The one question you must ask your doctor

The one question you must ask your doctor

Your doctor has more control over your life than anyone — other than you.

Your doctor may be the first face you see as you’re born and the last one you see as you die. Doctors look deep inside you, in places nobody has been before. Doctors prescribe drugs that can kill you or save your life.

But how do you know if your doc is paying attention, really listening to your concerns, and taking the time to properly assess your condition?

You don’t. Unless you ask a question patients rarely ask: “Doc, are you being abused?”

Doctors are commonly bullied and abused by their employers. Don’t believe me? Watch this:

So why should you care?

Abused doctors may be extremely frustrated, depressed — even suicidal.

Doctors like this who are thorough and who really, really care about their patients may leave their practices and patients or retire early just to escape the abuse.

The current health care system favors doctors who are willing to be abused and to abuse their patients by pushing them through in 5 to 10 minute appointments. The current health care system favors doctors who are willing to quickly throw pills at you and get you out the door. The current health care system favors doctors who are willing to ignore your serious symptoms and concerns or delay your treatment of potentially life-threatening conditions.

Abused doctors are being forced to abuse their patients. Is this the kind of health care you believe in?

There’s only one way to know if your doctor is being abused. Ask.

The life you save may save you.

Pamela Wible pioneered the community-designed ideal medical clinic and blogs at Ideal Medical Care. She is the author of Pet Goats and Pap Smears. Watch her TEDx talk, How to Get Naked with Your Doctor.

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  • Duncan Cross

    Ha — this question doesn’t even break my top forty. And what could I do if the answer is ‘yes’? Sure, being a doctor sucks more than it should, and I guess this is worse somehow from the days when some doctors abused their patients just because they believed that was their job. But this post presumes a model of medical care in which I am at the mercy of my doctor — and that’s false. In fact, it might even be abusive. And the prevalence of that model is exactly why patients aren’t in a position to do anything about their poor old doctors. Make me an equal partner in my care, and then I’ll be ready to worry about doctor problems.

    • http://www.idealmedicalcare.org PamelaWibleMD

      If the answer is YES, you have several options:

      1) Find another doctor who is not abused and would be more likely to invest the time and energy to discern what would be most therapeutic for your medical condition.

      2) Stop supporting organizations that abuse health care staff.

      3) Continue supporting organizations that abuse health care staff (and their patients).

      4) Be more compassionate with the person who may be suffering in front of you. Suggest that they (like any abused person) should leave their abuser.

      5) Pretend like this is not a problem, complete your appointment, get what you need, and leave.

      other ideas?

      • DoubtfulGuest

        Dr. Wible, a few months ago your message was to ask us to show concern and appreciation for our doctors…ask how they’re doing and mean it, or do something small to brighten their day. I tried that with one of my docs (the first opportunity since) and was really glad I did, so thank you.

        I’ll have to watch the video later, but I’d like to know how other docs feel about your latest proposal, what they’d like to be asked, and how. And what follow-up would they want from patients if they say yes? If I were a doc, I sure would feel bad to trust a patient, only to have them say “Well! I’ll just find someone new who has no issues.” Good luck with that…right?

        This whole idea of being at the mercy of our doctors is terrifying, and true. I can see PK and Duncan’s points…this comes across as putting too much responsibility on the patients. I have been sort of used as a therapist by a doc and it’s an awful feeling. The subject matter wasn’t sketchy or anything — just frustrations with his son. But it kept me from getting the medical care I needed.

        Now, one thing I can do is to say I try to read and learn about the stressors that doctors are facing these days. I want to put them at ease with me. But then we have to be able to trust that doctors will not take advantage…

        • http://www.idealmedicalcare.org PamelaWibleMD

          Not all patients may feel comfortable asking. That’s okay. I only bring this up because abuse and bullying of physicians it is far more common than even I recognized. And it can actually be hazardous for a patient’s health (and obviously it is for the physician).

          And so awesome that you brightened your doctor’s day! It is easier than you think. . . .

          • DoubtfulGuest

            I’m glad you are talking about it, and I want to understand. I’ll be curious to see other people’s thoughts about this.

          • http://www.idealmedicalcare.org PamelaWibleMD

            Me too. Taboo topic in many ways, but my therapist calls me the “Dr. Kevorkian of Medical Taboos” so I guess it is my job to bring this stuff up.

          • Patient Kit

            It’s not just about the comfort level of patients with doing this. It’s also about sensing whether the doctor is comfortable with it or if it’s only going to make things worse. What you’re suggesting could easily come off as a confrontational intervention to some docs. Maybe I listen to my psychotherapist sister too much (who is terrific at what she does), but you have to know what you’re doing when you ask a potentially emotionally fragile person questions like this.

          • http://www.idealmedicalcare.org PamelaWibleMD

            Agree.

          • TheresaWillett MDPhD

            As an outspoken critic of the status quo and lack of transparency, I have been bullied and seen my colleagues get bullied. I am the only one who left- most docs allow themselves to be powerless.

          • buzzkillerjsmith

            Never complain. Never frown. Keep smiling. Then quit.

            That’s the culture of the business types. Although I hate them, I’ve learned a thing or two about them over these many years.

          • http://www.idealmedicalcare.org PamelaWibleMD

            What have you learned that has been most helpful?

          • buzzkillerjsmith

            They don’t care about your feelings. They care about keeping machine moving forward. So keep it positive, goal-directed, even if the suggestions, yours or theirs, are doomed to failure.

            Ask questions instead of making statements.

            They’re nicer after they have eaten.

            Many are sadistic. Don’t let them see you sweat.

            Use the phrase “good patient care” a lot. It puts them at a temporary disadvantage.

            Ask for raises a lot. Over and over again, even if you’ve just gotten one. Probe their limits.

            Quit once you have found a new job. Don’t give much notice or they’ll hurt you in the meantime.

          • http://www.idealmedicalcare.org PamelaWibleMD

            I was asked to sign a contract that stipulated if I ever wanted to leave I would need to give an 18 month notice AND find a suitable replacement.

            18 months? That’s a prison sentence.

            Who is a replacement for me?

            Didn’t sign. I would have been trapped forever.

          • Sarah

            No way!!!! That’s incredible!!!

          • TheresaWillett MDPhD

            gosh, I guess my 6 month notice requirement doesn’t sound that bad :-

          • Sarah

            Good point about not resigning until you have another position. I naively said to a friend how commendable it was that Oregon Health and Science University hired the oncologist who sued Kaiser. She was like are you kidding?? I’m sure she got the position at OHSU before suing Kaiser.

          • http://www.idealmedicalcare.org PamelaWibleMD

            Most docs continue to be victims and they perpetuate the very model that creates their burnout and despair.

          • Sarah

            Here’s an example of another doc like yourself that had the courage to speak up and ultimately filed a lawsuit against her employer for impeding her ability to adhere to her Hippocratic Oath of “do no harm” to her patients. It will be interesting to see the outcome of her case.

            http://www.oregonlive.com/portland/index.ssf/2014/04/former_oncologist_claims_kaise.html

          • TheresaWillett MDPhD

            thanks for the info- I had not seen that before. Brave doc to go the next step of taking the dirty laundry public!

          • Sarah

            I think that making the “:dirty laundry” public might be the way to go.

          • http://www.idealmedicalcare.org PamelaWibleMD

            Great one! I called her up and thanked her.

          • Sarah

            Great, Dr. Wible! I have actually comtemplated sending her a thank you note. I think that I will go ahead and do that!

        • Patient Kit

          DG, I too am interested in hearing how other doctors feel about being asked by their patients whether they are being abused and bullied. One regular doc here, in particular, I’m guessing would not welcome this if it starts trending. But, as always, I could be wrong.

          • DoubtfulGuest

            I haven’t the foggiest idea which one, PK, not a clue. ;)
            Should be along any minute now…

            But really, those exchanges have been more productive lately. Thought-provoking points made on both sides. And so we wait…;)

          • Patient Kit

            The sound of other docs chiming in on this subject is so loud, it’s hurting my eyes. It’s like a stampede.

          • DoubtfulGuest

            My snark-o-meter has fallen silent. I’m perplexed.

          • buzzkillerjsmith

            Ok, I’ll bite. You can’t solve our problems. Don’t even try.

            Abuse is a strong word, but if you are an abused doctor, quit. If you don’t quit, then you are letting yourself be abused.

