Demonizing Physicians

The disturbing tendency to try to blame all the problems in health care on physicians seems to be escalating, which shouldn’t be surprising considering the tenor of the recent elections.  The sound-bite mentality supports little else but scapegoating.

John Mandrola, MD, in “The Growing Culture of Hostile Dependency towards Doctors” does a good job of summarizing the problems with demonizing physicians.

You know this: quality health care—real quality, not spreadsheet or Internet quality—stems from basic human-to-human interaction, between patient and doctor. Healthcare 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:

  1. We need face time with the patient—not with a computer screen.
  2. We need time to listen, to examine and to treat.
  3. We need to feel trusted.
  4. We need our self-esteem.
  5. We need leeway to be human.
  6. And of course, we need to be paid a fair wage for the years of training that it took to acquire these skills.

In his discussion of hostility towards physicians, Dr. Mandrola referred to a blog post by Dr. Westby G. Fisher, “The Growing Culture of Hostile Dependency Toward Caregivers.”  Dr. Fisher had been offended by a The Wall Street Journal’s promotion of a book under the newspaper headline: “How to Stop Hospitals from Killing Us.” The following passage is from Dr. Fishers’s editorial letter to the Wall Street Journal, which this esteemed newspaper chose not to publish:

I am seeing a culture of hostile dependency growing toward caregivers.  The theme is like an adolescent who realizes his parents have feet of clay.  He comes out of his childhood bubble and realizes his parents have failures and limitations because they are human beings.  This results in the adolescent feeling unsafe, unprotected and vulnerable. Since this is not a pleasant feeling, narcissistic rage is triggered toward the people he needs and depends on the most.  None of this occurs at a conscious level.  Most of us understand this behavior simply as “adolescent rebellion,” not understanding the powerful issues at play. So when we spotlight one side of the patient safety story without acknowledging the realities health care workers face like looming staffing shortages and pay cuts, we risk fanning the flames of narcissistic rage against the very caregivers whom we depend on the most—the very caregivers who are striving to do more with less, check boxes while still looking in the patient’s eyes, meet productivity ratios, all while working in a highly litigious environment.  Why would we do this and why would we allocated money as Dr. Makary suggests, for punitive top-down solutions instead of spending that same money on supporting and educating our frontline providers?

The problems with the costs and quality of health care are exceedingly complex. So complex that they really can’t be definitively defined, much in the manner of Heisenberg’s Uncertainty Principle.  In the Canadian Family Physician,  Dr. Diane Kelsell’s “Uncertainty Principle,” she tells the story of a patient who survived the unsurvivable. Sometimes a patient’s response may not follow the norm and physicians may be unable to explain why.

Physicians are part of the health care system, but they are not the cause of the dysfunction of our health care system.  As I have so often written here, blaming the physician for proscribed behavior is blaming the physician for practice patterns over which they often have very little control.

Yes, here comes my punch line again.  The treating physician is the practitioner who knows the patients and who can offer treatment plans based upon patient needs. But Medicare, federal regulations, and insurances have substituted check lists of treatment options which may or may not fit the patient needs. It’s time to stop blaming physicians for treatment options over which they have very little control.

As Dr. Mandrola says of physicians, “we need them to listen, examine, and treat.” There are no easy, clearcut answers to the problem of our dysfunctional health care system. Health care reform, to be successful, will have to largely return medical decision-making to the persons most qualified to diagnose and treat health issues—physicians in cooperation with their patients.

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