Is the practice of medicine making doctors sick?

by Carolyn Thomas   @HeartSisters   

Sue Robins of Vancouver has an irresistible writing talent that’s somehow both quietly approachable and yet sneakily explosive. We see this talent in her book A Bird’s Eye View: Stories of  a Life Lived in Health Care. We also see it in her compelling blog essay, “We Are All In This Together” as she explores the “basic lack of humanity that ails health care – a lack of humanity for patients, families, staff, clinicians, physicians and administrators.”  As Sue says:

“We are all in this mess together.    .     .

“I know that patients are suffering. I know that those who work in health care are suffering. It strikes me that we are suffering for the same reason. We do not feel seen. We do not feel heard. We feel left out. We don’t have control of our own lives. Over and over, I see a plea from patients asking for respect, dignity and inclusion in issues that matter greatly in their own lives.

“I think health professionals crave the same respect, dignity and inclusion in issues that matter greatly in their lives, too.”

One of the most compelling parts of this essay was a description of Sue’s oncologist.  She wrote:

“When I was going through cancer treatment, I wanted to see my oncologist’s heart. She never allowed me a peek in. She had a constructed a tall, seemingly impenetrable wall around her heart and it was protected by the system-built lack of time she spent with me.

The combination of those two things made me feel invisible and miserable. My oncologist seemed miserable too, trapped inside her well-dressed facade. She never smiled, so neither did I. I walked out of every appointment as demoralized as she seemed to be. I felt her unhappiness. I wanted to tell her  we are all in this together, but she never gave me a chance.”

I wondered when I read those words if that oncologist has ever read Sue’s 2019 post, or if she is even remotely aware that her professional demeanor might be making her patients feel “invisible and miserable”.  It’s dreadful for everybody all around – including for that doctor, the one who “never smiled”. Imagine being that doctor. Imagine being her patient.

Just last week I received a surprisingly hostile reader comment in response to what I thought was a relatively benign blog article – specifically on doctor-patient communication and the value of listening to one’s patients. What’s not to love, right?

The comment-writer was a physician, using his real name, who wrote:

“Damn right. Wah wah wah. We’re already an hour behind and we have 6 people waiting, 10 FMLA forms to fill out, 62 prescriptions to refill, and more. Get a therapist.”

You know this physician is treading close to his own personal best-before date when he actually signs his own name to a public referral for psychotherapy to somebody he hasn’t even examined.

I looked him up on Twitter. He lives in Texas and loves football. Based on his med school graduation year, he’s likely a bit younger than I am (translation: ready for retirement). When he’s not leaving snarky Twitter comments, he’s probably a nice enough guy.

But it seems that he no longer cares what patients or his colleagues think of his snark – and that is a sad sign. It means he is able to respond in this way to people he doesn’t even know, the ones like me who dare to write about the importance of being a good listener – or anything else he’s sick and tired of hearing about.

It’s important to add here that although it may seem at first blush that his comment was aimed at me personally, I didn’t take it that way.

That’s because what he was railing against were the statements I quoted in that article from several well-respected physicians and researchers who had shared their own opinions on the value of listening to patients – including Dr. Catherine Kreatsoulas (Harvard),  Dr. Jerome Groopman (Harvard), Dr. Victor Montori (Mayo Clinic) among others.

So some of that knee jerk snark, unfortunately, landed upon those distinguished heads. I was merely their messenger.

What I’ve learned here at Heart Sisters World Headquarters over the years, however, is that it’s apparently far easier for docs to openly criticize a lowly patient than to aim that same criticism at their peers.

The first response to this physician from my other blog readers was not surprising. For example:

“I’m glad you’re not my doctor. Wow!”

That’s an understandable reaction. But ultimately, I was struck by how deeply unhappy and exhausted this man must be.

Where is the humanity in his own workplace? Why would his employers make it almost impossible for him to take the time to be a good listener? All those people out there in his waiting room, all those forms to fill out, all those prescriptions to refill. All the relentless demands from those damned patients who keep coming in. . .

