is hard to counter these perceptions when there is a lot of power and money driving them.

          • JR

            I saw that article (In Delivery Rooms, Reducing Births of Convenience). They are right that the high cesarean rate is a problem.

            I also completely disagree with the suggested solution. Making the doctor salaried just puts the fee for service at the hospital level.

            I’m also strongly against hospitals buying out private practices so they can use a loophole to charge “facility fees” for visits outside the hospital. I think that loophole needs to be closed pronto.

            I know all the media is controlled by 5 businesses, wonder what kind of stakes those business owners have in big business hospitals eh?

          • Patient Kit

            Big Phama, insurance companies and corporate hospital systems are all huge advertisers in mainstream media and advertising is media’s most important revenue stream.

            Some enterprising rogue reporter should do an investigative piece on THAT conflict of interest. Start with the NY Times. Analyze the percentage of their advertising paid for by the above-mentioned big three. Then analyze how many news and editorial artIcles were published during the same time that advance that big three’s agenda of turning the public against doctors. Could be an interesting project.

          • FEDUP MD

            Also, docs have been watching people die for thousands of years. While I am sure over these thousands of years many have despaired, I doubt highly this is any worse than before. In fact, now that we can actually do stuff, probably better. I doubt for thousands of years that half of docs report being burned out and that 90% would not recommend their kids go into medicine, however.

          • Arby

            I think it has been shown that autonomy is one of the biggest factors in work-place satisfaction. Too bad that micro-managing others has been demonstrated in the real world to be one of the biggest drivers of promotions and monetary rewards.

          • Patient Kit

            It sometimes comes off like doctors only started to understand and care about the dire effects of the economy and our healthcare system once it started to affect them — like the pain of the spiraling down middle class is abstract but doctors’ pain is real. It reminds me of how people started to care about things like AIDS and outsourcing only when it started to affect them directly. Not very endearing to those who were affected first.

            If this is not how doctors really feel, there is power in understanding when you are coming off in a way that does not reflect how you really feel and think — and making an effort to change how you are being perceived. If you don’t find a way to do that, it’s a wall between patients and docs — just where the profit-driven powers that make money off of both of our pain want us.

          • Lisa

            I agree…

          • Mike Henderson

            “The easiest type of pain to tolerate, is someone else’s.” I think it is human nature to understand one’s own pain and not appreciate the pain of others – physicians vs patients and vice versa. But getting to the point of seeing the big picture and that, as another poster said, we are all suffering from the same systemic problem, we need to work together and not tear each other down to the benefit of “corpmed”.

          • Patient Kit

            Human nature maybe, but I guess I have high expectations of doctors because I do expect them to be able to understand others’ pain. Isn’t that a necessary quality to have to be a good doctor? If we are going to fight for a better healthcare system, patients and doctors need to resist corpmed’s strategy of dividing and conquering us. Instead, we need to make a conscious effort to unite and conquer corpmed.

          • Mike Henderson

            We are human first, then doctors. Also, there is something about the training process, be it right or wrong, that makes it difficult to empathize with others. I still remember running codes hours at a time in the early morning hours until after the next resident came in to the ICU. Under those conditions, you just run on automatic and really can’t imagine there is any other way to get the job done or learn.

          • Patient Kit

            Of course. I wouldn’t want it any other way. I definitely want my docs to be human, not superhuman or robots. And none of us humans are perfect. But I don’t think expecting empathy is expecting too much of doctors. I don’t want to be treated like a number, a case or a disease. If that’s true — that it’s hard for docs to empathize with others — well, that’s disturbing. I’m one lucky patient to have a wonderful doc. I’ll be sure not to take him for granted.

          • Arby

            Expecting empathy from another individual is expecting too much. Would you expect courage from another, your child to love you? These are things that have come from a person’s own heart, they can’t be expected, demanded or bought and sold.

            A doctor doesn’t need to display empathy to do his job well. To do his job with excellence, I concur, but how many of us perform with excellence everyday. When a doctor gives empathy, that is a gift. And, if you’ve been empathic, you know it comes at a cost. Rewarding to them, maybe, but there is an emotional price they pay for it to give to us, and I am grateful when they do.

          • http://www.thepatientdoc.com The Patient Doc

            I agree that we are being divided and conquered, so how do we unite and make a change?

          • Patient Kit

            I think a good case can be made that the corruption and excesses of Wall St and banking and the culture of that world has directly affected many many people in serious and devastating lifechanging ways. Maybe not directly killing us but, for many, the end result is the same. Call it indirectly killing us. That said, I get your point about the dire effect of this kind of corporate culture in medicine and I agree that we don’t want that. I’m just not willing to let Wall St off the hook because they don’t operate in an OR.

