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I'm the doctor, that's why! (This months EMN column)

This is the age of intellectual democracy.  In a frightening departure from millennia of human tradition, everyone is now an expert in everything.  Turn on the television or surf Internet news services.  We somehow believe that polls of individuals are useful for guiding policy, in everything from international politics to morals and religion.  Legislators and marketing experts trust this information, as if masses of humans had extensive experience in diplomacy and warfare, in economics and federal tax structures, rather than what so many do have expertise in; video games and the accumulated out-takes from American Idol.

It’s especially odious in the world of medicine.  How many times do we argue with patients that they don’t need an antibiotic or x-ray, admission or laboratory test?  A family once skeptically asked me to show them the x-ray I had taken of their child, who swallowed a coin.  Once they saw it, they were satisfied that I hadn’t missed anything.  They weren’t radiologists, but they were experts.  Because any idiot can be a physician, right?

Many things have contributed to this maddening state of affairs.  On some level, it’s good.  Americans should be a people willing to ask questions.  This willingness to stand against authority is what made us, and continues to make us, a great nation.  It’s also what drives other countries crazy…we don’t just settle for platitudes and ‘because I said so,’ on either side of the political spectrum.

But there’s more.  Some of this sense of general expertise also stems from the business and customer service model that perpetuates everything from retail stores to medicine and government.  It teaches people that because they are the customer, they are always right.  They can complain, cajole, refuse to pay and endlessly badger anyone in a business or position of authority.  And because we dread to tell them no, to disagree, to (G-d forbid) not believe them, they get what they want.  Ergo, they become tiny little tyrannical experts in everything from cell-phones to angioplasty.

Furthermore, the Internet has blossomed with information ready for the taking.  Go to any medical information site and you can learn enough to ask endless questions of your physician and leave them miserable, even though what you have is just that…information.  It isn’t the same as experience and it doesn’t compensate for years of practice.  Add to that the explosion of assorted ancillary health fields, and the millions of persons yearning to ‘work as a medical professional’ and we are inundated with patients and their assorted spouses, parents, in-laws and cousins twice removed, all of whom have completed medical assistant’s programs and suddenly know as much or more than we, with our pathetic little DO’s or MD’s.

I have conversations with family members who say ‘well, I know you don’t think anything is wrong, but my sister is in LPN school, and she says I have pneumonia and I need antibiotics!’  Let’s see:  LPN school, one year.  Board certified emergency physician, 11 years, plus 13 years in practice.  Oh, I can see why the LPN is smarter than me!  I don’t have enough education or experience!  Or I don’t wear cute scrubs with bunnies or John Deere tractors on them.  Sometimes patients look at me and say, ‘well, I think I need some more tests done.’  ‘Fine,’ I say, ‘what tests do you want?’  ‘Oh, I don’t know, you’re the doctor!’  Precisely the point.

The plain truth of the matter is this:  we are the experts.  After sacrificing years to be educated, and surrendering much of our health, longevity and sanity to work at all hours and learn the complexities of treating sick and injured humans, we deserve the respect we have earned.  We have surrendered it too easily to insurance industry representatives with business degrees, who can deny care over the phone; to consultants in marketing; to intermediate care providers and assorted health-care administrators. But when it all comes down to brass-tacks, whose name always shows up on the chart?  Who goes to court?  Who is accountable for all of it?  The physician.  The expert.  The final word.

It’s time we took it all back.  We are the ones who know the way a person looks when they’re about to die.  We know how to interpret the x-rays and electrocardiograms.  We know whether to worry about that blood-pressure or not.  We know when to operate, and when to send someone home.  We physicians know, intimately, the way the human heart sounds, and the way the pulse feels in the well and in the afflicted.  We recognize the smile of the sick child and the blank stare of meningitis; the blue cast of blood from a ruptured spleen and the gasp of the pulmonary embolus.

It is our education, coupled with the experience of practice, the experience of touching, smelling and seeing and listening to thousands and thousands of persons in every phase of living and dying, that grants us the right to say no and yes to our patients, to agree or to disagree with their myriad and often unreasonable desires.  It is this that should, if we were wise, put us in the driver’s seat of the future of medicine, rather than letting it be guided by the mass of people, or the tottering inefficiency of government guidelines.