And only more of the same to look forward to tomorrow, and the next day, and the day after that. I wonder if he asks himself: “Is this why I went to med school all those years ago?”

Luckily for patients, not all doctors are this unhappy at work. I know this, because I’ve been writing about many of them for 11 years. Everybody has moments like this, of course, but generally, many if not most behave and sound as if they truly like their jobs.

Here’s an example: Dr. Alex Nataros is a family physician; like me, he lives on Vancouver Island off the beautiful west coast of Canada. Back in May, I read his letter to the editor of the local newspaper, the Comox Valley Record. This letter was all about kindness during the COVID-19 pandemic, which he summarized like this:

“All that matters is basic human kindness.”

And here’s what young Dr. Nataros wrote on Twitter recently:

During my ‘Meet & Greet’ new patient appointments, I always try to make a point of asking widows for the name of their late partner and gently how/when they died. So far it seems to be helpful as a therapeutic touchstone during future encounters.”

I’ve decided that whenever I get snarky comments from doctors from now on, I will think of physicians like Dr. Nataros, who’s out there carefully listening to the precious stories of his widowed patients. That’s basic human kindness for you.

I’ve never met Dr. Nataros, but his attitude reminds me of Mayo Clinic’s Dr. Victor Montori. (Alex and Victor: I hope you two can meet one day!)

I was thrilled to spend some time with Dr. Montori in person during my last trip to Mayo Clinic in 2015, but I was already a huge fan long before then. For years, I’d been writing about and quoting him and his groundbreaking work at Mayo on concepts like Minimally Disruptive Medicine (Care That Fits) or patient decision aids or the burden of treatment among his many other patient-centred passions.

When I first watched this TEDx talk of Dr. Montori speaking about his vision for a return to medicine that is “careful and kind”, I almost wept with joy and hope. Not only is Dr. Montori one of the most compelling public speakers I’ve ever heard, but his message is profoundly important and uplifting – for both healthcare professionals and patients alike.

And when Dr. Gordon Guyatt, a Distinguished Professor of Medicine at McMaster University, reviewed Dr. Montori’s wonderful little book Why We Revolt: A Patient Revolution for Careful and Kind Care, this is how he wrote about its impact:

As a physician primarily involved in research, I do four stints of inpatient clinical care each year. I’ve resolved to re-read one of the chapters of Victor’s book before each clinical care rotation to remind myself of the caring doctor – following Victor’s model – I would like to be.”

In his book, Dr. Montori urges his colleagues to fight back against what he calls “industrialized medicine”, the kind of workplace environment that has clobbered job satisfaction for so many health care professionals.

When Drs. Joseph S. Ross and Akshay Pendyal at Yale University reviewed this book in the British Medical Journal (BMJ), they wrote:

“The physician workforce, largely as a consequence of bureaucratization, is experiencing unprecedented rates of burnout.

As bad as things are for clinicians, patients are faring even worse.

Ask patients about their most recent visit to the clinic, or, worse yet, a time they were admitted to the hospital. They’ll likely tell you about a clinician who barely looked up from a screen, or the experience of being awoken several times in the middle of the night to have their temperature taken. Where, in all of this, does the actual ‘healing’ part come in?”

In that same review, Dr. Pendyal described the crazy-making daily frustration that plagues so many physicians, particularly in the U.S. where the practice of medicine is largely under the weighty thumb of the for-profit insurance industry (unlike here in Canada – also known to some Americans as “commie pinko land of socialized medicine”).  As Dr. Pendyal writes:

“Today, I spent more than 30 minutes on hold with an insurance company, attempting to obtain prior authorization for a simple stress test; I clicked countless times within my clinic’s electronic health record, all in an effort to find a single scanned copy of an ECG; and, in the spirit of ‘quality improvement,’ I received several alerts reminding me that, well, shouldn’t I be working just a tad harder to lower my patients’ LDL cholesterol?”

Is it any wonder then that so many physicians may feel impatient with those non-physicians who tell them they should become better listeners?