          • Arby

            I agree, and I am not willing to let them off the hook either. Where I can, I call attention to their abuses to reduce the naïveté around business that so many still have. Business goes where it thinks it can extract money or gain influence to extract money. They are no different than swarms of locusts. They’ve stripped housing and manufacturing and are now well into higher education and healthcare. Yet, healthcare to me still is a very special case.

            I am able to see both the commonality and the uniqueness of their situation at the same time and hope others can understand it too. To give you an analogy that I hope makes sense. One of my stressed out co-workers occasionally would say this about our director. “Why did she give me this work to do when she can do it herself? Isn’t my time as valuable as hers?” Finally I replied with no, it isn’t. After getting the look of death, I explained that in the human sense, all of our time is the same. Bill Gates and I are equals. However, in the business sense, her time is actually more valuable and it shows because business is willing to pay her much more than us for the same amount of time.

            So, yes, those of us hurting, our pain is the same. Yet, what physicians are called on to do is much more valuable than what someone like me who published web content was doing. Even though it cost me dearly to work in those conditions.

            Also, on the subject of other comments, I don’t much care now that doctors are late to the party and I know some of them are just as guilty as any businessman. But for those that still concern themselves about what is best for their patients, the only thing I care about is that we work together, because our foes truly are laughing all the way to the bank.

        • dee

          Suffering is already highest in medicine, and that is without all of the leeches adding to the already stressful profession. diagnosing, treating, and making people happy is a burden on anyone who has to do it. Having to protect patients from themselves, too unknowing to care that the system does not act in their best interest, doesn’t help. We are all doomed.

          • Lisa

            I don’t need a doctor to protect me from myself; I don’t even need my doctor to make me happy. I do need my doctor to accurately dieagnosis me and to give me my options for treatment. That said, I know and care the system does not act in my best interest.

          • Patient Kit

            Persist, at your peril, in insisting that doctors are suffering more than any other working human. It will only alienate you from patients who work and are exploited everywhere else. Alienating patients is not a good strategy for going up against the powers that be to try to change things. A condescending attitude toward patients won’t help either.

          • JR

            I don’t agree suffering is any higher in medicine than elsewhere…

            But if *You* are suffering, Please see Pamela Wible’s post (I know she is one person who will listen to other doctors without judgement and provide understanding).

    • dee

      You don’t understand when a doc is given 10 minutes with a new patient, and that new patient has unstable hypertension, diabetes, lung problems, and arthritic complaints, and needs refills, that must be entered on frustrating EMRs, and then the patient wants durable goods, like a walker, toilet lift and the like, 10 minutes turn into 60, and the other 5 patients, scheduled from the last hour have to wait. And when they have to wait, they complain about the doctor, and the doctor loses his or her job. And trust this; they will complain if they don’t get everything they need. And at the end of the day, the doc goes home and has to complete electronic medical records, EMRs that were not created by doctors, and then tries to remember everything done, and everything said. and then has to complete a bunch of government mandated stuff, also on the computer, that a 3rd grader could do, taking over 1 hour on a chart after seeing 25 people a day. People do not understand that if they allow this unsustainable system to continue, the lack of time to think will, alone, impair their doctor and if the doctor is impaired, what happens to the patient? Yes, the whole system is falling apart, but bad doctoring leads to death for patients, and there are absolutely NO consequences. It is just as serious as bad lawyering, Given too many cases, lawyers cannot think, research, investigate- and this leads to life sentences for the innocent or the death penalty for those who never committed a crime. Yes, the middle class is suffering, but no one else has paid so much, and has to continue to pay, or delayed their gratification for so long, as doctors. And there is NO light at the end of the tunnel. Thus the high suicide rate. Lack of empathy by people like you, who makes everyone equal, seems to be the order of the day. It’s a circle man, and what happens in one segment of that circle affects all involved in the circle.

      • Patient Kit

        I think some of us do understand. Doctors are suffering in our system. But your patients are suffering too. In order to reach out to those patients who do not understand your issues, you really have to stop framing this in terms of competitive pain. There is absolutely nothing to gain by continuing to try to claim that doctors are somehow worse off and more deserving than their patients. That kind of talk only pushes patients away from understanding what you want them to know. You need to stop creating more barriers between you and patients and start creating more bridges.

        I understand that doctors are feeling a deep sense of betrayal. This is not what you signed up for, not what you worked hard for and sacrificed many years of your life for. But patients are feeling deeply betrayed too by a system in which we work hard for our whole lives and then struggle to get medical care when we need it. That sense of mutual betrayal needs to be harnessed and used as glue for the doctor-patient relationship and as fuel to fight for change together. Not against each other, not in competition with each other.

        If you think many patients do not understand, then you need to find ways to make them understand. But that won’t happen unless you approach this in a way that makes patients open to listening to what you have to say. To that end, your opening line should not be something that turns patients off.