            All of us are hassled, some more than others. Hassles are to be put up with.

          • DoubtfulGuest

            Hello, Sir. We were hoping you’d make an appearance. I appreciate your thoughts, especially right now. Abandon all hope, then go backpacking?

          • buzzkillerjsmith

            Close but not quite. Abandon all hope, watch the US shred Germany tomorrow, then go backpacking on July 2 up Lostine River Trail in Eagle Cap. I think the snow is melted.

          • Patient Kit

            Glad to hear you’re enjoying the World Cup, Doc. I am too. Looking forward to both the USA/Germany and Mexico/Netherlands matches coming up. Russia/Algeria too. “Shredding” sounds abusive. Enjoy! ;-)

          • DoubtfulGuest

            You were right, Dr. Buzz. These posts just do not have the intellectual integrity of the rest of the site. There’s no sincere attempt to clarify definitions or anything that would move the discussion beyond emotional button-pushing. Can I get brain bleach without a prescription?

          • buzzkillerjsmith

            Ouch.

            You said it, not me.

          • buzzkillerjsmith

            Ouch.

            You said it, not me.

          • buzzkillerjsmith

            All hope has truly been abandoned. This time I’m not kidding.

            We lost to the Krauts and the ranger tells me the trail is snowed in and won’t be walkable until late July.

            We’re not going in on skis and doing a damn July snow camp, rain on snow and borderline hypothermia from the wet socks and a rivulet running through the tent at 3 am because some fool decided yet again to bring his dad’s old canvas tent because, even though he is a physician, he’s too cheap to go to REI or even Walmart and then sitting in said tent with my foul, idiotic, flatus-infested cohorts while they too complain about how crappy it is to be in medicine these days.

            I’ve done that way too many times.

          • TheresaWillett MDPhD

            I did quit. twice. Hard to find a replacement job that pays the rent, though. I also am spending a little extra time now saying goodbye to families, and I don’t hold back on the why.

          • buzzkillerjsmith

            I actually have held off on the why when quitting. Just riles ‘em up. I try to go through life just tiptoeing, smiling and nodding.

          • Sarah

            I’m sure the families really appreciate your honesty. I know that I would.

          • Nancy

            Doctors are inculcated in never to reveal any need for help or weakness. Good luck getting a doc admitting they need help. Why do you think over 500+ physicians kill themselves each year?? And this is number that is actually reported as suicide. Many go unreported.

  • Patient Kit

    I dunno. I’m having a hard time imagining most docs responding well to their patients asking them if they are abused and I doubt that most docs would respond “yes, I am being abused” to patients who do ask that no matter what was going on in their workplace. Nor do I think most patients want to spend a big chunk of their doctor visit talking about the doctor’s problems and issues.

    I just treat my docs like they are human beings, not superhuman, not perfect, allowed to have bad days like everyone else. I always keep in mind, for example, that all of my GYN ONC’s patients have cancer and that I’m not the only one or the worst off and that a lot of his days must be devastatingly hard. But would I ask him if he is being abused or bullied by his employer? No, I don’t think so. I can acknowledge him as a flawed and vulnerable human being (like all of us) and not take things that have nothing to do with me personally. I can extend kindness, understanding, respect and appreciation to my docs. But I’m not in a position to be a therapist to my docs. I don’t really think most docs want that from their patients. Do they?

    • http://www.idealmedicalcare.org PamelaWibleMD

      Depends on the length and quality of the relationship. Many primary care docs have taken care of multiple generations of family members. If you as a patent notice that your doctor who was once relaxed and personable is now distressed and harried with each visit, then the question may be a good one.

      Abused physicians are more likely to suffer burn out, depression, or worse. And yes, this will impact the quality of your care. It is far too common and not discussed openly.

      • Patient Kit

        I guess it depends on the doctor, the patient and the relationship. I do express appreciation to my docs all the time and I tend to make them smile and laugh. I do care about them as people. While I understand that this is a serious problem that effects both docs and patients, I’m still having a hard time imagining many docs responding well to being asked by patients multiple times a day whether they are being abused or bullied, especially — dare I say it? — male docs. I’m just not sure that the exam room is the place for that question.

        • DoubtfulGuest

          I wonder what variations might work better? Like specific questions about administration or our insurance companies giving them a hard time? But then how do gag rules come into play? I can definitely say as a patient I want to show basic courtesy and caring to my doctors. I also want to avoid doing anything that could inadvertently harm them.

          In my experience, dealing with abuse is a process. Everything I’ve heard from other people supports this. Sitting someone down and asking if they’re being abused can be too scary, and people often dig in their heels. What works better, to my knowledge, is people gently saying over a period of time, “So-and-so is being too hard on you” or “You didn’t deserve that” or “That was inappropriate”. Or maybe even “This sort of thing meets the definition of abuse”.

          Another issue I’d like to see addressed is mental health support for doctors, or lack thereof. I don’t know what to do, as a patient. If a doctor did tell me specifics, such as being yelled at by a boss, I’d say “Well, you’re a great doctor and you don’t have to take that”. Beyond that, I’m not sure what’s right. Yes, it’s hard enough for men in general to say they’re being abused, much less male doctors. Good point.

          • http://www.idealmedicalcare.org PamelaWibleMD

            It’s hard for many docs – especially men – to ask for help.

        • http://www.idealmedicalcare.org PamelaWibleMD

          Maybe a letter . . .

          • Patient Kit

            Really? Most docs would like getting letters from patients asking them whether they are abused or bullied? How would they respond to those letters? I would think many docs, especially male docs, would not know what to do with that. I think if you’re going to actually ask a person that, it should be done in person. I know you care and mean well, Dr W, and I’m not saying we patients can’t be supportive of our docs in our own ways. But confronting them with questions of abuse and bullying, which typically involves shame, seems like playing with fire when it involves docs who are in real emotional trouble. You can’t ask people to pry open cans of emotional worms who are not qualified to deal with it once the can is open. I think doctors’ colleagues are probably better prepared to deal with it if a doc is really in trouble.

          • DoubtfulGuest

            I would add that patients’ lack of qualifications could backfire on the docs…like, I’m sorry, but if a patient says it, it’s less likely to be real. :/

            And letters…whoa…way to trigger risk management and legal jumpiness…How does that not end up in the chart, and seen by large numbers of people?

          • http://www.idealmedicalcare.org PamelaWibleMD

            Use your best judgment and common sense. This is a very real problem. Ignoring it is not the answer. Do what you feel is right for you. But do something.

          • DoubtfulGuest

            It’s not just what’s right for us, but wondering what our doctors want.

          • http://www.idealmedicalcare.org PamelaWibleMD

            Agree that docs’ colleagues are often the best to begin such conversations. But many doctors have told me that a kind word of support has made a huge difference in their lives.

            The doc in the video above did not really even “get” that she was being abused until her husband called it abuse. And then she watched the video. And she was horrified. It IS horrifying the way our healers our treated at work.

            We need to correct identify what is going on if we are to fix things. Whether a trusted patent or doc colleague chooses to discuss such things, it is helpful to use terminology that is accurate.

            Example: You are the last patient of the day. You know the doctor well because he has been treating your family for 10+ years. Maybe he attends your church. You suspect he is burned out. That may be a perfect time to ask whether he feels overworked, abused, bullied . . .

            And just listen . . . care . . . that is often enough.

        • rbthe4th2

          I’d have to totally agree with PK on this one. This is something that needs to be handled by doctors themselves. With all due respect, patients have little enough time as it is and on OUR dime, I need my time to get healthy. Frankly this crosses the line to entitlement.

          • http://www.idealmedicalcare.org PamelaWibleMD

            Ok. But patients WILL suffer the consequences of burying their heads in the sand. You do not necessarily need to help any doctor who is on the edge. That is obviously not your job as a patient. But let me assure you that this is impacting the quality of your medical care. So what would you like to do if anything?

          • rbthe4th2

            Not one thing. I tried to help a doctor and got blacklisted – by doctors. Why are we expected to do something about your rotten work environment? Its their responsibility to take care of it. Not us. Seriously, go out and tell people they need to spend their own copay and insurance money and their 10 min. of office time on their doctors’ feelings of a tough work place? Try working for Micky Dee’s, the government, construction and see how those workers feel. I have done more research on blood work and pointed out more issues to doctors than they have to me.

