Friday, November 23, 2012

The Growing Culture of Hostile Dependency Towards Doctors

By John Mandrola, MD 
Cardiac Electrophysiologist
Baptist Medical Associates
Louisville, Ken.

Let’s start with a disclaimer: I am not complaining; I’m just stating the facts.

Honest fact: The morale of doctors in the real world is low — and sinking lower.

I know what you are thinking. “Come on, Mandrola, you are nuts if you expect us to feel sympathy for doctors — of all professions.”

Well, you can think that if you wish, but I’m calling it as I see them. And here is why it matters:

Because when you are sick, an available, rested, un-rushed and talented doctor is really important.

You know this: quality health care — real quality, not spreadsheet or Internet quality — stems from basic human-to-human interaction, between patient and doctor. Health care reform, with its emphasis on metrics, prevention of fraud and cost-cutting measures has forgotten the basics. Namely, that humans, who have dedicated their life and committed their self-esteem, practice medicine. To take care of people well, doctors need things:
  • We need face time with the patient — not with a computer screen.
  • We need time to listen, to examine and to treat.
  • We need to feel trusted.
  • We need our self-esteem.
  • We need leeway to be human.
  • And of course, we need to be paid a fair wage for the years of training that it took to acquire these skills.
In support of this view, I’ll call your attention to four posts from real doctors:

My colleague Doctor Wes Fisher talks of the growing culture of hostile dependency towards caregivers. Wes is rightly disturbed by a sensational and one-sided book review of surgeon-author Dr. Mark Makary’s Unaccountable. Agree or not with Wes, his words come from the heart of a man who hangs a lot of his self-esteem on the doctoring peg. Wes is a guy I would want to have as a doctor. If health care reform keeps going in this direction, patients will have fewer Wes Fishers around to pull them out of fires.

Here’s a quote (via email) from an esteemed colleague — another guy you would want as your doctor:
We doctors are absolutely being demonized.  Every day something new is written pinning our health care crisis squarely on our shoulders.  It’s really affecting me emotionally.  I’ve actually started to think it might be a good idea to take a media holiday for a while.  I appreciate that you still have the energy to fight.  I’m getting pretty tired.
One of the most obvious unintended consequences of cutting health care costs on the backs of doctors is the flight of good primary care doctors to concierge medicine. One of the best posts I have read on the topic of dropping out comes from Dr. Rob Lamberts. Dr. Rob is a beautiful writer and another passionate practitioner of medicine. I’ve been reading his stuff for years, and it is clear that Dr. Rob has unequivocally mastered the obvious.

Finally, there’s me. I wrote an In the Prime post today about the two sides of the canvas of health care reform. It was in response to a nicely written opinion piece in the Courier-Journal. A local doctor pointed out that we must not settle for anything less than universal insurance coverage. He’s right; but there is also the important question: What good is universal coverage if there are not enough caregivers?

Doctors don’t expect sympathy. That’s not what we want. We want the people — our patients — to know the consequences of hostility towards caregivers — be it in mistrust, hyper-regulation or lower pay.

We welcome reform, but we can’t sit still and watch it destroy the practice of medicine.

John Mandrola is a cardiologist who blogs at Dr. John M. This blog post originally appeared on


Anonymous said...

I think some of this hostility or lack of trust (at least for me) comes from the fact that more and more of health care costs are related to lifestyle diseases--diseases that need to be prevented in the public sphere BEFORE someone goes to a doctor's office.

When someone does go to a physician and finds out they have high blood pressure, diabetes, heart disease, overweight, etc. the solution that most doctors prescribe are: exercise more, eat better, take this medication. But that doesn't result in a positive outcome (most of the time) because people do not know how to eat better, where to exercise, how to find the time, etc. etc. Because the way that Dr. visits are reimbursed by insurance companies, doctors themselves to do not have the time to counsel a patient in these matters.

Furthermore, the medical system in this country teaches doctors to REACT to a disease instead of PREVENTING it. This is marvelous if I were in a car accident and needed an emergency operation. However, this does not help the millions of people who suffer from lifestyle disease because typical medicine is not helping to fix lifestyle. We need to fix the public sphere so that people can thrive. By public sphere I am talking about advocating for healthier communities.

Because the "average" person does not have much contact with the insurance industry or lawmakers, the blame of our medical system gets placed upon doctors, because they are at the front line.

What I would like to see is a paradigm shift in the medical system starting with medical school to place more emphasis on true lifestyle disease prevention and less emphasis on taking a pill and putting a bandage on something that will never heal unless the root cause is fixed. This will entail new partnerships and a new way to think about prevention, healing and medicine.

Anonymous said...

What do you think about the emergence of concierge medicine! ?

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