      • JR

        First time I went to my new doctor where I was squeezed in (swollen goopy tonsil ick), I left with two future visits scheduled before I was out the door (blood work, follow up to blood work/full physical) and then ended up with even more visits (vaccine catch ups, follow up on chronic issues) etc. I know a few others that go there and no one ever leaves without a followup appointment, it’s standard routine for everyone. It works so well I can’t figure out why it’s not routine for all offices.

        So yeah, I don’t understand why a doctor would try to address that all in a 10 minute visit rather than do multiple visits. Even the patient advocacy sites instruct patients “one appointment per issue.”

        If your EMR sucks, buy “Don’t make me think” by Steve Krung and make all your techies and managers and decision makers read it. (Pipe dream, I know. But a critical book for anyone in a position to recommend, buy, or build software.)

        Business Software – all business software – is designed with management in mind first, customers second, and business users? THEY CAN BE TRAINED! We don’t need to make it easy for business users! Just train them!

        Until the ones holding the purses strings prioritize the business users, it won’t happen. But trust me: Business software in general sucks for employees and makes their life difficult.

        • DrTWillett

          From my experience with many families, if I try to make them come back to talk about anything in addition to a ‘well’ visit, they complain, or just don’t come back. If I deal with it at the time and document and bill appropriately for my efforts, the insurance company sends them a copay notice, and they complain. No win!

          • JR

            Does this mean that “well” visits don’t have a co-pay, but “problem” visits have a co-pay, and people are scheduling “well” visits and bringing up problems?

          • DrTWillett

            Yes- at least for the private insurance. Unfortunately, most of my well visits are booked as ‘well 4yr, no concerns’- then the parents bring up things that have been going on for a few months. Sometimes it is hard to know right off the bat what will require the equivalent of a second visit (in which case I should tell the parent that to address it at that time will generate a copay, costing yet more discussion in an already cramped visit), or if it is something really simple that I will just write off as part of the well visit. In order to stay on time for the rest of my patients, I book my well visits as 30 min to anticipate this, and only ‘bill’ for a few of the more complicated secondary issues. Unfortunately, the powers that be scowl upon that, for they want my schedule jam packed with billable goodness. Most parents don’t realize that the time they are given for those visits is 15min. Sometimes 10, sometimes 20, but in most practices, 30min for a well visit is a luxury. Being stubborn about giving people time has made me difficult to employ, but wouldn’t have it any other way. Now if I could just find a direct-pay practice for kids around here…

          • JR

            That’s why the “gee if everyone was salaried there would be less fee for service” argument is a joke. It seems that individual doctors in general aren’t behind the “10 minute visit” push – it’s the businesses.

          • DrTWillett

            There is a growing movement toward more meaningful medical practice. Check out Dr. Pamela Wible’s site: http://www.idealmedicalcare.org/blog/ Support for direct pay or alternative models happens to be even more rare in pediatrics. I think it is similar to the idea behind kids’ haircuts costing less but actually taking more effort. If hairdressers charged by time, most wouldn’t pay for the service. Of course many families would do anything for their children, but not many think they can afford the cost. The system is so very complicated and overwhelming.

          • JR

            I love Pamela’s articles. She’s made me see that not all doctors are bad, and it’s just about finding the right one. I’ve got a pretty good one now.

            The articles around here make me think my doc is a Mystical Unicorn, because he has an independent practice and takes all insurance/medicaid/medicare and has 30 minute appointments with his patients. I assume he can do this because he’s older and more established, and is probably winding down for retirement.

          • Arby

            I think you are correct about your doctor’s practice. I get 30 minutes only because I am Complexity Level 4 (out of 5). Something you never want to be.

          • JR

            Medical stuff + life – we all have our challenges right? I don’t think I’m level 4 every visit. But probably was on my last one (had a flare up) but feeling good today.

    • annette ciotti

      Dr Fitch, did you intend this to be “presented as something unique to the medical community”?

    • buzzkillersmith

      Not unique, but if you didn’t read a physician blog, you would not have to have these issues presented to you at all.

      I’m sure there is plenty of room over at the blogs for teachers, firemen, plumbers, Walmart workers, you name it.

      • JR

        I think of this as a “medical blog” – since posts are from many different perspectives: students, researchers, patients, etc…

      • Patient Kit

        With all due respect, Dr Buzz, calling KMD a “physician blog” and implying that all non-physicians here are mere outsider/visitors, sounds a tad territorial. When I stumbled onto KMD a few months ago, I was pleasantly surprised that doctors and patients are actually talking to each other here and we’re talking to each other about difficult issues.

