The idealized doctor is dead. Or at least on death’s door.

The American medical establishment has systematically clogged his arteries with paperwork, lined his lungs with rules, and filled his intestines with, that’s right you guessed it, shit. There he lay, in a comatose state, awaiting to be pronounced. Only one thing is sustaining his overworked body.


Four months into my intern year and I’m just realizing how crucial maintaining my idealism — as unrealistic as it may be — is to not only my well-being, but also to medicine. A century-old phenomenon, the disillusionment of the American doctor is a well-known tragedy. In 1927, Francis W. Peabody wrote that “one of the essential qualities of the clinician is interest in humanity, for the secret of the care of the patient is caring for the patient.” What would Dr. Peabody say today regarding me working 12 to 14 hours per day and only spending 1 to 2 of those hours (if lucky) with my patients?

What do I do with the other 10 hours? Well, over many years the combination of our medical system and the big business of medicine (insurance companies and profiting hospitals) have inadvertently (I hope) created what I like to call the “doctor wheel.” Just like the silly mouse, we endlessly run in our wheel until the day is over, the cage has been opened, and a new doctor is to take our place. Until the next shift of course. The wheel is comprised of notes (admission notes, progress notes, transfer notes, discharge notes), orders, phone calls, order changes, pages, consultations, and so on. A whirlwind of glorified administrative and managerial work that sucks up most of my day. The words thriving and personal satisfaction seem less appropriate than the word survival.

In 1978, Samuel Shem published the House of God. A cynical, yet partially truthful portrayal of the surreal journey through the world of residency. The line, “the patient is the one with the disease” (not the doctor), is frequently repeated in the novel and has stuck with me since. Many times, I have found myself confused, frustrated, upset, and flat out in disbelief that my beloved profession has become what it has, only to remember this line in order to calm me down and bring me back to reality.

As the doctor, I am here to heal, help, support. I am to be the voice for the voiceless. The patient needs me to be sound of mind. But how can this be done when the American medical system is diseased itself? We ask our patients (often overworked and underpaid themselves) to travel long distances, sit happily in waiting rooms for hours, and receive treatments they rarely understand and may not even need — all for a nice profit to the system.

Shem was wrong; I am the one with the disease.

And, I couldn’t be luckier.

I feel pity for those who see the suffering, the inequalities, the redundancies, and the bullsh*t, and do not feel uneasiness, disgust, even anger. The American medical system has “cured” them.

I can only hope it doesn’t cure me. The battle has begun.

Igor Shumskiy is a pediatrics resident who blogs at the Journal of a Young Doctor.

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