            I’m sorry Dr. W. but put this out in public and you are going to see one huge backlash. We have 10 minutes or 15 for an appointment. It took me 3 months for several doctors to get in to see them. I am not wasting my time on worrying about doctors’ work environment when I’m paying for a professional contractor’s time and concentration, who needs to fix me in that time.

            Are you all going to pay for the use of our time?

          • http://www.idealmedicalcare.org PamelaWibleMD

            Well if you do not care about supporting an organization that abuses your doctor, there is nothing I can do about that. The abuse will trickle down right on to you.

            I wrote this blog (in part) to help patients protect themselves.

            It is your choice. Support abuse and become abused yourself. Or not.

            Being a victim and being abused is a choice.

          • DoubtfulGuest

            Dr. Wible, this comment of yours is going too far. It almost sounds like a threat — completely ignoring the vulnerability of patients and the fact that in many cases we *do not have a choice* to need medical care.

            We’re talking actual sick or dying people, okay? Not well visits, not “find another doctor you can connect with better”. I agree with you that patients should show their doctors compassion and do something to help if we can but 1) specific guidance is lacking and 2) there’s no attempt to define what is the appropriate role for patients. e.g. how much time out of our 10-15 minute visits and without crossing boundaries that could damage us or our docs.

            rbthe4th2 did try to help one of his docs and got stepped on for it.

          • rbthe4th2

            Agreed! Being nice, I totally agree with. I think doctors need to understand most of us are not at our best when we’re sick. Maybe you all should say that in a good way.

            Let me know when someone is going to take the doctor who harmed me and my family to task. All I see is a bunch of stuff about how I need to be nice to the one who may have permanently damaged me, definitely my reputation and I want to know WHY I am expected to spend the rest of my life, my money and my time to support doctors for this?

          • http://www.idealmedicalcare.org PamelaWibleMD

            No threat. I’m not the kind of person. If you are in the ER with a heart attack that would not be the right time to talk to your doc about abuse and stress. If you are in for a well visit with the guy who cared for all your kids, the man who attends your church, whom you know well, why not share your concerns?

            Hard to give specific guidance without the specific case. Abuse does trickle down. A 30-minute physical that becomes a 15-minute physical (yes, some docs are forced to do physicals in 15-20 minutes) may feel pretty rough. You will notice the difference.

          • DoubtfulGuest

            I don’t doubt that you are a good person, but you need to find a different way to address your anger than you are doing here sometimes. Several people here have explained the problems with asking their docs directly.

            I did watch the video. As a semi-complex patient, I’m willing (and fortunately able to pay) to split up my visits in whatever way would be easiest for the doc to handle. I don’t mind going back a few weeks later or whatever, another co-pay. Or scheduling and paying for a longer visit when that’s allowed. Doctors need to use grown-up words to explain what they need instead of acting out against their patients.

            You must be careful and very specific with your definitions of abuse. If we throw the word around too freely, it’s not taken seriously. I agree that the abominably short visits are an “abusive practice” by the health care system. A form of abuse, to be sure, but different than my examples. Poetic license, perhaps, the emotional arc and all…but it may have a very different effect than you intended.

          • http://www.idealmedicalcare.org PamelaWibleMD

            Its not about anger. It’s about justice. Justice for patients is inextricably linked to justice for doctors.

          • rbthe4th2

            {{scratching head}} How so? How is giving me appropriate medical care, apologizing, fixing records, sitting down and talking with me face to face, how is that justice for the doctor? Its justice for me, but not for them. How about paying back the money that we’ve spent chasing around because people don’t know what to do without the specialist care? Is that justice for the doctor?

            Since when is justice served by someone getting hurt and passing it on?

            Justice would be the medical community coming together and saying it is time we stop this shaming garbage and treat our brothers and sisters and help them get back to functioning well. Its saying medicine is stressful. We’re going to help.

            We’re not going to put our heads in the sand and we’re not going to tear your career up. We’re going to hire some help, we’re going to get you a scribe. We’re going to cut hours 1/2 day on Tuesday.

            We’ll not dock your pay or hurt your career for needing a helping hand because that is what healing is all about.

            THAT is justice.

            Randy

          • http://www.idealmedicalcare.org PamelaWibleMD

            Agree with your solutions Randy. We are in this together.

          • DoubtfulGuest

            Something’s missing in your response to him. Dr. Kevin’s posting policies are around here somewhere, for reference.

          • http://www.idealmedicalcare.org PamelaWibleMD

            So wish we could all have this conversation in person. I am hosting a luncheon today and the community is invited for a discussion and Q/A. Would love to have all of you there.

          • DoubtfulGuest

            Thank you very much, but that would not solve the problem here.

          • DoubtfulGuest

            Did you actually just add this about the rough physical exam? The doctor was rough because he was *mad at me* because I was starting to figure out I’d been misdiagnosed. This was not a new patient visit or complete physical, but a quick follow-up exam. It is not up to you to tell patients what we will feel or notice. I’ve had quick exams before without the roughness, I’m not stupid. I ask that you step right back over the line you crossed with Randy earlier today, and I recommend you apologize to him.

          • http://www.idealmedicalcare.org PamelaWibleMD

            Not sure what you are referring to. Did not just add the “rough physical” part above. I have felt when working under pressure that my physical exams became kind of rough. People need time to get relaxed enough to trust doctors to pry into parts of their bodies. It is an honor to care for people and these exams take time.

          • DoubtfulGuest

            Okay, so I missed it the first time. When I asked for specific advice earlier, it was for how individual doctors on this board would want to be HELPED. Not how to excuse another doctor’s mistreatment of a patient. Do you understand the difference?

            How ’bout asking your patients if they feel you’re being rough? That’s what’s most important. Most people can distinguish between something that’s intentional and unintentional. You know the difference, in how someone touches you when they’re angry? And for something you didn’t even do wrong? I would prefer he’d just refused to examine me, but it was taking me awhile to figure out what was going on. Please stop trying to excuse it.

            It would be healthier to focus on your own feelings here. It would have come across much nicer if you’d said something like “I would like to be more careful and gentle with my exams but the time limits interfere”. That has nothing whatever to do with anything I experienced. It had nothing whatever to do with my not having enough time to relax. It was not a Pap smear. It was a muscle exam, for a myopathy, which I did turn out to have.

            Now then, about Randy? That is where this whole problem started on your post.

          • rbthe4th2

            Welcome to the real world! Poor doctors they’re the only ones who have to suck up being abused by customers and their businesses that pay them to do a job. Why don’t you ask my family how they get that working at McD’s? What about my friends that own their own businesses and get yelled at or their employees make mistakes they have to pay for? What about the blacklisting of patients when they make a mistake? Dumping patients when its their own fault? They dont want to lose anything, so they let patients die or live in pain or other types of things rather than report mistakes and fix them. If everyone took a stand, fine but that isn’t what’s happening.

            So I guess rape victims deserve their abuse because someone abused them?

            No one deserves to pass on abuse. They deserve to get help to make it better.

            So far I’ve not seen one shred of evidence that says we should spend our money, our workplaces money in the form of insurance pays, for an independant contractors’ potentially harmful or maybe not opinion that isn’t always rooted in medical research (and are doctors going to give us back our money when they’re wrong on a diagnosis or apologize to us publically on it? How about all those who got slung with “mental illnesses” when the problems were lack of education or knowledge on the doctors’ part or oh well take it because I’m tired and don’t care?), our time off, because doctors have a tough place in life.

            At least at retirement you have it a lot better than we do. I just saw figures on some surgeon’s pay. I’d like to have $18K a month to play with. I could pay off my bills, my families bills, and start a WONDERFUL nest egg. These doctors (and I’m not talking the 40% of MD/MD couples now) are talking $500K – $4M for retirement eggs at younger ages than any one of my lower middle class families will ever reach.

            You want to the prestige of caring for people, you get paid for it. That is part and parcel of the life. I’m very sorry for a number of doctors and I do what I think is fair to help out. I do a lot more than my share. I do what DG does.

            I’ve had more than my share of bad docs who have cost me, my family, and others, when they’ve said we have no skin in the game and we don’t want it on our records or any where we messed up. Dont want to pay for it financially either.

            When you all start getting real skin in the game like we have, like pilots have, let me know. But threatening me like a former surgeon did (I’m not the one dragging lawyers into this but when you stalk my other half, I call the cops), says we are not in this together and making veiled threats because you have work place problems does not indicate that we’re together.