So here is our announcement:  Attention patients and families of patients, regulators, government officials, commentators, angry bloggers and reporters:  I am the physician.  That makes me the expert.  I realize that we live in the age of polls, surveys, empowerment and self-help.  I realize that the opinion of the masses generally matters more than the opinion of the educated.  But as one of the educated, as one of those who considers his opinion more valid than many others, let me say what most physicians are too nice to say.  Medicine is not a democracy.  I appreciate your opinion, and you may accept or refuse anything I offer.  You may even tell me what you think, and what has worked before.  But I get the final vote.  I have earned that vote through years of caring for the sick, and I am accountable for my mistakes, as is evident by my very expensive malpractice insurance.  You may refer me to any one of your resources or family members, but in the end, like it or not, one unassailable fact remains:  I’m the doctor, not you.  Deal with it.

Ed Leap

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26 Comments

Judy

2007-05-28 17:27:16 Reply

That attitude is why it took me 5 days to convince a boatload of physicians that my husband did NOT have ITP. The fact that his internist and cardiologist didn’t think so did not impress them. 20 years of CBCs done on annual physicals did not impress them. They were doctors, damnit and I was only his wife (and a nurse), so I couldn’t possibly know ANYTHING.

Finally I asked the right question. “Did you look at his labs from the referring hospital?”

Turns out nobody had. Oops. Hematologist was called. Funny thing. He didn’t think my husband had ITP either. He even knew how to treat the problem. 5 days with a platelet count of 30K and postponing bypass surgery because the wife couldn’t possibly be right.

I know that physicians are right MOST of the time, but you aren’t perfect.

Edwinlea

2007-05-28 20:56:15 Reply

Judy,

You’re right…we are imperfect. I freely admit that, and what you’re describing falls into hubris. I always listen to suggestions my patients make. But in the end, the responsibility still falls to me.

Someone once asked me to bring an x-ray into their room so that they could confirm that their child’s swallowed coin was, indeed, gone. They weren’t radiologists, but they knew they knew as much as I.

I’m constantly barraged by situations in which people confront me with why I should do what they want, not what’s right. It’s a different problem from yours, in some ways. Similar, but different.

The reason we have issues of antibiotic overuse and resistant strains of bacteria is that doctors a) are often lazy and b) are unwilling to stand for what is right in their practices. Similar problems occur in the epidemic of prescription drug abuse, etc., and even in the way our culture has allowed insurance companies and government agencies to mandate medical therapies.

So, I sympathize. Any doctor who ignores a patient’s wife, especially when she’s a nurse, is looking for embarrassment. But any doctor that caves in because someone simply looked on WebMD or has a cousin’s uncle’s brother who’s a nursing assistant, well that’s just sloppy.

Ed

Amy

2007-05-29 01:43:57 Reply

I understand that the buck stops with you, but as a patient it sometimes really hard to phrase the question … is there anything else it could be? … because sometimes having lived in your body and knowing what “normal” is, doesn’t carry as much weight as it should.

Judy

2007-05-29 04:57:43 Reply

Fortunately no harm was done in the long run. There were other complicating factors which would likely have delayed the surgery in any case – including a very challenging crossmatch – and if it had become truly unsafe, they would have transfused platelets and O negative blood and gone on with the surgery. The drug which caused the problem has since been taken off the market for causing similar responses in other patients.

It was a different situation, because I was asking questions, not telling them how to do their jobs. Frustrating on both sides, because they had a puzzle they could have solved had they listened — and it took me 5 days to realize that no one had paid attention to the labs from the referring hospital.

I usually avoid telling physicians that I am a nurse if at all possible. Most don’t treat me differently when they find out, but a few presume that I know more about my condition than I actually do. I’m a NICU nurse, so while I know the vocabulary, I also know my limits.

The whole antibiotic thing is really crazy. People demand them, then they don’t finish them because they’ve started to feel better. They save the “extra” for the next illness and the cycle goes on. My internist knows I’d just as soon not take them if at all possible, and I trust her judgment as to when they are actually needed.

Will

2007-05-29 15:54:38 Reply

Wonderful column by EdwinLea. Judy, no one is perfect but you are still obviously upset. Edwin made a wonderful statement on how medicine should not be viewed as a business/customer model. Judy, no one is saying doctors should not listen to patients but simply that that patients are not exactly customers and that doctors have to balance many different things in their decision-making process all in the best interests of the patient who may not be in a position to realize or understand such. So, Judy, I’m sorry you had a bad experience and commented on such but what about the millions of patients who had good experiences and correct diagnoses. We often don’t hear enough of the good news….

