A crisis of physician intra-professional respect [PODCAST]

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“What has become of medicine today? What has become of the sacred patient-physician relationship? What has become of medical offices- aren’t they supposed to be healing places? Who goes to a medical clinic (no matter how Big the Name) to be insulted and diminished and hurt? What has become of physicians as stewards of healing?

Why is this happening to us?

How much have we been hurt, as doctors, to not be able to see past our own ego and agenda and use our hard-earned healing potential to harm instead of soothe and heal?”

Corina Fratila is an endocrinologist.

She shares her story and discusses her KevinMD article, “Are physicians the stewards of healing that they are meant to be?”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show we have Corina Fratila. She is an endocrinologist, and she wrote the KevinMD article “Are physicians the stewards of healing that they are meant to be?” Corina, welcome to the show.

Corina Fratila: Thank you so much, Kevin. It’s good to be here.

Kevin Pho: So we’ll get into your article in a little bit, but first off, can you share your story and your journey to where you are today?

Corina Fratila: I went to medical school in Romania, which is a communist country with a lot of oppression and corruption. I studied hard for six years in medical school to prepare for the end-of-medical-school exam. The exam determines who gets into what residency; it essentially determines the rest of your life as a doctor in Romania. But the system was so corrupt, to the point that the day after the exam, I found out that a lot of my medical school colleagues had had access to the exam questions and answers the day prior to the exam. It ended up being a national scandal, and the exam was canceled, and all the graduates took the residency exam all over again. But by then, I had lost trust in the system. So I decided to learn English and leave my home country.

It took me two years to prepare. I went to a neighboring country, Hungary, to take the USMLE exam. Eventually I moved to New York City. I did my residency and endocrinology fellowship at Albert Einstein Montefiore Medical System. Residency was very exciting, but also, as we all know, very difficult, sometimes working more than 120 hours a week some weeks. I was thrown into the deep end of the pool, but I’m proud of the clinician I have become.

After residency, I moved to Maryland to be close to the only relative I had in the United States at the time, my sister, and I joined a large group of endocrinologists. That was a good time for me, in the sense that I met my husband, who’s Korean. As a matter of fact, today is a coincidence, because today is our wedding anniversary. And we now have two beautiful daughters, who are now 10.

I worked in this group for nearly 14 years, but I always wanted to have my own practice. That was my dream. So on April 1st, 2019, I opened the doors to my own practice, Ideal Endocrinology, in Baltimore. I finally felt, 20 years after leaving Romania, that I was living the dream. Everything I had ever wanted had materialized. I was finally practicing medicine the way I wanted.

My new clinic is a dream come true. In my mind, I call it the mutual admiration society. I admire my patients for their tireless quest for answers, their desire to become healthier and, in turn, better humans. And I think, and many of my patients have told me so, that they admired me too. I love my clinic so much that on the days when I feel tired or my body aches, I walk into my clinic and I feel better. I think of it as the healing place.

I’m board-certified in endocrinology, and most of the time I practice conventional medicine in many ways, but I also integrate many alternative modalities that I have found very useful over the years. I recommend meditation and yoga, journaling, and posing. Of course, besides all the board-certified endocrinology stuff I do, I monitor my patients’ sleep and their blood sugar with various sensors, and I often give them feedback on their parameters so they can manage their health better. I’m the doctor I wish I had had when I had my own health challenges.

I’ve always practiced this way, but with all the outside pressures in the revolving-door clinic, I felt frustrated that there was never enough time and space to address the whole being, only bits and pieces. Towards the end in the revolving-door clinic, in my previous job, I felt that I was starting to give my patients what I had to give from a place that was not what I imagined when I dreamed of becoming a doctor. I was giving from fear and resentment, not from genuine care and love.

Kevin Pho: So you talk about your practice being an ideal medical clinic. Now, that is a special type of practice. Can you tell me more about what an ideal medical clinic is?

Corina Fratila: An ideal medical clinic: I did join the ideal medical movement, which was started by Pamela Wible, but I have my own take on my ideal medical clinic, which is that my patients and I kind of decide together how we want our office visit to go. It’s not necessarily coming from an authoritarian point of view. It’s not necessary that I’m the dictator, or, you know, I don’t practice the old model of medicine, but we kind of decide together what the best thing is for their health. We know that the body has an innate capacity to heal, and we know that the patient eventually decides what’s best for them, and I’m there just to guide them. I’m not there to impose my views, necessarily.

Kevin Pho: And you refer to your old clinic as the revolving-door clinic.

Corina Fratila: Well, unfortunately, the way medicine is practiced in the United States, there are all these pressures that come from various third parties, like insurance companies and administration. And whenever you have all these practices imposed on doctors and on healers, unfortunately, there’s never enough time. So you can’t possibly spend, you know, sometimes I spend even two hours with a patient in my clinic. In my previous clinic, if I spent more than probably 20 minutes with a follow-up, I couldn’t have made it.

Kevin Pho: So let’s transition into your KevinMD article, “Are physicians the stewards of healing that they are meant to be?” Now, for those who haven’t read the story in your article, can you just walk my audience through it and share the reasons why you decided to write it?

Corina Fratila: So in my new clinic, one of my patients reported symptoms that made it clear that she needed surgery, which is not something I was trained to do, so I had to refer her out. I referred her to one of the local medical institutions, a big local name, just because prior to going into practice on my own, when I was part of the large group, this is where I used to refer my patients for surgery.