Dr. Dike Drummond’s sole professional focus since 2011 has been addressing what he calls “the modern burnout epidemic” among his colleagues. The author of the book Stop Physician Burnout: What To Do When Working Harder Isn’t Working, he cites three commonly observed early signs of burnout among healthcare professionals:

  1. Emotional Exhaustion:  Doctors are tapped out after the office day, hospital rounds or being on call and are unable to recover with time off. Over time, their energy level begins to follow a downward spiral.
  2. Depersonalization:  This shows up as cynicism or a negative, callous, excessively detached response to their job duties. Often, burned-out doctors will begin to blame and complain about their patients and their problems.
  3. Reduced Accomplishment:  Here, physician burnout has doctors start to question whether they are offering quality care, or whether what they do really matters at all.

As Boston surgeon Dr. Rena Xu wrote in The Atlantic, the burden of electronic medical records and demanding regulations may also be contributing to a historic doctor shortage:

“In medicine, burned-out doctors are more likely to make medical errors, work less efficiently, and refer their patients to other providers, increasing the overall complexity (and with it, the cost) of care.

“They’re also at high risk of attrition: a survey of nearly 7,000 U.S. physicians, published last year in the journal  Mayo Clinic Proceedings, reported that one in 50 planned to leave medicine altogether in the next two years.”

I don’t want physicians to leave their profession. I don’t want them to feel so beaten down by relentless bureaucratic demands that their only relief is to quit. I don’t want doctors like our football-loving Texan to become so mean-spirited that he needs to publicly take out his resentment on patients he doesn’t even know. His comment to me (and essentially, to other patients) was really saying: If you need to be listened to, go pay for a therapist to listen to you – because I simply don’t have time at work to do that anymore.” 

I also don’t want patients to suffer the consequences of missed diagnoses or inappropriate care or ineffective communication because suffering health care professionals see listening as optional.

I want decision-makers (and all healthcare professionals) to read Dr. Victor Montori’s book on “careful and kind” care, and to pay special attention to his book’s suggestions on how to make that happen within the restrictions of modern medicine.

I want patients to acknowledge, as Sue Robins already has, that our health professionals crave the same respect, dignity and inclusion in issues that matter to their lives  – just as patients do, too. And I want our healthcare professionals to acknowledge that, as Sue so astutely reminds us, their patients often feel unseen, or unheard, or left out, or without any control of our own lives. 

But respect and caring must flow in both directions to heal what ails the medical profession.

Take care, stay safe. . .

Image: Christo Anestev, Pixabay

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Q:  What’s been your experience with a healthcare professional who seemed truly happy at work?

NOTE FROM CAROLYN:  I wrote more about doctor-patient communication in my book A Woman’s Guide to Living with Heart Disease, (Johns Hopkins University Press, 2017). You can save 20% off the book’s cover price if you order it directly from Johns Hopkins University Press (use their code HTWN). Or ask for it at your local library, your favourite independent bookshop, or order it online (paperback, hardcover or e-book) at Amazon.

See also:

– Sue Robin’s book A Bird’s Eye View: Stories of  a Life Lived in Health Care, and more terrific essays on her website, SueRobins.com

-Dr. Montori’s book Why We Revolt: A Patient Revolution for Careful and Kind Careand his brilliant TEDx talk video

-Dr. Dike Drummond’s website The Happy MD on preventing and treating physician burnout

-How Minimally Disruptive Medicine is happily disrupting healthcare

-Living with the “burden of treatment”

-Kindness in healthcare: missing in action?

-the Patient Revolution website, and their Patient Tools to help you at your next medical appointment

-the Minimally Disruptive Medicine/ “Care That Fits” website

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24 thoughts on “Is the practice of medicine making doctors sick?

  1. I don’t think the practice of medicine makes doctors sick all by itself. Burnout is a common occurrence in doctors because of the nature of the calling and the nature of the profit driven modern medical practice (USA).