        I don’t know the history of KMD or what Dr Pho’s intention was when he started this site. But if it has evolved past only docs talking to each other, I think that is one of the things that makes KMD a truly special place with the potential to seed a doctor-patient grassroots movement. There is still plenty of room for venting to the choir here, but the really good discussions are the hard ones where we don’t all agree but we learn things about each other that we don’t have time to talk about in the exam room.

        This is a place where we can hash out our conflicting priorities and discover our common ground and, hopefully, strategize together about how to make things better in our healthcare system for both docs and patients.

        • http://www.kevinmd.com kevinmd

          Thank you. You summarized one of my goals here nicely.

          Kevin

          • Patient Kit

            Thank you for creating this place and for letting me in. I think some really interesting stuff is happening here that has the potential to spark something significant.

        • buzzkillerjsmith

          You got me to thinking. I have repeated the same stuff here over and over and over and have had zero impact.

          I don’t mind irritating other people, but irritating myself is an irritation too far. I’ll try to cut back on the number of comments. It’s a slow process so please be patient.

          • EmilyAnon

            I for one don’t want you to cut back on your comments, Dr. Buzz. Even though people here tend to dig in their heels on certain issues, I’m sure many minds on both sides are changed after a contentious discussion, even though they don’t admit it. Plus so many of your comments are fun and would be missed.

          • Patient Kit

            I certainly don’t want you to cut back on your comments, Dr Buzz. I’ve only been here a few months but I’ve reached a point, a few times, during particularly raucous discussions, that I considered not posting here for a while. I couldn’t stop myself though. I was back to commenting within 24 hours. I know that many don’t agree with me here and some might even dislike me. But the discussions are just too good and interesting to pass up. As for whether they have any effect on how people think about things, don’t forget that there are many many more people reading these discussions than participating in them. I would bet that what you have to say is having more impact than you know. There is room for both cynicism and optimism here.

          • buzzkillerjsmith

            Thanks for the kind words, but this is an echo chamber. A mass market paper would get more people to thinking. They probably won’t have me, but maybe they will.

          • Patient Kit

            Perhaps it woud cheer you up to know that I too have had my moments of utter despair. Days when I thought it would have been easier if I had just died on the OR table last year so I wouldn’t have to struggle with our healthcare system going forward. But that would have been really crappy for both me and my wonderful doctor as well as my friends and family. So I bounce back and fight on.

            But it remains totally within the realm of possibility for this hopeless optimist to be brought over permanently to the dark side of total hopelessness. You are not alone, Dr Buzz. I am thisclose to giving up on the idea of primary care and just self-treating anything that doesn’t require a specialist. When that happens you can call me FauxDoctor Patient Kit and I will feel the pain of being both a patient and my own doctor. If only this was some absurdist existential theatre piece instead of real f-ing life. I’m going to go jump into the water now and swim a mile or so. It always makes me feel better while solving absolutely nothing.

    • DrTWillett

      It is true that all but the ‘ruling class’ in this country are currently suffering. However, I think the main differentiation of physicians vs other employed workers is responsibilities.
      As I have commented elsewhere, my husband works in IT and makes more with a bachelor’s degree than I ever will as a primary care pediatrician (unless I do 10 minute well child visits… 10 minute!!!). That is just to make a point of perspective in terms of the money. More important, though, is the difference in responsibility. If I mess up at work, someone’s child could suffer harm. If he messes up, someone re-writes some code or reconfigures some servers. And whether or not I have messed up, I can be sued. We knowingly take on the responsibility for others, but until you have felt it weigh on you in person, day after day, it is hard to understand. This is not unique to medicine, but the reason for people within medicine to complain with exclusivity like this is because of all that other baggage that goes with the profession.

      • JR

        So this train operator had worked a bunch of overtime and was tired. And derailed the train, injuring 32 people. Train operators though, they don’t have a lot of responsibility for people’s safety right?
        http://www.cnn.com/2014/03/24/us/chicago-ohare-train-derailment/

        There’s a social worker who is ordered to return a child to their parents, only to learn the child died:
        http://www.wftv.com/news/news/local/9-investigates-did-dcf-fail-these-children/nfpqr/

        I suppose you consider technical problems taking out a chunk of the internet for a day not to be stressful. The news didn’t catch onto how big this really was, they only noticed this one tiny blip:
        http://www.tampabay.com/news/education/k12/pasco-hernando-schools-battling-computer-problems-during-fcat/2176268

        I guess that’s inconvenient not life and limb right? I suppose technical problems don’t matter until 911 goes down due to technical problems:
        http://www.thenewstribune.com/2014/04/11/3145519/centurylink-vague-on-cause-of.html

        What about the nuclear engineer who works at a Nuclear power plant, writing down readings on a chart every X number of minutes and sounding alerts if there is a problem?

        What about the guy at the power company who has to drive his truck out to fix a downed power line?

        And you think none of those things generate lawsuits?