            It means lines in the sand have been drawn.

            By you not us.

          • http://www.idealmedicalcare.org PamelaWibleMD

            Furthermore the sooner patients and physicians realize that we are in this together, the better.

          • rbthe4th2

            Really? So when are you all going to give up malpractice caps? When are you all going to allow patients on state boards to be at least 1/2 of what is on there and more open cases, etc. open up the NPDB and I can go on … so that we’re all in this together?

            Not just make your workplace better because if we don’t, we’ll get and deserve the abuse given to us.

            I support docs getting paid for EHR work, I support docs getting paid for phone calls, peer to peer review (that is if they won’t let me do them, I’ve “entertained” docs before when I tell them give me a number and I’ll say something to them), but I expect there are a number of concessions docs need to make. Transparency, mistake fixes, etc. and I do not see ONE doctor group advocating for this.

            It works both ways.

          • DoubtfulGuest

            Ah, “transparency”. CorpMEd has co-opted that word and given it a whole different meaning these days. I found that out the hard way.

            Well, you and I don’t agree on each point here, but I’m deeply concerned with some of Dr. Wible’s statements this time. Your first comment on this post was entirely reasonable.

            We’ve got to get past the “listen to your heart” and “use best judgment” nebulousness. It’s a no-brainer that human interactions need some flexibility and spontaneity, I’d never argue against that. But the questions about individual patient vs. collective/public responsibility are very important. And the lack of specific, non-conflicting information — here as everywhere else on this blog — has me tearing my hair out. Don’t doctors love to give instructions? ;)

            There is an aspect to those replies and the original post that feels a bit like an abusive parent saying to a child: “Well, I wasn’t raised in a loving home, I can’t help myself. So…you better take care of me, solve my problems, or…start runnin’.” :/

          • rbthe4th2

            Yes and you are one of those I’m thinking of when I say that if doctors want our help in changing the system, they have to give up a lot for that. The fact remains is that there is a lot about medicine, medical education, decisions w/patients and not for them, “transparency”, quality ratings, a slew of things need to be addressed before coming and saying what was said.

            Your second paragraph was good. I also noted the “do something” but what are we supposed to do? I’ve seen people go with legitimate complaints and concerns to hospitals, docs, state med boards, JCAHO, etc. and they get crapped on. Witness the VA – and be a veteran and have vet family members.

            Your last paragraph is EXACTLY why I’ve been telling people to come on here and ask to make sure we’re not interpreting wrongly. There is a very good reason doctors are getting yelped at for being spoiled and entitled and frankly that is the message portrayed here.

            I understand that Dr. Wible is passionate on helping doctors. However the response here is like a Streisand effect on people because who wants to help docs when its like we’re the cause and savior of all their problems? I notice not one other doctor (or a few) are helping her out and that tells me a lot.

            I do expect that doctors should help each other. BIG time. I don’t mean in hiding mistakes but doing like what some are doing now: help them to realize it, to fix it, and help the patient out. Be human. Do the humane thing. Doctors tell us we dont know what med life is like. Ok fine, then your responsibility help each other and stop stabbing each other in the back like it is a failing to need help. I’ve reached out before and I will suffer financially and physically and of course mentally for it the rest of my life. All do to a docs ego.

            Until the medical world changes itself, sorry, no dice.

          • DoubtfulGuest

            Yes, the other doctors’ silence speaks volumes. I expect there is some shame involved. That is a problem. I hate to think of doctors being afraid to ask for help. If any of them have reasonable requests/suggestions, just tell me anonymously, I will go try it right now.

            I AM relieved that some doctors remember their basic ***ethical obligation*** to patients and apparently they “get it”, that some aspects of this post are not okay.

            Or, there’s some unknown variable to explain the lack of involvement here? Probably…

          • http://www.idealmedicalcare.org PamelaWibleMD

            There is a reason the doctor in the video wanted to be concealed. Doctors fear speaking about their abuse. What this doc explains is familiar to many (if not all) doctors. And yes—very interesting that other docs are not chiming in . . .

          • http://www.idealmedicalcare.org PamelaWibleMD

            And btw the rest of her interview is far worse and much more shocking than the piece excerpted in this blog. Patients have no idea what goes on behind the doors of these clinics . . .

          • Sarah

            The Dean of the School of Nursing at a major university that I worked at once said that she would never have a family member in the hospital without having another family member there around the clock. She said that nurses were overworked and had way too high of a patient load. Therefore, way too many mistakes were happening.

            Her statement and the conversation that followed taught me much about the importance of patients and families bering their own advocates.

          • DoubtfulGuest

            I don’t have a problem with the statement that because doctors and nurses are abused, it affects quality of care. That is totally legit. Sleep deprivation and all that, it’s biology. There’s no intent to abuse in those cases. Outright malice toward patients, though, threatening them with abuse, justifying it…if this comes down just to definitions, then it all needs to get sorted out, very clearly.

          • rbthe4th2

            I think there are going to be people who want to go to a doc because if they get healed, who BETTER than to go to than someone who has been the route and understands? I think it is despicable of doctors to not help their own. I also think it is despicable that they deny and defend rather than admit and fix missed/delayed dx’es. I think not getting paid for EHR’s and phone calls to patients and doctors on their behalf is wrong. I think not telling someone that you made a mistake and how you are going to fix it is wrong.

            Again I have no problem with Dr. Wible wanting to help others. However … maybe there are other ways of going about it. We the patients have been stripped of everything but complaining on the internet. Anything else is a waste of time. I’ve seen stats on med mal. Its a joke for the most part. I want to see more on docs side of the house for transparency and education on missed/delayed dx’s and how they’re handling that, blacklisting, before I’d go to bat for anything else.

          • DoubtfulGuest

            “But let me assure you that this is impacting the quality of your medical care.”

            THIS is reasonable and makes sense. Abused doc misses a diagnosis, has trouble paying attention, is jumpy and anxious so visits are awkward. Sure, I can see that.

            But below, it looks like you’re actually saying that an abused doc will abuse a patient. Yelling, name-calling, inappropriate comments? Being rough during a physical exam? I’ve been on the receiving end of that second one. It’s terrifying. Docs, if you’re testing a patient’s neck extensor and flexor strength, you don’t have to glare angrily right up in our faces while you’re pushing on our heads. Particularly if the reason you’re mad is because you made a serious mistake and you’re afraid we’re going to find out.

            Dr. Wible, you would get more support if you’d even try to recognize appropriate boundaries. You’re putting too much on the patients’ shoulders here.

          • http://www.idealmedicalcare.org PamelaWibleMD

            Abuse trickles down to everyone. Those who are aware of it have the moral responsibility to do something about it. Would you walk away from a home where a child or dog is being abused because it is not your responsibility?

            I guess everyone chooses their battles. Ignoring abuse of healthcare workers, will only perpetuate the continued abuse of healthcare workers as if this is somehow normal. And patients will continue to suffer.

            If you do not like the abuse you are receiving as a patient, consider where it is actually coming from.
            Doctors did not go to med school to be mean to their patients, to stare angrily at their patients, or to be rough during a physical exam.

          • DoubtfulGuest

            Dr. Wible, I’ve come up with about 50% of the specific suggestions to help here, so far. I have also tried unsuccessfully to ask for specific advice from other doctors reading. Why don’t you ask Randy what he tried before to help his doc? He’s not ignoring anything. You are not listening.

            Are you telling me that doctors are not at all responsible for their specific acts of rage against patients in their exam rooms?

          • http://www.idealmedicalcare.org PamelaWibleMD

            Everyone carries responsibility for what they do in their lives. But we all sometimes need help. Even the perpetrators of crimes need help as do the victims. A call for empathy here. Do what you feel is most heeling for you and others. No one-size-fits-all recipe.

          • DoubtfulGuest

            I. Did. Try. To. Help.

            So. Did. Randy.

            I’m going for a walk now.

          • http://www.idealmedicalcare.org PamelaWibleMD

            Good idea! Thanks for all you have done and continue to do. Much appreciated.

          • Anne-Marie

            Whoa. Let’s reel the line back in a few feet. Kids and animals truly are powerless to speak for themselves or change their situation. There’s a world of difference between this and a competent adult with a medical degree and a professional license.

