Norm Ponders
Doctors
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This page has been long in writing due to various distractions and some "writer's block" as I struggled on how to express myself.  It was first posted with some parts complete, and some parts still in outline form.  Comments are welcome.  With changes anticipated in the near future, I hope to finalize it and organize it better over the next few weeks. Because of some good suggestions, I may overhaul my approach.
Below are some brief paragraphs only to give some sense of where I am going.  I was mild in my statements below, but it is time to tell it like it is, folks.  We as doctors are way more responsible for the current crisis than most would like to admit.  We have danced right along with the insurance companies, pharmaceuticals, medical suppliers, etc. etc., in creating an expensive and poor quality system.  Money drives it all, and doctors along with everyone else maximize their charges with payment rules generated by the specialists and AMA.  We have become reductionists, treating people like sacks of sand or molecules who supposedly follow the rules of thermodyamics.  Technology rules.  People are being digitalized in their care by unnecessary technology (which rewards highly), and we ignore our humanity.  We ignore the psychosocial, cultural and spiritual sides of our beings. 

Doctors

 

 No obstetrician has ever been sued for performing a cesarean section too soon on a patient in labor.

                                                 Anonymous obstetrician making a labor management decision

 When in doubt, cut it out.

                                                  An old medical axiom.

 

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Sometimes the dark side overcomes what Lincoln called the better angels of our nature.

                                                  General Corman in Apocalypse Now speaking of the  

                                                  change in the heart of Colonel Kurtz.

 

What and who are the better angels of our nature?  Lincoln was suggesting these were humaneness, compassion, goodwill, tolerance, and other good things

`                                                Ambassador Ronald D.. Palmer

 


Introduction

 The role of doctors both directly and indirectly contributes to the rising costs of medicine and must be examined.  While doctors receive about 20% of the health care budget, they very directly contribute to the majority of spending in other areas (or they used to until insurance companies recently butted in).  Writing about doctors is the most difficult task I have undertaken.  The task is more difficult because of my perspective as a practicing family physician.  I neither wish to be a medical apologist or a medical heretic.  It must be stated in advance that there are thousands of committed caring hard-working doctors across the country.  It must also be acknowledged that there is a shift among even well intended occurring in the direction of commercial and economic values, away from the professional and ethical orientations.  Whether by nature of the system, ignorance, seduction, or greed, it is occurring.  The shift is away from doctors being humanitarian scientists to being entrepreneurial scientists. 

 Looking at the motivation of physicians on a bell curve, it probably could be stated that perhaps 5% at one end of the curve are committed and are driven by a calling to serve people.  They were not influenced by money and perks.  On the other end of the curve probably 5% were bad apples from the start.  The 90% in the middle of the curve are the ones whom I believe have changed the most.

 For the most part they chose medical careers as a way to help people in a respectable profession and likely have a reasonable income.  I really don't believe that these people started out wanting to be millionaires.  Medicine was once a very enjoyable profession with shared goals of patient care, teamwork, teaching, learning and a goal of excellence.  I do not believe I am just speaking for myself when I consider my past experiences.  The very most enjoyable and stimulating years my practice were my first two in the public health service setting.  I worked in a clinic for migrant farm workers.  Everyone rolled up their sleeves, worked together, supported each other, and worked hard.  Money did not influence.  I know many physicians who say the same thing about their joy in professionalism at the time of military service, Indian health service, Peace Corps work, teaching, etc. Today the system environment has changed and I'm going to review various aspects of how we got here and where we must go.

 

My writings on doctors are mostly complete and hopefully will appear soon.  I discuss many areas of training and practice, including "The School of Medicine", "The Culture of Medicine", "The Bank of Medicine", Corruption, and other issues.  Below is a snippet from what I called "The Church of Medicine". 

The Church of Medicine 

The result of training and then entering the real world is a group of people who believe in the hierarchy role, standards of care, and are under economic pressure.  The fraternity of medicine walks together with allegiance to practice guidelines and standards of care, and woe be to those who deviate. 
The American College of obstetricians and gynecologists (ACOG) is a very good example of an organization that propagates standards.  The standards are developed, put into policy manuals and medical records of patients and virtually become law.  The very glaring problem of ACOG guidelines are that they are not necessarily based on wise medical practices.  Rather a legal committee develops them to decrease exposure to lawsuits.  Again these guides are not based on good medical practice but on decreasing legal exposure. 

An example I experienced many years ago was during that time when ACOG guidelines said that all pregnant women should be screened for diabetes with some form of blood glucose tolerance test.  I was attending a meeting with prestigious medical experts lecturing on various topics.  There was a speaker who is a renowned professor in diabetes and pregnancy who asked the audience how many people present screen every patient for diabetes with some form of blood glucose testing.  As I sat there, every hand in the room soared into the air except mine.  The professor said, okay let me ask this differently----- is there anyone here who doesn't test every single patient.  I paused.  I slowly raise my hand which was the only one in the room that went up.  As I looked around the room I saw the slits of angry eyes with heads forwarded, glaring.  Some gasped and threw their heads back eyes open and sputtered.  It reminded me of the poker dogs.  I heard someone say "I wouldn't want to be his malpractice carrier".  Someone behind me was glaring into my back and I felt my shirt getting warm and ready to burst into flames.  Then the speaker said "well, I am glad there is one person in the room with the courage to think for himself."  He then went on to give a very good presentation on why there are obvious low-risk patients who don't need this testing.

 

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