Kitty

2007-05-29 16:30:41 Reply

I don’t normally ask for antibiotics nor do I pester doctors for tests. I don’t want antibiotics unless I have a bacterial infection and they can help; I don’t want an unnecessary CT or MRI. I don’t want to look at my X-rays. I may refuse a test occasionally if it appears defensive, but I do it without wasting anybody’s time. I do look up information on the web, but I rarely if ever discuss it with the doctor.

But… I wish that when I was 33 I had asked my ObGyn to check my FSH and estradiol. I wish I insisted. I wish that when I complained about 2- and 3- months delays in periods and the doctor ordered a pregnancy test and a thyroid test, I’d have asked to check my FSH/estradiol as well. I wish I asked about it a year later when I had another 3 month delay. And a year later. I wish I insisted on it with another doctor when I finally realized that what prevented me to function normally and caused me to call our maintenance people was not a heating/conditioning system malfunction but hot flushes, mentioned it to my doctor and he ignored it because it was all in my had, and you cannot possibly be in menopausal in your 30s.

Maybe it wouldn’t have made a difference. But maybe at 33, I was still ovulating occasionally and still could’ve found a way to have a child (I was single, so it wasn’t that easy). Maybe instead of looking for a man who wants to have children, I’d be looking for one who already has them. Maybe not. Maybe I would’ve still had osteopenia at 40-something, but maybe not. I’d never know. Maybe a earlier POF diagnosis would’ve simply made me more miserable earlier, but maybe it would’ve spared me years of symptoms I didn’t understand (and to those who don’t know menopausal symptoms are more severe at younger age). I don’t know. But if I had to do it again, I’d insist on having my hormones checked at 33.

D-Day

2007-05-29 17:40:03 Reply

You may be accountable as far as medical liability, the patient is the one who is ultimately responsible because the patient is the one who has to live or die by the medical decisions that are made. Doctors aren’t slaves and shouldn’t have to provide care they don’t believe is necessary, obviously. But I don’t think that you can fairly complain in the same breath about patients who want to verify test results, look at films, talk to other providers, since its the patient who lives with the results (or not). Yes, you have a lot more experience than the aunt who’s a nurse or the cousin who’s a chiropractor. But people don’t doubt the doctor’s medical expertise, they doubt whether this specialist who they’ve met one time for 10 minutes has the expertise and experience in the patient and their history, background, and condition.

Do you think a reasonable patient would ignore a friend who is a nurse who knows them, spends time with them over a period of years, and can tell there is something wrong? Especially versus a doctor who may have the experience to technically diagnose a problem, but who seems like he just doesn’t care to (especially for complicated or chronic conditions)? No one expects doctors to never make mistakes. Why should a patient let all treatment decisions go unquestioned so that they end up being the one on whom the mistake was made?

I don’t doubt that patients say stupid things and make stupid decisions, but that’s their health and their prerogative. And if you’re going to complain about it, I can’t believe that you would also complain about the ones that make an extra effort to verify the care you’re providing.

Wozzeck

2007-05-29 18:14:05 Reply

“The plain truth of the matter is this: we are the experts.”

What a bunch of self-regarding BS. And, how much of what you do is evidence-based? Probably not more than 20%. The point is most of what doctors do is just winging it–or doing what they’ve been trained to do. In most cases, they cannot say with scientific confidence that what they do does, in fact, any good whatsoever.

Patients must demand that whenever a physician recommends a course of treatment, he provides adequate citation to the most recent epidemiological data. If s/he cannot, the doctor must make explicit his reasoning. If the patient does not find the reasoning acceptable, he should simply refuse.

john hawkins

2007-05-29 19:02:05 Reply

Yes you are the doc. I see you rarely and it’s usually the PA not you.
I’m not suer so don’t run all those extra tests. I can’t afford (don’t want to pay for) them. Don’t prescribe the latest drugs you heard about if there is a tried & true cheap one that works.

Give a reasoned explanation and I’ll follow your course of treatment like a lamb.