            There are some serious ethical issues involved in asking patients to in effect become a caregiver for the doctor’s emotional needs. Who’s the patient in this scenario? The roles start to look a little blurred, at least to me, and I’m not sure this is where we ought to be going.

            This whole discussion has really made me think, though, and I appreciate that you have openly put the issues on the table.

          • DoubtfulGuest

            Thank you Anne-Marie. It did start out as a productive discussion, didn’t it, and should have continued as such? But it’s hard to tear myself away because I feel like I’ve been going crazy for the last several hours. I’m not…smoking anything…and yet this stuff is still right in front of me on the screen. Since you and Dr. Buzz showed up, at least the room has stopped spinning. Good on ya!

          • Anne-Marie

            Hang in there, DG.

            I keep wondering what Arthur Caplan, my favorite bioethicist, would say about all of this. I think he would argue in favor of boundaries.

          • DoubtfulGuest

            I have steam coming out of my ears. Do you think it’s anything serious? Should I see a doctor?

          • Anne-Marie

            LOL, I’m not qualified to offer medical advice online… but as long as the steam is white and confined to your ears, you’re probably OK.

            Seriously, my workplace is not the best, but when I am with clients, the interaction is always about them. Not about me. I may bring my own frustrations and stress and fatigue and whatever to the encounter, but it’s my responsibility to not let it get in the way. It is not, nor should it be, my client’s responsibility to fix my crummy work environment.

            My $0.02, anyway.

          • rbthe4th2

            Hey some of us do try. Once you get attacked like I did, and will suffer for it, you lose your willingness to do anything.

          • http://www.idealmedicalcare.org PamelaWibleMD

            Agree. Patient can never solve doc’s crummy work situation. That’s up to the doc. But giving feedback from a place of concern should be a part of every human relationship.

          • http://www.idealmedicalcare.org PamelaWibleMD

            Yes. Just trying to start conversations. I never claim to have all the solutions. But certainly we won’t solve problems if we don’t know they exist.

          • DoubtfulGuest

            “Just trying to start conversations.”

            I used to believe this, but I don’t anymore.

          • DoubtfulGuest

            I am still dumbfounded that this very reasonable comment generated the response it did. Even if I partly disagree. I haven’t been this PO’ed in quite awhile.

    • RScarlet

      I can just imagine a patient going to the admin and saying ‘your doctor said you are abusing him. Now you must stop this’.

      So what do you think is going to happen to a bunch of people who can fire them and ruin their reputations and careers? I can this happening in a very fast Kardashian moment.

      • http://www.idealmedicalcare.org PamelaWibleMD

        Since the majority of doctors have been or are being abused, I guess they would lose most of their docs. How do you think that will work out for them?

        And change is always risky. Think civil rights. Women’s rights. Power in numbers.

        • rbthe4th2

          They would get NP’s or the like to do as much as possible. I frankly doubt they’d be able to do that. Have you seen a contract with a hospital or corporation?

  • QQQ

    The true meaning of “abuse of power” from the powers that be on these healthcare workers!

    • http://www.idealmedicalcare.org PamelaWibleMD

      Oh it WILL end.

      Mark my words.

      To solve a problem we must first claim that it exists. So many patients are pitted against their doctors. They think their docs are rich, greedy, arrogant, uncaring. Have they ever thought, “Gee, maybe my doctor is being abused. Maybe that’s why I am not getting the care I deserve.”

      • QQQ

        Well thanks for the response Pamela. However I just have one more question to ask….why are many allowing this to continue?

        I”m new really to your discussions and intrigued with this one! Are many afraid to express their emotions because they don’t want to be considered “unruly” or “out of line”?

        • http://www.idealmedicalcare.org PamelaWibleMD

          Doctors are over-regulated and many suffer from PTSD (witnessing all the trauma and suffering of our daily careers) with NO RELEASE VALVE for our suffering. Confidentiality prevents us from even discussing our patients with our spouses. Due to mental health stigma in this culture and especially in our profession, those who ask for help are often considered weak and a psych diagnosis may derail one’s career. So docs keep it in and we are easily victimized. We have no union. We have really nobody coming to support us and so many coming to prey upon us financially and otherwise. It is a silent tragedy that even doctors do not like to recognize as it is extremely painful and widespread.

          • QQQ

            Well that is a terrible thing what’s happening to these healthcare workers in all specialties. No union, hardly no one to turn for support, and many just suffer in silence! Its just stunning how our brightest get treated for trying to help others!

            Do you least get a pension? I heard government doctors (prison and military)have them.

          • http://www.idealmedicalcare.org PamelaWibleMD

            I’m self employed (and happy). My dad worked for the city as a doc and got a pension. Government and military doctors have their own trials and tribulations. Happy where I am—even without a pension.

          • QQQ

            Understood. Thank you! (^_^)v

  • http://www.idealmedicalcare.org PamelaWibleMD

    May work for some to rephrase. I favor the word abuse because that is the true descriptor.

  • http://www.idealmedicalcare.org PamelaWibleMD

    OK. Yes. Whatever method most suits you. Grateful that you all are moved to do anything. :)

  • http://www.idealmedicalcare.org PamelaWibleMD

    Medical practices run only on physician-generated revenue. So it is simple math. Amount coming in minus expenses. Here are a few common problems:

    1) Low reimbursing insurance plans. Medicare often does not reimburse enough to cover the light bill during your visit SO since doc do not like being mean by telling old people they will not see them any longer they have to INCREASE volume to offset the low reimbursement

    2) High overhead – multiple staff needed to deal with unfunded mandates and bureaucratic BS forced on physicians. In big box clinics there are many managers walking around with clipboards telling docs to move faster. Why? Well docs need to generate enough money to pay their salaries too.

    SOLUTION: DISINTERMEDIATION = remove the middlemen—the no-value added intermediaries. Stop signing contracts with abusive third parties that destabilize physician practices.

    What drives much of what you (and your doctor) dislikes in these assembly line visits are the issues above. Believe me: Docs did not go into medicine to rush people through a production line. We want to help people. Our greatest joy is the patient relationship. Our next greatest joy is academic stimulation. We get neither in 10 minute visits. The high-volume clinic is driven by high overhead.

    My solution has been to disinter mediate and run a low overhead clinic, I still see anyone who wants to see me regardless of their insurance or lack thereof.

    Hope this helps!

  • http://www.idealmedicalcare.org PamelaWibleMD

    You might just share that with her. From a place of compassion share your true feelings.

    • Sarah

      I have told her many times (via thank you cards) how grateful I am for her care, how challenging it must be to work with cancer patients on a daily basis, etc. But she never even acknowledged the cards. Now we (all of her patients) just received a letter from her stating that she has accepted another position back East and will be leaving. I’m hoping that this is a move in the right direction and not just climbing the next rung on the ladder…..but who am I to say what is “right” for another person.

      • http://www.idealmedicalcare.org PamelaWibleMD

        All you can do is what you did. And I thank you for being compassionate with her. Even if she has not thanked you personally. I can not imagine that your kindness has had no effect on her. You never know the ripple effect of one kind gesture.

        • Sarah

          Thanks, Pamela.
          I have recently decided that the best solution….for me….. may be to opt out of traditional medicine and go the naturopathic route. I’m hopeful that naturopaths may not be so stressed out and might be practicing in a less toxic environment.

          • http://www.idealmedicalcare.org PamelaWibleMD

            Yes. The right person for some patients may be a massage therapist, a naturopath, or someone else. Not all allopaths are unhappy or stressed. There are many who are thriving in small independent practices. Keep looking. You will find the right doc for you. No reason to continue a failing relationship.

  • http://www.idealmedicalcare.org PamelaWibleMD

    There is an art to medical practice and art to human communication. I am not giving the full instruction manual on how to have these conversations. Only that it would be worthy to recognize the abuse and to address it in the best way that you know how. Listen to your mind, heart, soul. Do what seems best in the situation in which you find yourself.

    I do know ignoring the abuse can be catastrophic for the doc and patient. So we are all in this together ultimately.

  • Sarah

    Seems like this discussion is getting a little heated. It is understandable since we’ve all had different experiences with doctors.