    Since the 1970’s, physician burnout rates have been over 30% – higher than the non-physician employee population. In the last 10 years they have pushed up towards 50%. Being a physician is difficult. Simultaneously overloading docs with electronic medical records and all the dictates of 40 insurance plans is extremely taxing to half of docs on any given day. And there are ways forward: Here is an older blog post with some key insights on the nature of burnout itself.

    Thanks for the mention in the article.

    Dike
    Dike Drummond MD
    CEO, http://www.TheHappyMD.com

    Liked by 1 person

    1. Thanks very much for weighing in here, Dr. Drummond, and for that link to your article on preventing physician burnout. Interesting definition of physician burnout as a “dilemma” (e.g. “You can’t solve a dilemma for a simple reason – it is NOT a problem. You address a dilemma with a different word: ‘strategy’, with 3 – 5 steps/parts/tools that you use in combination to maintain the energy balance that you seek.”

      As long as physicians (or anybody experiencing burnout) seek just one magical solution to their ‘problem’, or blame one single issue (EMRs) for the pain they feel, we’re not likely to see a solution. Your site is such a useful resource.

      I appreciate your input here. Take care, stay safe….

      Like

  2. Yes, all of this, yes. As a terminal cancer patient, seeing practitioners who show their humanity is key.

    I have to fight hard enough to maintain quality of life and I can’t do that if I feel dismissed or that the doctor isn’t all in to help protect the time I have left.

    I’ve left doctors and complain regularly when my needs aren’t met by all levels of the practices where I seek treatment. As a lawyer, I get the patient/client centered treatment model better than most, and call bulls*it regularly at my cancer center.

    Liked by 1 person

    1. Thank you for sharing your unique perspective, Abigail. I’m feeling disheartened that any patient, anywhere, would have to complain about inadequate or inconsiderate treatment. Why would you have to do that? Isn’t that the very definition of “care”? And why should you have to “call bulls*it regularly at your cancer center?!?!? That is appalling..

      And if this treatment is happening to you, I can only imagine what a quieter or less informed patient must be enduring wsilently. That fear of being perceived as a “difficult patient” is real!

      I wish you only clinicians who will care for you and about you the way they would their own families.

      Take care, and stay safe… ♥

      Liked by 1 person

      1. Because I’m totally fine to be vocal and I wear the label, difficult patient, with pride, I consider it my responsibility to speak up for all those people who don’t or can’t.

        Yes, it’s ridiculous that it’s necessary. I’ve been meeting biweekly with the senior leadership at my cancer center to address all these types of issues. It’s systemic and the tone is set from the top.

        Liked by 1 person

        1. Bless you for meeting regularly with senior leaders at your cancer centre, Abigail! What you’re sharing with them will help to improve care for those patients who are too sick or too overwhelmed to stand up for themselves well into the future – IF those senior folks sincerely pay attention. I’ve never met you – but why do I get the feeling that they WILL pay attention to YOU?! 🙂

          I’m no shrinking violet, but when the Emergency Department doc misdiagnosed my heart attack as acid reflux and sent me home, feeling embarrassed and humiliated for wasting their very valuable time, I can tell you that I couldn’t get out of that hospital fast enough. That experience had a profound impact on me (basically I was telling myself that I’d rather be dead than embarrassed!)

          I’ve been involved in a number of “patients included” projects over several years that in the end, turned out to be meaningless exercises (i.e. “Let’s include a real patient on this project so we can say that we’re patient-centric…”) so I’m a bit leary these days of appearing as the token patient voice, a tickbox to be checked off some project manager’s list, because the truth is that I have barely enough energy most days to function – and that’s on a good day.

          Throw in a dismissive doctor or a rude nurse or a room full of healthcare administrators who ignore what I’m saying, and I can crumble like a bad cookie… Look at the example I mentioned in this article: I write what I think is a useful post on the importance of listening to patients, based on evidence – and Dr. Texas feels compelled to put me back in my place….

          Sometimes it IS necessary to “call bulls*it” out loud when you hear it or see it. Dr. Montori’s Minimally Disruptive Medicine, and his call for a patient-led revolution in health care concept is just one example of how this could work.
          Keep up the good work you’re doing!