        I’m not arguing that being a doctor isn’t frustrating, but here you are putting yourself on a pedestal claiming your different, your’re special, and no one else can understand.

        That’s the message you want the public to see when you ask them for their help to make your life better? That they can’t possibly comprehend your struggles?

        (And tech education isn’t a good comparison. If you graduate from med school, your chance of having a job is… at least 90%? The screening process happens at admission. For all other programs, we’re graduating more people with degrees than jobs are available. Business constantly complain that computer science degrees are worthless, workers either get trained and learn it on the job (working their way up from a low paid position) or they learn it on their own doing open source (working for free)). (http://www.kegel.com/academy/getting-hired.html) And that’s not even getting into the fact that the big tech companies have all assigned agreements not to approach each other’s employees in order to keep tech salaries down: http://www.cnet.com/news/judge-denies-request-for-summary-judgment-in-tech-firm-wage-suit/))

        Even your toaster and your car have software in them now. Bad software can cause a car crash or a fire.

        • DrTWillett

          Yes, and there are forums for each of those groups to express their angst and frustration. This is ours. Nobody is saying doctors are on a pedestal, we are saying that each group has unique stressors. As someone else stated in this discussion, competitive pain is not useful. We are not saying our pain is worse or more important, just different.

          • JR

            No, this isn’t your forum. This isn’t a forum at all but a blog for doctors and patients and medical techs and nurses and everyone to come together. It’s not all doctor posts here.

            I think that the best way to bridge the divide between doctors and patients is to put us together. It’s not just me learning you’re point of view, but you learning my point of view too.

            I came here to learn and also came here to teach, because it’s clear many doctors have a thing or two I could teach them, if they’d like to listen.

            If so many doctors believe that triggering PTSD in a patient is “not their issue” and something someone else needs to deal with, how are they treating their fellow doctors with PTSD? Zero understanding?

            Perhaps we have more in common then you think.

          • Patient Kit

            That was me who said that competitive pain is counterproductive and I whole-heartedly believe that. One of the things I hear doctors saying repeatedly here is that you feel like mainstream media, fueled by corporate Big Health’s agenda, is demonizing doctors and turning patients against you. I agree. There is an intentional divide & conquer strategy in play. The best way for doctors to try to counter that attack on you is to engage in good, difficult dialogue with patients. That happens here at KMD. This thread is a good example. If you feel the media is unfairly painting doctors as elitist, it’s in your best interest to use KMD as a place to debunk that image and find the common ground that should have docs and patients on the same side. Insistence that doctors somehow have it worse than the rest of us is only going to further alienate the public. I’m sure that’s not your goal.

            I don’t agree with everything JR says but I agree with some of it. Claiming KMD as “your forum” puts me in my place as your guest. I’d rather be your partner in this fight against our common enemy.

          • DrTWillett

            Hi Kit, sorry that it sounded like I was trying to be exclusive for doctors. By ‘ours’ I meant folks suffering in healthcare, so that should include all parties. I was just intending to express that the pain points from other areas of the human predicament, while equally valid, are not necessarily germane to the points that are made here. Healthcare is intimate, frightening, honorable, barbaric, and universal.

  • Lisa

    There is no solution as long as medicine is a for profit enterprise.

    • Patient Kit

      That is the bottom line for me. And no amount of more equitable distribution of those profits, with more money going to primary care docs, is going to solve our healthcare system’s major problems — at least, not for many patients.

      • NewMexicoRam

        The day America makes a “non-profit” decision in paying our doctors (meaning reduced salaries across the board) is the day that the government had better pay for college and medical school tuition at 100%, and take over all the in-office expenses as well.

        • Patient Kit

          I’ve said numerous times here that I support subsidizing medical education. Don’t tax payers already pay for residency programs? I’m all for paying for med school too. It would increase the pool of potential doctors to include many who would never consider it solely because of the cost of education. And doctors’ debt load from education wouldn’t be such a big factor in how much they need to be paid. As for salaries, how much do doctors get paid in other countries where their healthcare system isn’t driven by Big Business?

          Because, really, the solution to all of our problems in the US will not be resolved by simply paying primary care docs more. That may be the answer to some of your immediate problems but, looking at the bigger picture, it’s going to take much more than that.

          I understand that you feel betrayed by the way things have changed in our healthcare system and I’m sincerely sorry for that. Believe me, people who have worked hard their whole life and can’t access the medical care they need feel betrayed too. There is no shortage of people out here who feel very deeply betrayed.

    • NormRx

      Yea, non profits are best. Try the VA system, what a joke.

      • Lisa

        I think the VA’s woes are mostly due to budgetary woes versus the need. Blame the politicians who are intent on cutting budgets without regard for the consequences for that one. I do believe veterans would fare no better in the for profit world as their are limited ways to treat their complicated problems and still make money.