    Sounds like we all have…..in our own way….tried to show compassion, empathy, gratitude to our docs. But as much as we may feel empathy for their situations, they have to make their own choices…….to stay in a possible toxic work enviroment or find another way to practice their craft. I’m sure…..at one time or another…..most people have had to make difficult choices regarding their workplace situation. I know I have. I left one of the highest paying positions I ever held in my life in public health research because of unethical practices that were being implemented by the management of the research group. Before leaving, I addressed these issues with management numerous times to no avail. Exacerbated, I sought advice from a well respected former colleague of mine at a different research institute. Her wise words were “ultimately you have to decide whether you can do this job and still feel good about yourself.” As soon as she said those words, I knew I couldn’t and so I resigned. It ended up being the best decision of my life…….although in hindsight I wish I have also been a whistleblower……but this was the first time I had ever experienced such a situation…..so it was all new to me.

    The point I’m trying to make is that doctors need to stand up and take responsibilites for themselves…….and quit acting like victims. And we, as patients, need to do the work that it takes to go out and find other doctors……good doctors……doctors that are a “good fit” for US if we feel that we are not getting good care. It takes work for doctors and patients to do both of these things……but the alternative is to do nothing and accept inadequate care…..or in the docs case not follow and honor their Hipporcratic Oath…. “first do no harm.”

    We all are confronted with these moral quandries at sometime in our lives. And our decisions show us…. and make us into the human beings we ultimately become.

    • http://www.idealmedicalcare.org PamelaWibleMD

      Agree 100%.

      To doctors: You can not be a healer and victim at the same time so choose one.

      To patients: You are paying for health care. Make sure you are getting what you are paying for. If you are not, speak up, move on. Do not accept poor treatment. Do not be a victim.

      • DoubtfulGuest

        Darn it, the walk didn’t help. This is getting ridiculous. How many times have we been told on this blog that unless we go to a direct pay practice we are not paying for our care?

        You know full well that doctors have lots of different ways to put up roadblocks to patients seeing a different physician. I did the “work” to get the care I needed, and here’s the minimum we have to deal with: 1) wait months to see the new one, 2) pay for yet another new patient visit, 3) find some tactful way to indicate that fresh eyes are needed and 4) try to be super-personable while praying the new doc doesn’t decide we’re a criminal. That is *not counting* how do you get past any bad stuff that may be in the chart from the previous doc. We’re not true consumers, nor would you want us to be. Hence, not having consumer power.

        This healer vs. victim thing just comes across as fluff. I don’t have a problem with docs asking for our help to some reasonable extent. But you’ve made your position clear on doctors abusing patients, and you’ve gone too far.

        • rbthe4th2

          You left out a big one: the retaliation that happens when you as the NON MD turn out to be right and the MD turns out to be wrong.

          Bonus points when it is a specialist. Double those if it is a sub specialist (which it is in my case).

          Certain reasons why the little women’s sisters say they don’t argue with her on some things. Never argue with a walking google

          even if it is fair haired and eyed and short.

          Unless you also have a suicide wish …

          • DoubtfulGuest

            Ha! Sounds like someone I’d get along with.

          • rbthe4th2

            Um no. Ever argued with a computer? I say this at work because she doesn’t read this.
            Also so she doesn’t fink back to the Elders of the church …

          • buzzkillerjsmith

            I’ve been a doc for 25 years and have never been in a situation where I admitted that I was wrong and the patient was right.

            But when that does happen, I kick the patient out of my practice, call security, and sometimes have the patient put on a 72-hour involuntary psychiatric hold and then deny that any of it ever happened.

            It’s worked out pretty well so far. I’m thinking about setting up some (expensive) seminars for other docs on “the doctor-patient relationship.”

          • rbthe4th2

            ROFL. LOL. LMHO. Made my day …
            They didn’t put me on a 72 hour involuntary but they did get another doctor (their known buddy) to sling “mental” accusations at me. Unfortunately, the doc missed that there was never a record before that time of any issues, nor would the “documentation” they put down support such allegations, nor would my record of volunteer work, church involvement, no criminal record, etc. even not being in trouble with my homeowners assocation, support that I was ever an issue. For starters.
            Shoot I don’t care that the doc was wrong and I was right. I only care that he realize we’re not stupid, listen to our medical research and concerns, and give me & the other half the appropriate care. Don’t screw up records.

            If you set the seminars up, you should charge what the (unmentionable word for the) MOC committee charges you all, or will be charging for the MOC’s and CE’s that aren’t paid for by your hospital/company/employers.
            Maybe even double. Turnabout is fair play.
            With all due respect to Dr. Wible, I’d expect to see a higher suicide rate after I saw ABIM’s new “requirements”.
            and I thought only the govt. did stupid things.

          • TheresaWillett MDPhD

            I recommend the book “How Doctors Think” to any provider or patient who wants to understand how easily and systematically bias and error enter into our assessments. Several stories of patients triumphing over stagnant thinking.

          • Sarah

            I love Dr. Groopman’s work. Two of his other books that I found to be very helpful are Your Medical Mind: How to Decide What is Right for You, and The Anatomy of Hope: How People Prevail in the Face of Illness. I read all three of those books after being diagnosed with an advanced stage cancer and found them to be very helpful…..even shared them with my oncology team.

            There’s also a great interview with him on NPR’s Fresh Air with Terry Gross.

          • Patient Kit

            I read and liked Dr Jerome Groopman’s “How Doctors Think”. It was very interesting. I also read and liked Dr Danielle Ofri’s “What Doctors Feel: How Emotions Affect the Practice of Medicine”. Both worth reading.

          • TheresaWillett MDPhD

            thanks, I will check that out too!

          • rbthe4th2

            Thanks Dr. Willett, I will see about checking that out.

          • buzzkillerjsmith

            When in doubt, blame the nurses. If you can’t blame the nurses, blame the patient. If you can’t blame the patient, blame the system.

            My first lecture in medical school.

          • rbthe4th2

            You mean it wasn’t:

            Thou shalt follow the Lord thy attending, with all thy heart, with all they soul, with all thy mind, and with all thy strength?

            I’ve had some docs that apologized or the like for things and fixed them with me. I never did anything but thank them and brag on them. Its sad that some rotten apples spoil it for many.

            Or the other is that the medical profession doesn’t really do a good job on helping their own in terms of work stress that causes suicide or family problems. If you all treat each other like this, how is it you can not judge your patients? I think there is a fine line between helping a doctor and helping to the point of where patient care suffers.

          • rbthe4th2

            ROFL. LOL. Where does blame the insurance company and spouse come into that?

        • http://www.idealmedicalcare.org PamelaWibleMD

          By the way, I am a fan of direct pay for primary care.

          If you hired a third party to pay your restart bill, you pay twice as much, wait 2 weeks for a table and have 7 minutes to eat.

          Disintermediation is key.

          • DoubtfulGuest

            I am open to direct pay and already familiar with this analogy. I know other patients have concerns and I can see that side as well. This has nothing to do with the fact that by and large, most practices still are not DPC. Your statement about patients paying for their care and having free choice of docs isn’t true or relevant.

            I don’t require this low-level instruction. Some of your earlier statements on this post are a poor strategy for “selling” disintermediation, if that’s your aim. Back to the drawing board, please.

          • http://www.idealmedicalcare.org PamelaWibleMD

            I so wish we could go out for tea and discuss this in person. I find online conversations sometimes deteriorate and that is never my intention to offend anyone.

          • DoubtfulGuest

            You know the line you crossed with Randy (and to some extent with me). You know how to step back over to your side of the appropriate boundary and you know the proper response when you have crossed a line with someone. This has gone far beyond the usual zone of confusion with internet discussions. We were all having a nice chat, until YOU crossed the line. Randy’s initial comment was a point for debate, but your response to him created a hostile environment for patients here.

    • DoubtfulGuest

      Thank you for this, Sarah. I mostly agree with you.

  • http://www.idealmedicalcare.org PamelaWibleMD

    Suer thing. Ask me anything. I’m an open book.

  • DoubtfulGuest

    A refresher on posting policies, from Dr. Kevin’s terms o’ use page:

    http://www.kevinmd.com/blog/terms-of-use-agreement

    “You may not post content that is obscene, defamatory, threatening, fraudulent, invasive of another person’s privacy rights, or is otherwise unlawful.”

  • buzzkillerjsmith

    Shocking indeed.

    If only the CorpMed czars knew.

  • Kirsti Nore

    I just posted a long post here. But I made a mistake and it’s not here.
    So second try.