          Liked by 1 person

          1. You are so right!! I’ve been learning more about myself and my personality lately and that’s helped me understand more about how and why I react.

            As an Enneagram Type 8, I’m comfortable with anger. I feel it and I express it. There’s also nothing that makes me more angry than injustice and disparities and lack of care. I’ve spent nearly 20 years as a lawyer and my pro bono niche was in the foster care system, where I’ve fought the system for years. So I suppose I’m uniquely suited for this.

            At the very least I know I’ve found a purpose in the midst of my diagnosis. ❤️

            Like

  3. Hello Carolyn,
    I can relate to what you shared in this post. I’ve seen the impact of the system on doctors and their staff. In the process of seeking treatment for AFib, on more than one occasion I summoned the courage to call the on-call doctor after hours, only to literally be screamed at.

    After one particularly hurried appointment with a cardiologist in which I was interrupted numerous times and repeatedly dismissed, through the tears I cried all the way home, I vowed to find a doctor who was kind and patient and who would listen to me.

    It took a whole lot of very hard work, but I actually did it!

    My cardiac electrophysiologist is like no doctor I’ve ever encountered. When I shared a few horror stories, he said that the behavior was a product of having 8 minutes to spend with a patient and that he’d been told by the hospital when they hired him that he wouldn’t work that way. This conversation took place in a 15-minute chat we had after a wound check appt. He had told me to text him and he’d stop by for a chat, which he did. Not even an official appointment. I was blown away.

    I have his cell # and text if I have a question. Most of the time, he responds immediately. Recently, he called from vacation. Once I realized that’s where he was, I insisted he wait till later, but no, he wanted to.

    I am told that he gives his number to all patients.

    On top of his medical and technical prowess, he has been helping me heal from the many highly stressful encounters I’ve had in the past few years simply by being kind, gentle, compassionate and patient with me. He also played my favorite music when he did my ablation. 🙂

    Because the health system he’s in made him out-of-network for my insurance, that end of the equation has been really challenging. So now I just text and he calls me and we don’t even schedule an appointment. He insisted on this after I got a $600 bill for a 10-minute official phone appt. I did end up finding a wonderful person on the billing side who is helping me out with that mess.

    I’m in the process of scheduling a brief hospital stay for medication dosing. The main reason I’m able to do this is because the doctor insisted that it be at no charge to me. The financial executive is making that happen. I feel very, very fortunate.

    The moral of the story for me is that it is true that so many doctors are harried and pressured by the system. There are those who somehow manage the stress such that they don’t take it out on patients.They are heroes, truly!

    The health care system can be so difficult to navigate. I encourage other patients to keep advocating for themselves. Keep looking for good doctors. Keep asking for help. The doctors are out there! It may take a lot of work to find them, but it is worth it. Especially for dealing with a heart condition.

    Thanks for the topic and the great work you are doing.

    Liked by 1 person

    1. Thanks for this, Grace – I’m 100% sure that most readers will be envious of your quite amazing electrophysiologist! When you write “he has been helping me heal from the many highly stressful encounters I’ve had in the past few years simply by being kind, gentle, compassionate and patient with me”, you touch on such an important point. It reminds me of a landmark study on end-of-life care by Dr. Harvey Chochinov that concluded, in short: “Patients feel better when doctors listen to them.” Why, I wondered at the time I read this study when I was working in palliative care, do we even NEED to do studies to prove what every human being already knows instinctively? So that docs who read these medical journals can think about this concept and say, “Hey! Maybe I’ll try listening to see if it helps my patients!” ?!?!?