I hired you for your knowledge and skill but I am still the one who decides what I do with my body.

Meghan

2007-05-29 22:05:08 Reply

Dr. Leap

Been reading your blog for a while now, and I love it! I’ve been a nurse for 3 years, ER for 1 year. Your most recent post reminded me of something that I wanted to vent on. I’ve always been aware that insurance dictates treatment far more often than it should- but I had a case last week that really cheesed me off. I guess this case really highlighted to me what the docs have been fighting with for years. Pt presented with typical symptoms of a kidney stone, and stated that this pain was similar to previous episodes of kidneys stones. Typical work up of UA and non-contrast CT was ordered. Pt ended up refusing CT b/c after the last stone, the insurance company refused to cover CT and told pt to ask for an x-ray next time. Well, I ran this by our doctor who told me about the x-ray we used to do for kidney stones. He said that we don’t do them anymore, and he does not consider it best practice. It seems to me that this pt has cause for prosecuting the insurance company for practicing medicine without a license. It’s so ridiculous! A doctor should have the right to perform a work-up which is consistent with their knowledge of and with national standards of best practice. And a patient should have the right to that work-up without non-medical folks interfering. It just really made me want to tear my hair out! I can’t imagine how you docs deal with that frustration day to day. As if the practice of medicine isn’t difficult or complicated enough, you have to deal with non-medical bureaucratic crap too! Sorry to rant in your comments, but it really is quite ridiculous that a doctor, with years of training and experience, should have to defer to an insurance company when trying to make a clinical judgement. Thanks for all that you do!

Meghan

Max

2007-05-31 23:03:17 Reply

Wow . I mean so you spent many years in med school and residency rote memorizing lots of stuff and getting experience . That’s good.

But how much you actually spent learning that particular issue your patient has? – Patient has more drive and desire to go extra mile and get information to the issue which is critical to him

I mean not to diminish anything but medicine is not rocket science. Smart person can make good decisions based on right information even if he himself is not expert in the area.

Instead docs consider themselves gods. I mean give me good reasons for you not doing what , except “I am a doctor ,trust me” .- I am sorry no – majority of people are very mediocre at their chosen field . I encounter that everyday in engineering , and in no way I would trust somebody solely based on their credentials .

If you cant present good arguments for your cases chances are you yourself do not really know the issue well. – And pleas don’t BS about a “huge pool of invaluable experience” – majority of diagnosis, prescription protocols are step by step blind guides. And sadly that what many doctors do – that is where my personal mistrust comes from.

Heck you guys dont even bother to research the issue beyond lab test range. How can you expect smart patient to trust you?

mCA

2007-06-10 05:13:39 Reply

I use to agree with everything you have just said. Until I was 38 years old I always had great respect for your profession. I would even tell people…”well, he is the doctor so obviously he knows what he is doing”.

But, then my Dad began having chest pains and I began taking him to the ER. he had NEVER in his life been to an ER before. They treated him with an anti-acid and sent him home. Second trip, a little more anti-acid.. third trip I blew a gasket. He was admitted over night for observation with the message, to me, to come back and get him in the morning because they knew this is just GERD. Unfortunately, my dad suffered a fatal heart attack later that night.

this has been more than a decade ago and hopefully when 70 yo men show up in your ER now complaining of chest and arm pain you do a bit more than hand them a GI cocktail. Oh they did an EKG and blood work which was all normal but I now know there were other things they should have also done. So for me it is too late…Sorry, I just dont trust you. Not with my loved ones, so I am going to ask every damn question imaginable. Deal with it.

Edwinlea

2007-06-10 20:53:12 Reply

mCA,

I’m very sorry about your dad. Truly sorry. And I’ll tell you, I have to be talked out of admitting every 70 year old with chest pain. I think we’re better than ever at heart disease, and certainly ever more cautious.

But again, I’m not saying doctor’s shouldn’t listen carefully to the concerns of patients and families. I’m not saying we should discount their concerns. I’m not saying we’re gods or infallible. I’m not saying that I’m a genius and patients are idiots. I’m not saying any of that.

I’m saying that we live in a time when there is a presumption that expertise no longer exists, as long as the Internet is available. And that all medical knowledge is equivalent to that of a physician as long as someone else has a minimal amount of medical training. And it isn’t true. If it were true, we wouldn’t carry malpractice insurance, because we wouldn’t be liable, since everyone would have the same fund of knowledge and experience we have.