The experience that my patient had and reported to me was terrifying. From the first step, she said, in the big-name clinic she experienced nothing but rude, arrogant, condescending, and insensitive comments and behavior. Of course, the fact that she was seeing a “back-alley doctor,” as an endocrinologist and a lot of the doctors in private practice are seen these days, did not help: a doctor who recommends dietary interventions and knows her patients’ lives and families in intimate detail, who actually spends time listening to the patient and the family and tries to make sense of the whole picture. That was not a welcome sight for the big-name clinic doctor. The patient and her mother were dismissed in a rude and abrupt fashion. Her symptoms were discarded, her quest were entered was trashed, and she was made to feel small, insignificant, ignorant. She was recommended to never see her fringe doctor again and to just go to the big-name clinic for treatment.

So my article looked at this question, explored this question, of the lack of collegiality and the lack of intraprofessional respect that bleeds into patient care. I use the same referral sources as previously, but I am treated completely differently now that I’m in my own private practice. So let me tell you how other doctors have reacted to me opening my own clinic. I noticed two types of responses from doctors: the jealous, dismissive, shunning crowd and the curious and excited group. I have actually received a letter from a patient who is also a physician, who mentioned that she’s never met such a happy doctor before.

The culmination of this, let me show you how this plays out for my patient. I can handle doctors being happy or jealous of me, right, because I have big skin. When this bleeds into patient care, I think it’s unethical. I send my patient to get surgery, and this is a referral source I used for years. Now that she’s coming from my small private clinic, she was shunned and dismissed. So I think this is a crisis of intraprofessional respect, and the fact that it bleeds into patient care is huge. And of course, this is just a symptom of a bigger problem: how sick our health care system is.

I think we all, as doctors, need to practice what one of my favorite authors calls enlightened humility, which, in her words, means that of course we know some things, right, because we went to school for so many years. Of course we do. But there’s a whole other world that keeps revealing itself to us, and we need to remain open to that. We need to remain fluid and porous and nimble, because we need to meet the times, the reality of the moment we’re in. And all of us as healers, we need to stay in this enlightened humility, which is a really hard thing to do.

Kevin Pho: Now, when you were referred to as a back-alley doctor, what was your reaction, and what was going through your mind when you heard another doctor call you that?

Corina Fratila: Well, I was a little bit sad. I was a little bit upset. But for some reason, it became very clear to me that this was literally a symptom of the times. It was a symptom of what was going on. And the fact that my patient and I, and generally my patients and I, have such strong relationships of course helps clarify things for me, because the patient didn’t mention that to me to hurt me in any way. She just mentioned it as a matter of fact, and also as an observation of how terrifying it is for a patient to spend time in a big clinic that doesn’t really put the patient at the center, where it’s more about politics and more about, again, a lack of intraprofessional respect, and it’s almost like the patient didn’t matter at all.

Kevin Pho: Now, was this an isolated occurrence, or does this happen regularly?

Corina Fratila: Well, this was the first time it happened to me, but I’ve heard it happened previously from other physicians who are in private practice.

Kevin Pho: Now, what are some of your suggestions to improve the communication and the respect between the big-name centers and the smaller private practice clinicians?

Corina Fratila: Well, it’s just as simple as picking up the phone and making a phone call. That’s something that literally would take, how long, a couple of minutes, right? But someone, particularly with my background, very much understands how, I mean, it’s almost like it’s corrupted. The system is corrupted, and this can sully the whole system, a whole profession, you know, this lack of collegiality, the competition, the suspicion that is present doctor to doctor. It’s very concerning, because I know where this can lead. And the physicians who think that they’re playing harmless games or politics, it’s dangerous, because it’s not just the lives of their colleagues they’re affecting, but the health of the patient. So yeah, it’s as simple as that. Even if you hate talking on the phone, which I know a lot of us hate today, send a text message, send an email. It doesn’t take long.

Kevin Pho: We’re talking to Corina Fratila. She is an endocrinologist, and she wrote the KevinMD article “Are physicians the stewards of healing that they are meant to be?” Corina, once again, you talk about the ideal medical clinic that was created by Dr. Pamela Wible. Now, for those physicians who may be working in large centers and considering transitioning to such a smaller practice, what are some factors that you need to consider in that decision-making process?

Corina Fratila: A very important factor to consider is having a low overhead, because having a very low overhead means that you’re free. Living simply, and just generally living simply at work and at home, is really the key to freedom. The other thing is that we all need to learn ways to overcome our fears in order to grow and flourish. Of course, fear will always be there, but we have to learn ways to overcome it and move on. For me, that has been priceless.

The other thing to consider is that we as doctors, I think, are all entrepreneurs, or at least business owners, at heart, and this has been kind of squashed out of us during medical education. We have been taught to live in fear, and this mentality of scarcity and fear has completely overwhelmed us. It’s almost like we can’t see outside the box.

Kevin Pho: And my final question: What is your take-home message that you want to leave with the KevinMD audience?

Corina Fratila: That I think it is up to all of us to recognize that the current system is designed to keep us small, imprisoned, and robot-like, and it is designed to very gainfully exploit the empaths. It’s up to every single one of us to remember why we became physicians, and that we are not providers. We are doctors, and we are healers. And once we overcome the victimization produced by exploitation, we will remember that we can be our best selves and give from abundance and not from fear and resentment, that we are the creators of our lives, and we shouldn’t be giving our power away to anybody.

And I also want to leave the audience with a question. I don’t really have the answer, please, but maybe some people will. How can we thrive without burning ourselves into the ground or tearing other people apart in the process? How can we lead and achieve in a more elegant and loving and joyful way?

Kevin Pho: Well, thank you so much for sharing your time and insight, and thanks again for being on the show.

Corina Fratila: Thank you.

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