      I too encourage all patients to advocate for themselves. But the trouble with being a patient is that often, patients are the least able to stand up to their doctors, and certainly if that doctor is “screaming” at them. Feeling sick rarely enables us to put our best selves forward. There is a profoundly powerful hierarchy alive and well in the practice of medicine, as I wrote more about here. As social scientists point out to explain this hierarchy, “the dominant group holding power in a given society (doctors) are disturbed by those who have historically had little power to dare question that dominance (patients) – which they blame as yet another basis for burnout. https://myheartsisters.org/2019/10/06/medical-hierarchy-shifts/

      Meanwhile, I’m so glad to hear about physicians like your EP!
      Take care, stay safe… ♥

      Like

      1. Thanks, Carolyn. Yes, I’m with you about wondering why it’s even necessary for anyone to study anything about the power of kindness and listening. Duh. 🙂 I was always thinking, “We are talking about the *human heart,* guys!” Did no one get the memo that it is more than a pile of muscle to be drugged and zapped??

        I was reflecting again on your excellent post and response to my comment and the truth is that the screaming doctors were actually the least of my concerns in dealing with AFib. Sad and horrifying, but true. When I was first diagnosed, my insurer at the time didn’t tell me till after 6 months of treatment, including an ablation, that they wouldn’t pay for any of it, based on a faulty claim of “pre-existing condition.” This was in the months before the Affordable Care Act made that illegal. So I had $150,000 in bills to deal with.

        Fighting off bankruptcy over 1.5 years is what made me into a fierce advocate for myself. I actually think the office staff, billing agents, and insurance staff can be far worse than the grumpy, dismissive docs.

        What I’ve found effective to do when feeling especially sick is to say, “I am doing my best here to be respectful, but I feel HORRIBLE right now! And I need your help!” A well-placed, polite fit has proven to be effective. It is the truth, after all.

        I definitely get how utterly miserable and difficult it is to persist when sick; I’ve found that it’s actually worked well to push it right at that time by telling the unvarnished truth and to keep asking for managers. Once I said, “I know that somewhere in your org there is a person with compassion, intelligence, power and authority who will be willing to help me here. I’d like you to connect me with that person now please.” And they actually did!

        The system itself in the US is dehumanizing and cruel and it affects everyone, unfortunately. Till we can get a new, humane system, I encourage everyone to persistently seek out those angels who manage to keep their humanity intact and who are doing their jobs for all the right reasons. They are there.

        Thanks, again. It’s nice to connect with women who “get it.”

        Liked by 1 person

        1. Yoiks! Grace, your story is yet another example of what an insane healthcare system your country – wealthiest country on earth! – is clinging to as if it’s actually working. The reality of the insurance industry – any insurance industry including healthcare – is that they don’t make money by approving your claims. They make money only by denying claims. That’s what they do to satisfy their clear mandate to serve their shareholders. It’s obscene.

          I have to tell you how much I like your straightforward but not “difficult” responses to healthcare professionals in order to reach them, e.g. “I am doing my best here to be respectful, but I feel HORRIBLE right now! And I need your help!” That kind of statement serves to interrupt the NO that’s about to come out of that person’s mouth, just long enough that their humanity might be reachable…

          There are those “angels” you mention – we all really need them…

          Thank you for that!!!

          Like

  4. Hi Carolyn,

    I have to say how impressed I am at the way you’ve so beautifully handled those comments from the doctor in Texas!

    Somehow you found the strength to move beyond ‘first blush’ (a place where I think I’d be stuck for a much longer period of time than what you have demonstrated) and move into a place of compassion, understanding and forgiveness. Instead of chastising him in your reply, which likely would have accelerated his anger even more, you wisely chose your words to reflect kindness!

    I’m so grateful to have discovered you. Keep up the good work! 🙂

    Liked by 1 person

  5. It seems to me that this is the essential quandary for doctors — in any other industry or profession, if you want to press the “higher-ups” to make changes that impact the bottom line, you’d have the option of going on strike. But for a doctor, going on strike might involve a patient’s death, and the doctor has taken an oath to do no harm. So they’re kinda in a vise.

    In a wise and humane society, we would recognize this, realize it was unfair, and make their happiness at work their top priority. Unfortunately, what we have is corporate greed-hogs telling doctors how to treat patients and be quick about it. It’s this very clear dilemma that’s one reason that healthcare for profit should not be allowed.