As a profession, it’s dangerous for physicians to let non-medical groups like advocacy or government organizations, insurers or anyone else tell them what is the right thing scientifically. Is it all science? Of course not. Not all that we do is ‘evidence based’. Some of it is ‘experience based’. And sometimes, that’s good.

Should I speak to medical family members? Should I respect their concerns? Absolutely. Should I change my therapy or treatment because they disagree? Usually not. I’ve done it, but not often.

So please continue to ask ‘every damn question imaginable’ as you so eloquently said, and I’ll deal with it, and try to give you the answers to every one of them. What you ask is important, and your opinion is valuable.

I just think physicians need to remember that our collective education and experience has meaning, and that we still have valuable expertise to contribute to our patients’ well-being.

Edwin

Jen

2007-06-20 03:02:34 Reply

Dr. Leap;

It is with great frustration that I read your article in Emergency Medicine News. As a parent, of a six year old boy who was diagnosed with high risk stage IV neuroblastoma just prior to celebrating his second birthday and then progressing over upfront and secondary treatment modalities. Followed promptly by numerous pediatric oncologists across this great country of ours advise us to take him home and allow him to die with dignity.

My boy is now six years old and off all anti-cancer treatments for over two years and free from the burden of neuroblastoma growing in his little body. Aside from hearing aides and a torso that looks similar to worn out cutting board, one would never know of his journey. Our son has had life joy and happiness precisely because we REFUSED to buy into the “Doctor knows best” mindset.

We, as parents, learned everything possible about our son’s cancer, devised a conventional treatment regimine and then found doctors who would adminster the anti-cancer agents we wanted adminstered. We bravely plunged into uncharted territory with the FDA, NCI and pharma successfully, without one day of med school or practice.

Fortunately one doesn’t need med school, fellowships and fancy addedums to their names to fight for the life of their child. Fortunately we live in a country where the freedom to choose compassion reigns for some.

Michelle

2007-06-20 19:26:40 Reply

Dr Leap,

There are two issues you have identified in your article to which I am responding. In the first, I agree that medicine is not a democracy. It is, however, another consumer market in this day and age (not saying I completley agree with it.) However, we are not, nor should we become Burger Kings where everything is the patient’s or family’s way. I, like many colleagues, have experienced first hand consumer complaints when they do not get what they want, when they want it. Yes, they complain, badger, cajole, and refuse to pay to get what they want. I am ready and willing to stand behind my evidenced based practice. The issue is management supporting the consumer instead of the provider who has listened to, seen and examined the patient or the provider choosing to give them what they want to stop the unwanted behavior.

Information, whether from internet, TV ads recommending a medication for every ailment, family member, or “assorted ancillary health fields,” is out there. This is both a positive movement and a concern. I think it helps some to realize the potential seriousness of their health issues, driving them to seek care when they would not otherwise. It is good that people ask questions. Providers only have what the person chooses to tell them and objective findings to guide a decision. The sum of all the parts is not equal to the whole. There are those patients on the other end of the spectrum, the group that no matter what you do, it isn’t enough. I choose to try to teach. Ultimately, the patient chooses whether to follow our instructions or not.

The second issue subtly addresses other non-physician providers lumped among the business and insurance non-medical groups that influence healthcare decision making. You stated, “We (physicians) have surrendered it too easily to insurance representatives with business degrees who can deny care over the phone, to consultants in marketing, to intermediate care providers and assorted health care administrators.” What is your position on physician assistants and nurse practitioners? I ask because when you ask, “Who is accountable for all of it?” In the state of Tennessee each provider is accountable for their own practice, with their name on the chart. The physician is not required to read and sign every chart. In other words, I am accountable for my mistakes.

Before you decide to take “it all back” remember there are others who have spent years to be educated and have surrendered much of their health, longevity, and sanity to work crazy hours and learn as much about the complexities of caring and treating for the sick and injured. We deserve the respect we have earned. I know how to interpret the x-rays and electrocardiograms. I know when to worry about blood pressures. I know when to refer someone to a physician (i.e. surgery) or when I can monitor them. Nurses are the ones at the bedside throughout the day and night. They know intimately the way the heart sounds, the changes in the way the pulse feels, the smile of sick child, the variations of respirations, and other indicators of persons wellbeing. Our education, coupled with the experience of practice, the experience of touching, smelling, seeing, and listening to those same thousands of people through every phase of living and dying is equally valuable.