        • NormRx

          Yea, budgetary woes, like the inner city schools where we are spending over $15,000/student/year and the kids are failing. Lisa, it isn’t always about money. I am a veteran and in the VA system. I went for my annual physical on Monday. I spent the first ten minutes with a nurse asking me the routine questions and entering them in the computer. The physician than came in and started complaining that I was scheduled for a physical at four in the afternoon. She checked my ears and listened to my heart sounds and I was out of there in ten minutes. The only reason I stay in the VA is because I have a drug benefit so if I should ever decide to purchase Medicare part D I am not penalized for delaying its purchase. They hire many foreign doctors that can’t get their state license and have little command of the English language. I would not even go once a year, but I am required to do so to stay in the system.

  • Mike Henderson

    This is a difficult a subject to explain as it is important. The writer is primarily getting at the experience of being a physician. While money is a factor, it isn’t the only factor affecting the experience of physicians and isn’t the main problem. The main problem is that the system is failing patients.

    The health care system is very complex, with many components that affect each other. To paint with broad strokes, I divide the system up into the art of medicine and the business of medicine.

    The art of medicine is better than I thought it would be prior to entering medical school. There is much to learn, the people that work in the health care system are smart, creative and hard working. You get to learn about your patients and from your patients. My life is better and richer, simply because of my role as a physician listening to patients. Because of this, I am a better physician and can teach future patients what I have learned previously. This is stuff you just can’t get in a textbook. So, on the one hand, the art of medicine makes being a physician the best profession for me. I am not aware of any other profession that would provide as much satisfaction.

    On the other hand, the business of medicine is pretty much the opposite. It is perverse and dysfunctional. The business of medicine should be supporting the art of medicine, yet it is the art of medicine that serves the business interests. It is because of this completely backwards relationship, I believe, that many if not most physicians are dissatisfied.

    The main mistake physicians make about complaining about the system is that we don’t acknowledge that it is patients who are suffering the most – they are harmed physically, emotionally and financially. The other mistake physicians make is not working together to fight back against the system. We have let learned helplessness take hold. I may be naive and/or arrogant, but believe that physicians are best suited to reform the healthcare system so it serves patients as they should be. the system doesn’t exist to provide physicians jobs, insurance company profits or someone for lawyers to sue

  • lord acton

    We physicians made this bed and now we can sleep in it.

    • Arby

      How so?

  • http://www.thepatientdoc.com The Patient Doc

    I am a primary care doc and a patient with lupus. For those who don’t know what lupus is it is an chronic autoimmune disease that can cause inflammation in just about any part of the body. I am 31 and may not be able to have children, have been in an out of the hospital, and go to work with severe fatigue and joint pain some days. The truth is I feel more despair about being a doctor than my health. I was diagnosed with lupus my 2nd year of residency and the only reason I completed it was because I knew I had so much med school debt. I love spending time with patients, and providing really excellent care for them but I feel like that has been taken away from me. All I do is fill out paperwork and stare at a computer screen. I get forced by administrators to see patients more quickly and order unnecessary tests so they can make more money, and when I don’t do what they want I get insulted and threatened. I know all of us are suffering in this broken system, but I feel doctors are feeling a very special kind of pain. We are not just hurting from our own personal/ work situations but also from the hopelessness of knowing we can’t help our patients the way we want to. I’m tired of watching some patients abuse the system, while others are being honest and struggling, and there’s nothing I can do about it. I’m tired of patients hating on doctors, because I love patients. We are all human, and we all are struggling, and we seriously just need to try to be more understanding of each other and try and see things from both perspectives.

    • Suzi Q 38

      “……….I’m tired of patients hating on doctors, because I love patients. We are all human, and we all are struggling, and we seriously just need to try to be more understanding of each other and try and see things from both perspectives……”

      Thank you, Doctor.

      I am sad that you are struggling through your life and work situation. Have you checked in with Pam Wimble, MD?
      Maybe she can assist you in figuring out the type of practice or work that would be better for you.

      There was a time when I liked my doctors very much, too.
      Unfortunately, the actions of two doctors have changed my opinion about physicians as a group.

      Also, I read some of the attitudes of a few of the physicians on this site and realizing that they are in a difficult “place” as far as practicing medicine goes.

      This attitude is transferred to us either directly or indirectly,
      depending on how stressed they are about their job.
      We are not used to this.

      Worse, yet, we as patients were not aware of the dangers that can occur when you are the patient of a doctor who is totally jaded and negative about h/her job. This is new to us.
      For me, I just discovered this in the last year or two.

      I have answered this dilemma by getting rid of doctors who really have little interest in me but accept my case and PPO insurance payments. They forgot about me and my complex medical problem as soon as they walked out the door.

      These doctors are dangerous for me because while they may be smart, but simply do not care.