    Liked by 2 people

    1. Hello Wendy – healthcare for profit carries the same obligation that any other corporate for-profit industry has: a duty to their shareholders to maximize profits. Period. No matter what all the hospital billboards or glossy brochures promise – like “our patients are our first priority!” – that simply cannot be true in what Dr. Montori calls “industrialized healthcare”.

      Interesting that you should mention doctors on strike. A study published in the journal Social Science and Medicine that analyzed physician strikes around the world over a 40 year period – in which doctors had withdrawn their services for between nine days and 17 weeks – reported no increase in mortality rates during any of the strikes compared to non-strike times. Despite those stats, most people still tend to see doctor strikes as an ethical dilemma that requires clear strategies to keep at least minimal key services open – especially for under-served patients in poor areas.

      There’s no easy cure for those ills.

      Take care, stay safe… ♥

      Like

  6. Speaking as a patient, and as a mom to a newly hatched MD…. it’s been an interesting journey as a med school concierge.

    Prior to retirement, I was a highly paid experienced project manager. From this limb, I have personally experienced the fallout of constant pivoting from the med school programs. Seems like a daily experience of having schedules and plans blow up from seemingly nowhere.

    The constant replan is deadly stressful, as is the mounting debt these young doctors accumulate by the hour. COVID has only exposed the mismanagement of our infrastructure, with no remaining financial reserves…. everywhere … in every aspect our our lives.

    You want free medical? Well, how about we tax you to pay for free medical school education? Does the general public realize that these young doctors in training and residents cannot qualify for any apartment in the cities that they work to provide care? One resident neurologist explained that he lived in subsidized housing, with high crime. He slept with a loaded gun under his pillow. And yet, somehow, they arrived at the office to begin the daily appointments, with a smile on their faces. Pretty sure the rich doctor paradigm is now blown, right?

    It seems that most patients do not want to take responsibility of their health and well being. They make excuses or lay blame upon others. Victims. Most are overweight, with diabetes and high blood pressure. Ask a person with diabetes how much they pay for glucose monitoring and you get deer in the headlight responses. Take their shoes off to examine their feet and find toenails that are so uncared for that the nails are curling over the end of their toes. Point out their lab results – the evidence that the numbers don’t lie. Counsel the patient and the excuses fly. Now you are well past the allotted time for the appointment, which is tracked data at the corporate medical centers. Then the patient feedback comments publicly appear, complaining that the doctor made them feel bad. Get too many of those feedback comments and your employer penalizes the doctor with his job or salary cuts. Why anyone would choose a profession to be a physician in this environment? It’s a calling.

    Appreciate the fact that mental health care facilities have had their budgets slashed and closed, beginning about 30 years ago. All those patients needing mental care are within the general public. So many people are struggling, and their health pays the price for the stress. They go to the doctor because they feel bad and need help but there is no other place to turn. The doctors have the same burdens of being adults in this world. They are exhausted, frustrated, broke and now are expected to be human shields for COVID.

    So, the taxpayers need to fund mental hospitals and outpatient clinics so that physicians have the ability to treat the basis for so many of their patients’ illness or pending illness. Nip the problems in the bud so that patients’ physical health remains strong. Families need elders that counsel the young to not take on debt and how to live strong and healthy. Families need to be strong. We all can do better.

    Liked by 1 person

    1. Anne, you’re in such a unique position to see both sides of this complex and overwhelming reality. If you haven’t done so already, please watch Dr. Montori’s TEDx talk – he speaks eloquently about many of the issues you raise.

      There is no simplistic solution to “fix” these problems. I agree – all of us (on both sides of the gurney) can do better!

      Like

  7. I’ve had experiences like that in the past and after my heart attack, I changed to a different GP practice on the way home from hospital!

    It is a husband and wife practice, both dedicated caring doctors who have taken time to get to know me. They give me as long as needed to explore my symptoms and help me understand test results.

    This is remarkably rare and very much appreciated now that I have complex health needs.

