Hey Docs! Would You Tolerate Being Called A KrankenbeHandler?
By
Leonard Zwelling
Since it seems that most American physicians have been willing to be called “providers” since about 1965 with the onset of Medicare, why not revert to the German word used by the Nazis 30 years before Lyndon Johnson’s Great Society to assure that Jewish physicians only treated Jewish patients? (see attached article from The American Journal of Medicine in December 2021 by Mangione, Mandell, and Post). And you thought this “provider” language started in the last ten years—not!
The brief literature perusal I did does not suggest any ulterior motive behind the use of the term “provider” in the United States by the insurance companies and others, but in both the U.S. and Nazi Germany, there was the aspect of the use of terms other than doctor that seemed to connote a diminution of authority in the hierarchy of society. (See Raz, Freedman and Roelcke in the Journal of General Internal Medicine 37:3479, 2022 who clarify the poor translation of the German word and the lack of its connection to the modern use of the term.)
It really doesn’t matter how many ways the healthcare-industrial complex wants to put the doctor in his or her place. This is what medicine has come to. Once, it seems like a long time ago, but it wasn’t, we doctors were organized into a system of individual or small group practices of mostly men who felt like they were in a profession or guild. They ran small businesses. It was hard to become a member of the guild. You treated other members of the guild with deep respect including the use of your services gratis. That was called “professional courtesy” and it is almost gone.
Trainees were subservient during their period of education and training. Trial by fire was your pledge period to entry into our fraternity. Were you ready to belong to the guild and be worthy of membership? Trainees would never question those teaching them, or if they did, they did so with great respect and a large amount of preparation in the library (ask your parents what that is) to acquire the knowledge necessary to question a senior physician. That’s all gone.
A close physician friend of over 50 years who still teaches medical students has told me that the students do not know how to do a medical history or a physical exam. On teaching rounds, which he demands be at the bedside, he watches the students do histories and physicals. The students are clueless.
He told me of a patient he saw whose eyes he examined with an ophthalmoscope because she was diabetic and he wanted to check the state of her small vessels, a source of complications in diabetes, and visible to the eye by examining the retina. My friend noted that all prior exams recorded in her Epic electronic medical record chart were normal—”pupils equal, round, reactive to light and accommodation” (abbreviated PERRLA).
My friend noted her right eye to be normal. Looking in her left eye led to a question.
“Excuse me, but do you have a glass eye?”
“Yes, I do.”
There is no way her P were ERRLA. The EPIC electronic medical record said they were, but that was impossible. What was more likely is that no previous examiner had looked in her eyes at all. This is the state of medicine today.
Another physician friend had a patient with a paralyzed left diaphragm. He asked the medical students assigned to him to examine the patient and tell him what they found. They all said the exam was normal. Then my friend showed them how to percuss a chest and listen to a patient’s lungs with a stethoscope to diagnose this problem. The students were flabbergasted. They had no idea how to examine a chest.
We physicians allowed our work to be monetized, our guild to be purchased, and our esprit de corps to be replaced by a race to accumulate the most RVUs. Our trainees and students are still bright, but their work ethic is colored by terms like work-life balance. In the guild, there was no work-life balance. Your work was your life. Everything else came second, including, unfortunately, your family. But without the benefits of the guild or the respect that came with it, the younger physicians seek that work-life balance instead of having a special place in society—that of healer.
For thousands of years, societal groups respected the power of the healer, the shaman, the physician. For reasons that I have never understood, we let ourselves become less powerful, less relevant, and surely less in control of the healthcare system. We became “providers.”
The real essence of the term “provider” is to equate us with physician-extenders of all kinds from nurses to chiropractors. We are no longer special. We no longer have a guild.
In Season 2, Episode 7 of the great series The Newsroom, when network owner Jane Fonda is told that the network has lost the public’s trust she screams:
“Get it back!”
Docs, that’s us. We need a way to get back to what we were, but I fear the time has passed for that to happen without a rebellion that would hurt patients. Nonetheless, I still believe that if one day, with a lot of planning, the clinical faculty of MD Anderson made a Wednesday look like Sunday, the financial impact would get the attention of the disconnected institutional leadership. Care for all patients in the hospital and all emergencies, but walk out of the clinics.
But without a Faculty Senate, courageous Divisional leaders, and department chairs fed up with 15-minute clinic visits and 900 new patients a week, this will go on.
Providers of MD Anderson, “we have met the enemy and he is us.” (from Pogo comic strip; Walt Kelly, 1970.)
Wouldn’t you like to be a real doctor again?