      I think there is hope that you can partner with physicians who are more positive and wish to care for patients like you do.

      Thank you for your post.

  • Arby

    I had similar thoughts, but was curious to know yours. Most professions have done this, it has just reached critical mass in yours now.

  • buzzkillersmith

    A simplified analysis:

    Expensive health care + medicine becoming more of a business as CorpMed’s eyes light up with dollar signs –> attempts at government control that underestimate the complexity of the situation and backfire –>demoralization of physicians in general–>big time demoralization of primary care physicians–> demoralization of patients + more subspecialty referrals–>even more expensive health care +medicine becoming more of a business as ….

    We are all familiar with feedback loops from freshman biology.

    • Mike Henderson

      Nice summary. Positive feedback loops are relatively rare as they are usually destructive, as I recall. Homeostasis relies mostly on negative feedback loops.

      • buzzkillersmith

        The anterior pituitary gland agrees with you.

  • buzzkillersmith

    A lot of truth in that. I just wish I could have done more of the making and less of the sleeping.

  • JR

    Oh?

    The post is “many people think that physicians are a wealthy, complaining, and unsympathetic bunch.”

    How do doctors change that opinion?

    By not arguing that they are unique and their challenges are unique.

    EMRs are no worse than other enterprise business systems. No business is worried about the usability of their systems to business users – only to customers because they might lose a sale. Business users can be trained.

    Lack of pay? Oh everyone is hurting there. Everyone is loosing ground.

    Lawsuits? Oh yeah, every manager has to watch their back on that one. I know plenty of people who’ve been sued by employees.

    Etc, etc, etc – these are all issues effecting all of the middle class. And this answers the author’s question about why doctors are coming off as pompus and entitled.

    So: Completely relevant to the topic at hand.

    • JMHP

      Title: How to respond to the despair of physicians
      Your quoted a sentence not the point of the blog.
      Your answer seems to be to list other people’s problems. I do not believe that is a good response. You do not need to be a physician or counselor to know that to describe other people’s or your own problems is how someone should respond to “despair.”

      • JR

        You know that’s not the original title of the article right?

      • JR

        Seems you are new here so some info:

        All the articles are not published here originally, they are republished from other blogs. Sometimes the original author will participate in comments, sometimes not.

        The articles are always re titled when posted, so the titles don’t reflect the opinions or views of the author, which has caused some mayhem in the past.

        The original title was “A Doctor’s Declaration of Independence: My Reply”.

        When responding to this article, I took into consideration that this is not someone in despair, but someone looking to preserve “the doctor-patient relationship we all cherish.”

  • buzzkillersmith

    How to respond to the despair to to take radical evasion action. Don’t just wallow. I think most of the docs here know this, but still.

    First, don’t go into family medicine of general internal medicine.

    Don’t buy anything. Forget the nice stuff because you have to work to get it and working too much literally kills in medicine. You have to pay off your loans. That’s evasive action job one.

    If you don’t buy anything and pay off your loans fast, you can go part time, which is the best way to survive in medicine today unless you can scam as below.

    If you have to work full time, see if you can scam a non-clinical job. Seeing sick people is for pikers. Get to the meetings and memos, maybe see pt a half day per week in case you get fired and have to go back to working for a living. Consider an MBA.

    Prostitute yourself to drug companies or device companies. Money to be made going around telling idiotdocs to prescribe the latest expensive drug. And drug company meals are pretty good.

    If, after all my good advice, you still insist on being a family doc or IM who sees sick people, scam some procedures: derm, sleep med,naturopath scams like oils or whatever (if that pays).

    • Suzi Q 38

      “…..Don’t buy anything. Forget the nice stuff because you have to work to get it and working too much literally kills in medicine. You have to pay off your loans. That’s evasive action job one….”

      You sound so flippant and ridiculous, Dr. Buzz. Almost like the musings of an angry teenager.

      Yes, you have to pay off your loans before they become so big that you end up with the 30 year plan. That is a given.
      Who wants to pay for their loans at the same time as paying for their adult children’s college.

      “Don’t buy anything” in the process???
      Hardly, with making $200K….others make more, and still others make less.

      That being said, I still enjoy your posts.