    Liked by 2 people

    1. Hello Jane – you changed GPs on the way home from the hospital?!? That’s a decisive action for a freshly-diagnosed heart patient! That terrific description of your husband-and-wife practice warms my own heart.

      Take care, and stay safe… ♥

      Liked by 1 person

      1. Yes, Carolyn, my previous GP did not pick up on heart issues. Despite having blood tests for underactive thyroid and pre-diabetes every six months for years, he hadn’t checked cholesterol.

        After what I now realise was a big heart warning whilst on holiday a few weeks before the attack, he concentrated solely on his (correct) suspicion of gallbladder issues. I’d said the episode felt like I might have been having a heart attack! I was referred for surgery for removal of gallbladder and large gallstone, but before I’d even seen the surgeon I had a STEMI!

        I was very angry that the heart was never even considered to be an issue. That’s why I changed GP on the way home from hospital.

        Liked by 1 person

        1. Yoiks! A good lesson for all physicians that YES it is possible to have two medical conditions at the same time. This is a disturbing reality, especially in women (for example, if you’re unlucky enough to have the word anxietyon your medical chart, you can pretty well predict that your cardiac symptoms will be interpreted as a mental health issue – but since there are very few scenarios that are more anxiety-producing than having a frickety-frackin’ heart attack, I’d predict that “anxious” would be an accurate word to describe most of these episodes!)

          I wrote about a similar case in this post about Debbie Orth, a woman who was experiencing both a heart attack and acid reflux at the same time (yet only her acid reflux was correctly diagnosed for five weeks).

          Meanwhile, I’m so glad you had such a positive experience and are doing well.

          Like

  8. I won’t spend too much time bragging about the kind caring Cardiologist I have… Who tells me to make my next appointment at the end of the day so we can talk longer…. and gave me his personal cell phone number when I returned to Denver from Mayo Clinic just 7 days after heart surgery.

    However, I want to talk about a decision he made 10 years ago. Dr R. was a part of a very large lucrative private practice here in the USA. The practice is profit driven and analyzed their data to make sure they made good quarterly profits to pay their MDs nicely. Ten years ago they cut the time for ALL patient visits by 5 mins. That doesn’t sound like much, but it was the tipping point for Dr R.

    He decided he did not want to practice that kind of short visit abrupt medicine and he left for a salaried position at an HMO where he had visits 10 mins longer and the pressure of making a profit off his back.

    Another doctor I have, a Cardiac Electrophysiologist, came into the room at our first visit quite briskly, and very business like. After our symptom review, I snuck in a question “How long have you worked here at Kaiser(HMO)?” I think he said 4 years, “I used to be over at the University.”

    “Really?” I said, “What made you leave?” He said “The constant pressure to do research and publish…I like taking care of patients, that’s what I do best, so I left.”

    I noticed his brisk ‘business self‘ relax half way through our conversation … as he remembered he was taking care of a patient and that’s what he loves.

    Sorry, for the long comment but I think these two stories reflect on medicine in the USA and give a couple of insights:

    1) Doctors need to evaluate their personal job satisfaction and if their job makes them unhappy, they need to leave … even if their retirement isn’t vested yet

    2) As patients, we can break through the business of medicine and remind doctors to keep it personal just by our attitude and compassion for them.

    Carolyn … Do you think your medical model in Canada leads to greater job satisfaction than we have in the USA?

    Love You and Thanks for this wonderful blog. I look forward to it every Sunday morning!

    Liked by 2 people

    1. Thanks for sharing those two stories and your insights, Jill – I too have a cardiologist who tells me to book the last appointment before lunch because he and I always seem to get involved in intense chats!

      In answer to your last question re Canadian doctors: in 2018 a Canada Health InfoWay report here found that 72 per cent of Canadian physicians were satisfied with their professional lives, but fewer (just 49 per cent) were satisfied with their work-life balance – which tends to be a significant issue across MOST workplaces.

      Take care and stay safe…. See you next Sunday! ♥

      Liked by 1 person

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