If You’re A Doctor, It
Sucks To Be You
By
Leonard Zwelling
I was chatting with a close physician friend recently. We
were trading war stories (whining, really, after all we are academics) about
the down-grading of our profession from that of a noble calling to that of
being the guy or gal behind the examining room door pushing patients through
the clinic at an ever-dizzying pace while trying to maintain eye contact with another
human (often very ill) despite the need to fixate on the computer screen
displaying that same patient’s medical record. Clerical work seems to be the
most constant activity in the day of a doctor. Insurance claims, electronic
medical records, forms to get lab tests and x-rays ordered and exponentially
expanding “books” that constitute hospital privilege applications crowd out the
activities that occupied previous generations of doctors—patient care.
I am not sure if any of you out there has seen a physician
of late as a patient, and if you have, whether that physician has been under
40, but you may find that both Marcus Welby and Greg House have died and gone
to the pathology department for a Y-shaped incision in favor of white coated,
well-rested people who could be your kids who order MRIs first and ask review
of systems questions later. I don’t blame the young docs. That’s how they have
been trained.
In undergraduate school they were encouraged to explore the
non-science, non-math options available at their Ivy League universities so
that they could become well-rounded. Given that the length of a college
semester is gradually approaching a few weeks then a midterm then a few more
weeks, then a seasonal break and then the final, is it any wonder the students
today have to crowd in as much as they can of college life as fast as possible.
Something has to give in their busy schedules. Who knew it would be going to
class?
The future docs then go to medical school (usually after
they spend a few years abroad finding themselves if they don’t have crushing
debt to repay). My generation had a similar option but the foreign destination
was Vietnam and not highly desirable so we went to class in return for tuition amounts
that middle class parents could actually afford. Once the new medical students
arrive they too eschew class and use on-line notes, Power Points and goodness
knows what else to learn basic science, just as they did in undergraduate
school. Once they get to the clinical years, they need to be home early to meet
the demands of their required sleep schedules. This nonsense will follow them
into residency where their hours of work are limited by law. This is to make
sure they make no mistakes in their training years due to being overly tired when
those decisions can be overseen by senior residents and attending physicians. Of course, the fact that they will finish
three years of training having not managed diabetic ketoacidosis from admission
to discharge, performed a midnight spinal tap or done a Gram stain may put the
patients they care for over the next 30 years in very great jeopardy since
there is no chief resident on call in the real world. No worries. They aren’t
going into private practice any way and hospitalists who never deliver
continuity of care will cover their really sick patients.
The
concept of private practice is a thing of the past anyway. They will be drawing
a salary from an HMO or ACO or some other such “organization” in which these
“professionals” will simply be cogs in the wheels of the health care-industrial
complex that will make money for a conglomerate of shareholders who own the
hospitals and clinics in which medicine is “practiced.” With enough practice,
maybe some of these young people will actually get good at it. I hope so, for
my current plan as I age and acquire an ever-lengthening medical problem list (you
don’t want to know, TMI) is to fill a big bowl with lustrous blue barbiturates
on a mantle piece at home with a sign saying: “If your current doctor retires
or dies or you don’t remember what these blue things are, TAKE THEM ALL.”
Doctors of America unite. You have nothing to lose but your
pride, if you have any left.
As a start, let’s commit to this little protest. The next
time you are in a conference room with the administrators of your “health care”
place of employment and the word “provider” is used in a sentence that is not
discussing your parents who paid the bills when you were a child, stop the
conversation and say to the speaker, do you understand that that word is to us
doctors the equivalent of an ethnic slur to an African-American, Hispanic or
Jew? (If you wish to be particularly crass you can use one of those awful
words, but I don’t recommend it).
It is up to us. All physicians over the age of 55 are going to
have to make a big sacrifice for our younger colleagues if we are to see
another generation of professionals actually preserve the role of healers and
confidantes that has been our job for 5000 years. Get angry. Get offended.
Speak up. If you don’t the next surgery you need may be done by a robot without
a human attached.
In the Broadway musical Avenue Q, the characters (and
puppets) of a very downscale neighborhood sing how it “sucks to be me.” Doctors
of the US, we better get ready with a similar song unless we call out those who
would rebrand us providers so as to be politically correct and not offend the PAs,
nurse practitioners and other “physician extenders” of the world.
We
brought all of them into this world and we will help them out. Let’s act like
who we really are while we are all still between Joni Mitchell’s “forceps and
the stone.”
Say it loudly please. We are not providers. WE ARE DOCTORS!