  • rbthe4th2

    Connection is right. When I have physicians who indicated they would put things in my medical records to get other doctors to question whether they would want a relationship with me, I don’t think they’re part of the human race. When I have MDs who believe its ok to call me names and joke on me, to get angry at me for asking questions, why would I be sympathetic to their plight? When I tried to get help for an overloaded doctor, that doctor ruined my relationships with others. I’ll pay the ultimate price for that. I was told there is nothing more that they can do for me. If this is how MD’s act, when other MD’s allow this type of behavior, do you think that shows a connection to patients? No, it indicates a connection to ego, to position, to money. Definitely not us. Somewhere the patient isn’t in there at all. When we extend a hand and you amputate it, do you think there is a way to make a connection, hand in hand, against the moneyed interests in medicine, or does it make doctors look like they’re a tool? When you’re own doctors set themselves up in national boards, making more money than those in the trenches, but hiking up MOC’s for the front line patient caring MD’s, do you think we believe in you? Your own kind sell yourselves to the wolves, others to hospital admins, and you wonder why there isn’t sympathy? When those of us who have tried to work with you in terms of payment for emails & phone calls to patients, for payment of peer to peer work for the insurance, and yet you drop us when we say we can’t pay for an office visit, do you think that makes a connection? When some of us try to work things out, like DG, and you blow us out of the water, you can bet we’re not going to be sympathetic. I have to admit, after the last barrage of being called an idiot by a doctor, its harder to have compassion for them.

    I’m sorry because there are many who are great doctors. What I said is true. Try to extend some of us a hand – not the sue happy ones and we would do the same for you. But those of us who tried to help, when you have fellow “professionals” that send us to our death, and then hound us on that way, what do you think we will remember? The good ones, or the ones who kill us?

    You know what my other half said? Her doctor told her she was the only one who sent him a Happy Doctors Day card. Yet another one will cause her to lose me. Is there any surprise there are strong feelings when one only cares about their position, power, money, ego, compared to the life of one you love?

  • buzzkillerjsmith

    Sure, pts are welcome. But if some find it irritating to listen to our rants, it is also appropriate to go elsewhere. Why would you want to put yourself through that?

    In addition, a big part of what should be done is to educate you all about how it is in our world.

    All opinions are not equally valid. The idea that they are is propaganda, nonsense foisted by conventional wisdom on people.

    It is true that medicine is an abusive profession. It is true that bad care and high costs have certain causes. It is true that most people have no idea why. It is true that rough comparisons with other HC systems bespeak a lack of understanding.

    Don’t listen to them. Listen to me. Not comforting, just mostly right.

    • JR

      This article isn’t a rant at all. It’s a pep talk by a motivational speaker.

      It states:
      1. The public doesn’t understand us.
      2. Give them this info, it’s the best to make them understand us!

      Then it goes on to give a bunch on unconvincing info. Like articles here over and over and over and over do.

      If the argument is “get the public on our side” then the solution is to find things that actually work to get the public on your side instead of alienating them.

  • Pam Pappas MD

    Dr. Fitch, Thank you for sharing this piece. Having treated many of my colleagues with ongoing depression, anxiety, and post-traumatic stress, I totally comprehend what you say about despair in physicians. It saddens me greatly that several of the commentators here seem to interpret such sentiments as evidence that physicians are “elitist.” Those 300 physicians per year who kill themselves, clearly have a hard time asking for help — and there are many more who are suffering but not dead yet. That you’re here speaking the unspeakable gives me great hope. Many issues to resolve here, and people need to know that their very own doctor may have PTSD. Best wishes.

  • Arby

    If only they could. All their push-back has to be a concerted effort or it will fail. Voices crying in the wilderness get picked off pretty easy by management.

  • Arby

    After reading most of the lay people’s comments here, I am convinced that they haven’t really suffered in their workplace environment. If they did, the
    most important thing would be resistance of that element in medicine, not worrying about who thinks they are suffering the most, like third-graders on a playground.

    Note, other businesses don’t get a pass just because we are focused on medicine. We are focused on medicine because that is where life and death decisions are made. Do you really want the GM mindset of “let’s kill everyone in a flaming ball of death to save a few cents” to happen daily across America? Or, at least when your health is on the line?

  • Patient Kit

    Thank you for sharing your personal story. You sound like a good, caring doctor. Your patients are lucky to have you.

    Not only are poor people invisible in this country, but they are regarded by many with real contempt. It’s awful. If there is anything I can say about myself, I think I can honestly say that nobody is invisible to me. I see and feel the deep pain all around me. It’s overwhelming and hard to miss. Maybe that’s why I have such a hard time understanding why empathy for others is so often said to be too much to ask or expect of doctors and of people in general. I don’t think it’s that hard to put on other people’s shoes.

    I also keep hearing that it’s too late — that corporate Big Health is too big and too strong to fight, that there is no way to make our healthcare system better for both docs and patients. I disagree. I think a lot of times things have to get really bad before people will begin to fight back. Hopefully, we’re near that breaking point now. Personally, I feel like I’m at a bizarre point where I both have nothing left to lose and still have everything to lose at the same time.

    • SteveCaley

      Splendid. Then do the right thing, and be proud of yourself!
      Do not be fooled by the “Visible” messages that people want you to buy. Look around, see real people. That’s the society we need to make better. Think and say your mind, and encourage others to do so.

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