    My take:Most of us are way to loyal to or doc’s. It’s a hassle to go doc hunting. Plus most of “our yearly’s” go to a lab anyway, results com back on mammogram, pap-smears, colonoscopy,etc.from lab-science.Exact science.

    As a very well-educated woman myself (Cand. Mag. Major: Pedagogics.),I actually have the experience of my doc speaking baby-language to me.

    I’m Scandinavian, have an accent, good economy, very creative an innovative.Got my green-card in 91. Lives in a nice house, but maybe not the supreme zip-code. I’m also skinny, with natural Scandinavian big boobs. Off course I get profiled. As dumb.

    Problem is: When is the right time to ask my doc if she is abused?
    You know it’s quite an insulting question to a Dr. with some pride left.

    I feel sorry for doctors.

    • rbthe4th2

      Oh dont go there. My lady decided to “help” with a few comments on the local fiber optic company. She’s also a “dumb” blonde with blue eyes and wore glasses. Most give her 5 foot tall … on a good day.

      But has college degree*S* in science and graduated in the tops of her classes … A’s in physics … spent the freshman summer of high school taking an extra “year” of math (all A’s).

      Her help consisted of saying if you don’t do X a particular # of feet apart, your fiber won’t work.

      They ignored her. She waited.

      A few months later they offered fiber to everyone in the area. She asked them why it took so long. She said did you have to redo the whole area? The customer person checked. They came back and said yes how did you know?

      She said check the phone conversations. I told you so.

      They gave us a few months worth of fiber free …

      I love her!!!!

      • DoubtfulGuest

        Now THAT is a great story!

    • http://www.idealmedicalcare.org PamelaWibleMD

      I think when we can view doctors as peers and treat each other as equals, we will all experience much healing.

      I also detest the treatment of patients as juveniles. We were told to talk to patients and give information to them at the 4th-grade level so that they could understand. I think that is an insult for many. I am not looking to make patients into dependents but into high functioning self-reliant people who can manage their own health and use me as a consultant now and then.

      When is the right time to ask your doc if she is abused? When it feels right. There is no uniform way to handle this.

  • annette ciotti

    If Corp Med is responsible for the abuse, or for leaving the doc open to abuse, the patient shouldn’t be expected to ask this question. And they may be less than comfortable asking the doc, if they think discussing it may get the doc in trouble with the higher powers. Plus the patient has already been waiting too long for the chronically behind schedule doc.

    • DoubtfulGuest

      I don’t care about wait times, Dr. C. I know it’s usually for a good reason. Thanks for your perspective. I’d be glad to say something if I knew it wouldn’t make things worse. Are there steps patients could take to help that we might not be aware of?

      • http://www.idealmedicalcare.org PamelaWibleMD

        Kindness and compassion and realize that the doctor is a human being. Do unto others . . . <3

        • DoubtfulGuest

          I asked *Dr. C.* what steps patients could take *that we might not be aware of*. Please stop, Dr. Wible.

    • http://www.idealmedicalcare.org PamelaWibleMD

      Ok.

      Use your best judgement regarding what works in your situation This blog was meant to open up dialogue on a pervasive problem. There is no one-size-fits-all solution or conversation that will fix this.

      But if you are unhappy with your harried doctor and the short visits, think about what the physician has shared in the video above.

      • JW

        I am never unhappy with those things. If I’m upset with my doc, it’s because they have minimized my disease in some way.

        If they have come to the end of useful ideas and can only repetitively recommend stuff I have tried that didn’t work well, I consider moving on. If they have no suggestions but instead imply or state that my disease isn’t real, I move on and feel ill-treated, but I consider that they may treat patients with better-recognized diagnoses better.

  • rbthe4th2

    One of the reasons for misdiagnosis I see is that doctors aren’t keeping up with medical research. I’ve got several years worth that show what is happening to me was predicted. Its just that docs don’t want to listen to me although I’m asking them to read the research.

    In other words, we docs can’t get past our own prejudices about non MD’s. Never judge a book by its cover. I had a doctor admit that about my wife.

    You would think people grounded in science would get that. My wife does.

    Asking tough questions also hurts ego.

    What I find so sad is that these 2 items and what Dr. Wible started talking about in terms of suicides & physicians, all have to do with prejudice in one way or another. You would think that scientific people would be able to look at that, but they’re just like us.

    Well not like my other half but she doesn’t read this. :) Her mother said she read the dictionary as a kid.

    • http://www.idealmedicalcare.org PamelaWibleMD

      Oh I think docs would love to read research and be academically stimulated by interesting patients, but they lack time todo so on the assembly line. It’s a lose-lose for everyone. Except may be the CEO?

      • Sarah

        I agree Dr. W. As someone who worked in health reasearch for over 20 years, it is just second nature for me to try and stay on top of the newest health research related to my conditions. I have had nothing but very receptive responses from all of my docs when I send them (via email in our electronic medical records system) new research on my medical conditions. On one occassion I had one of my docs thank me for the research abstracts but apologize that she had not had time to read them prior to my clinical visit. I think that good intentions are there…..by many docs……but once again the time factor gets in the way.

        • http://www.idealmedicalcare.org PamelaWibleMD

          Yes!

      • rbthe4th2

        No they don’t. They’re intimidated by them. Now I do have a few without egos that dont mind but I had several that told me they couldn’t do anything they hadn’t been trained for. I said you can’t read medical research and see if it applies to your patient?

        That is not a joke Dr. Wible. If you are wondering why I have some of the views I do on doctors, its because of some blatant refusals to read medical literature, to even consider it, or get angry for asking questions from the literature you read.

        These are not from urgent care type PCP’s, we’re talking all the way up to sub specialists who I know take their time.

        • Sarah

          Your experience has certainly not been my experience. Maybe it is how you present the research to your docs….or when you present it….lots of variables to take into consideration.

          • rbthe4th2

            I present it the same way I do to all: I have been researching and here is what I’ve found. Then state it. The ones who simply have their mind made up cut me off and ignore it. That’s 70% of them. The others listen and give their opinion. I stick to two different types of research only: the diagnosis that is really at the root of my problems and what items support that, and blood work testing. For example a low alkaline phosphatase, on all the reliable information sources I have: has heart bypass as the first cause, malnutrition as the 2nd. You can find out part of the causes by checking zinc, B12, folate and a couple other things. When the doctor asked me what do you have there (my first source), I stated I had low AP and I was concerned. I was told you wouldn’t have that unless you were malnourished. I said that’s me. The discussion ended there.

            So the doctor open ended it and then closed it because they made a decision that since I am not a BMI of 16, that I can’t be malnourished. That’s why they’re not fixing my problems: they refuse to recognize the medical research for several years that I fit the criteria for, and even verified neurologic, eye, muscular, blood & circulation (among other things) all fit together under that, they still refuse to deal with it because of their prejudice on weight. I’m not a teenage girl at BMI 16 so I have to be fine.

            Again, doctors attitudes and mindset, which they talk about us PATIENTS when the problem is their own personalities that are causing the problem. If it seems I’m like whatever you docs solve the issue, that’s because I’m not alone in my treatment. Doctors won’t face facts or issues in a number of cases and that makes it that much harder on them. If they don’t support trying to help their own brothers in arms by giving and helping one back from depression and the like that Dr. Wible talks about, why should we expect anything better?

          • Sarah

            Since you think that your medical probem is the result of a nutritional deficiency, perhaps it would be helpful to seek out the opinion of a naturopath.

          • rbthe4th2

            Sarah I’m missing part of my GI track and the rest doesn’t work right, I have multiple GI food problems also. I was fed thru a vein a couple of years ago due to lack of nutrition. This is well past the “easy” patient and a naturopath couldn’t do any better than what I have now. They also can’t treat it at this point.

          • Sarah

            A second opinion never hurts.

          • rbthe4th2

            and where do you expect this second opinion to come from? They want to see all tests, doctors notes, etc. When doctors get diagnoses wrong or miss them, they want to hide them. I have a ton of information regarding how they will protect their own against a patient. Like the main gist of this item is: some things doctors must work on themselves and behaviors like this, that are against patients but for themselves, are ones that cause mistrust and the like and are part of the reason why we patients should not be expected to fix what doctors should have professionally, morally and ethically, fixed themselves a long time ago. Once they moved to business level and stomped on patients in ways that weren’t right (the lawsuit crazy people who truly are just out for the money, that I can forgive, but not people like myself and DG who are asking for answers and to fix things and it is the DOCTOR who is the problem), this is why I say hey if you have a suicide problem, its not our bailiwick to fix it and to expect us to deal with it on our own time and dime is just way too much. Too threaten us on top of it saying we get what we deserve was enough for me to tell others, yep same old tactics.

          • rbthe4th2

            Sarah let me ask you something: have you had something that wasn’t simple to diagnose or look at? Have you ever wondered about blacklisting? That’s the difference. Doctors do it – to protect their own. One of their own made a mistake and they’re afraid to say he did. They’ll leave me without the right medical care because abandonment is not what they want to be known for – nor what he did that the govt. agrees is illegal.

          • Sarah

            Trust is the foundation of any relationship….particularly the doctor/patient relationship. If you don’t trust your doctor it is time to put the effort into finding one that you do trust.

          • rbthe4th2

            I haven’t trusted the one doctor for a long time but I have no choice as I have no care. You need to read some of Trisha Torrey’s comments about people saying they had really disagreeable doctors but can’t do anything about it due to retaliation and the lack of care. That’s what is happening to me. Doctor got caught and then did what he said he was going to do a long time ago: retaliate. In my records.

            Welcome to doctors’ personalities and control.

          • Sarah

            HIPAA gives patients the right to read and even amend their medical records……including doctors clinical notes. Contact your medical records department.

          • rbthe4th2

            Been that route. Who do you think the next doctor believes: his buddy or me? You can change records but only doctors can change their minds and their attitudes. If they’re not willing to give us a chance, why should we give that to them? I’m pointing this out because that’s a big issue, way too many times I’ve seen money and power from MD’s win out over the truth. This is one instance.

          • JW

            Do you live somewhere you can go to a third doc (not former doc and not his buddy)? Hang in there. I went through a lot of docs and a lot of years, but I finally started finding people who would treat me with respect. There are still some bad apples that I avoid, but I finally built a team I could work with.

            (I did have some snide notes in my chart from some docs, but most of the lies are omissions of S&S/ claims of good results when stuff was anything but fine or exam had not been done.)

          • http://www.idealmedicalcare.org PamelaWibleMD

            Never lose hope. . . have you seen the list of ideal clinics on my website? Maybe there is one in your neck of the woods.

          • rbthe4th2

            No, here the monopoly has most everything locked up and part of the care can’t be had at the other hospitals. Trying to go out of the area requires lots of time to travel off work so its not really feasible in terms of money or the like. That still doesn’t excuse docs who stalk or pay PI’s or get the risk managers to pay PI’s to stalk patients for standing up for their rights.

          • rbthe4th2

            I can get help in another area but its the specialist help that I need that isn’t available. They just want you to go back to the original doc and think that once it is a problem, blame the patient and not the doc who made a mistake. That’s a HUGE problem in medicine: one that isn’t discussed but needs addressing like the suicide support issue here. Not in the manner suggested: it needs to go to the heart of the culture of medicine.

  • DoubtfulGuest

    Welcome, by the way.

  • buzzkillerjsmith

    That’s great, that’s just great! I’m snorting and drooling here and I never guffaw without great provocation.

    Just one question: You aren’t my patient, are you?

  • http://www.idealmedicalcare.org PamelaWibleMD

    Hey 20% more polyps are identified before 11:00 am. So schedule your colonoscopies before 11:00 am.
    Doctor fatigue can lead to mistakes.

  • http://www.idealmedicalcare.org PamelaWibleMD

    See colonoscopy comment below.

    And let me know how that next office visit goes.

  • Karen Ronk

    This was a recent encounter with the umpteenth doctor I have seen in the last 18 months due to one encounter with a bad surgeon. This doctor, whom I like, describes me as “direct” because I really want to understand what is wrong with me and how much worse this condition that is ruining my life can possibly get. So, do other patients just want that “baby talk” and prescriptions? I find that hard to believe, but maybe it is so.

    Something is very wrong with the current state of our health care and the broken relationship between patients and doctors. As others have stated, patients have enough to deal with and cannot be expected to delve in depth into the emotional well being of their doctors. It is simply not our place or our responsibility. Yes, we should be courteous and not make ridiculous demands, but we are there to be taken care of and not to do the taking care.

  • DoubtfulGuest

    Dr. Kevin, after yesterday’s activity on this post, I’d like to double-check that patients are still welcome here? Thanks.

    http://en.wikipedia.org/wiki/Jumping_the_shark#mediaviewer/File:Fonzie_jumps_the_shark.PNG

  • Sarah

    Hi everyone. I just wanted to share this incredibly moving….. and IMO…. important TEDTalk by a doctor…….who is courageous enough to share his mistakes and the consequences of being a doctor in a society that expects perfection. I hope you will give him this time.

    http://www.ted.com/talks/brian_goldman_doctors_make_mistakes_can_we_talk_about_that

    • DoubtfulGuest

      I love this talk, Sarah. I’ve seen it a few times before. “Doctors are human and imperfect” is being misused in a twisted way on this post, though. I’d hope Dr. Goldman wouldn’t like to be associated with that.

      • Sarah

        DG, I’m so happy that you are familiar with this talk and see it’s ability to move us towards compassion for each other.
        DG, I personally, haven’t found anything inappropriate in our discussions on this blog. We are all here sharing our thoughts, experiences, musings, etc. to expand our understanding of important issues. In my mind, no one is right, no one is wrong. But through being open to each others experiences, thoughts, etc., in addition to our own, we can hopefully broaden our perspectives……at least that’s why I come here. I’m sure that’s why you come here, too.
        You have contributed greatly to this and other dialogues…..and I hope that you will continue to participate in theses discussions.
        There’s a wonderful Zen teaching …..”don’t bite the hook”. In other words, try not to let our attachments to an idea, to a viewpoint, etc. take us off course. I try to remind myself of that teaching when I catch myself getting pulled into conflict, off-centeredness, etc. I just want to offer it to you as something to consider.

        • DoubtfulGuest

          Thank you, Sarah. With all respect, I’ve been pretty open-minded, and Dr. Wible is the one personally targeting some patients here just for disagreeing with her. You have the right to disagree with me on what you see, but please don’t step into my personal space as well. Zen is not for me. I have often been the one to try to smooth things over here and see everyone’s viewpoint, and I’m done. I’m not seeing consistent and fairly enforced standards for conduct on this blog. I requested that Dr. Wible apologize and she has not done so. I did ask her for clarification several times. She’s gotten way too personal and needs to learn boundaries. All the best to you.

          • Sarah

            Thank you for your feedback, DG.
            Best to you also!

  • http://joannevalentinesimson.wordpress.com/ ValPas

    Wow! This goes a long way toward explaining why there is so much physician burn-out.

    • http://www.idealmedicalcare.org PamelaWibleMD

      Yes. Our doctors are really suffering and many are scared to reveal the extent of their pain.

  • JW

    Some of my doctors do seem harried (by EMR, by insurance rules, etc.), but other than being nice to them myself (and I try, even though not all of them are nice to me–though some are indeed nice, helpful, smart, everything I could ask for), I do not know what I can do.

    But I don’t understand: ask them and then what? I have only one, who treats me like a friend she would chat with.

    • http://www.idealmedicalcare.org PamelaWibleMD

      It is not your job to solve your doctor’s problems. But you can point out your doctor’s diagnosis. The life you save may save you.

  • JR DNR

    I didn’t read this as a literal suggestion, but rather as a message to provoke thought.

    And I liked it. It made me think. Thank you.

  • Nancy

    The very sad reality is that many doctors in my work describe themselves as abused. We just don’t want to think that this is going on here. Often doctors are put to shame for not seeing as many customers as the their organization should. Patients report them for not prescribing the patients drug of choice, regardless that it is not clinically appropriate. They are often dumped on by the system, when they should go home after a 13 hour day and a patient walks in, they are supposed to smile and accommodate. Never mind that this same person who showed up after hours was a no-show at an earlier appointment….I sill stop here.

  • Nancy

    Simply asking the question does not imply you will have to do therapy for the doc. It indicates care and compassion. Just asking the question [ and not providing answers or therapy] accomplishes the significant task of drawing the physicians’ attention to a red-flag.

  • Sarah

    could someone tell me how to unsubscribe from disqus? I can’t figure out how to do it.

    Thanks!

    • Sarah

      no need to reply. I figured it out!