Zelda

2007-09-29 01:35:02 Reply

Just a few words to the doubters in the comments (and yes I am late to this party, just going back through Dr. Leap’s archives, and I had to respond to this!):

1. As a second-year medical student, I am (for ONCE) uniquely qualified to tell you that the new crop of physicians is indeed being trained according to what is scientifically evident. We dread these weekly assignments in EBM (evidence-based medicine) because they are arduous and it’s a pain in the neck to go digging through PubMed for every ailment we encounter in our still-scary-and-foreign-to-us clinical scenarios.

However, our EBM findings are always measured up alongside “conventional” treatments…and I can tell you that in most cases, the conventions are indeed correlating with the science. This strikes me as obvious…how else would they be conventions? This isn’t the 1800s when young men followed their Pa the Town Doctor around to learn his trade for a few months. We have the technology and the science to really lay bare the pathophysiology of many disease courses as we currently know it. This is great news for everyone.

2. I am kind of dumbfounded at the fellow whose elderly father was sent home from the ED with an antacid after multiple episodes of chest pain. In the ED of the academic hospital where I am studying and training, everyone with any indication for MI gets an aspirin, a nitro tablet, and an EKG (unless it’s a 70 yo male who’s just taken Viagra :) ). The aspirin is cheap and the EKG is fast. I don’t understand what goes on at EDs when such a protocol is not commonplace. I am new and green and not even graduated but to me this protocol for angina-like chest pain is a no-brainer.

3. Sorry, Web-MDers, but if it was that easy and simple to become a practicing physician, everyone would be one. I can’t agree to those who think that doctors are not smart and that it’s not rocket science. You’re right, but sometimes it’s brain surgery :) While you are absolutely right that we spend a lot of our years in training doing “rote memorization”, that is merely the foundation. Like any other profession, doctors need a baseline level of knowledge which they must have committed to memory in order to function as doctors. unlike other professions, that base of knowledge is constantly growing, changing and evolving. Medical education is never complete. And rote memorization is not enough. Critical thinking is absolutely critical…and I guess unless you’re had any involvement in medicine as a profession, you are unable to appreciate how it is. Patients are not presented as perfect clinical vignettes. Symptoms are not clustered and lab values are not always perfectly aligned with the expected numbers for a supposed condition. Medicine is mentally, emotionally, and physically challenging. It’s sad that people think we memorize a bunch of books and then dive into our swimming pools of cash a la Scrooge McDuck.

Tom Ronnoc

2008-02-17 14:28:31 Reply

I always show a lot of deference to physicians. When I’ve said said something like “I’m kind of suspecting an ulcer”; they are responsive and explain their thinking on the matter.If you tell a physician “I have fibromylagia and I expect you to run x tests and I’m going on Y regimen, then your regarded as potentially litigious and very likely a pain to treat.

Picture someone in your work place trying to establish themselves as an authority on your job.Is there anyway they are going to come out as being OK with you.

Eugene

2008-06-25 20:30:43 Reply

Doc,
I mostly agree with what you had to say. If I did EM I would probably wind up in jail for going “postal” on someone due to the reasons you described.
However, having said that, and totally agreeing with you (although not unconditionally)
I have to make the following two comments : My Grandmother died because the chief of Gen Surg (i dont mean the chief resident) didnt do a proper suture somewhere along the arterial supply of the gallbladder.

also, because the needle looks a Hell of a lot bigger from the other side. See, I am a resident (so not so much experience, but I do have my little physician and surgeon license going), but I know what it is like to both be the ER doc and be the ER patient. I also happen to have cervical dystonia, which I am willing to bet neither you or most of our colleagues know what it is, are able to discern it, are able to do more than put two words together that they heard and come up with “something is wrong with your neck. I say all this not to offend yourself or my other colleagues. I say it because as a patient I know better than you how much klonopin and/or artane to take on any given day. I know when I took too much for my body that day, as well as the reverse. So sometimes it behooves to listen. Of course I do NOT allow myself to be pushed around by patients in terms of medical care. I give advice , I listen to the patient, and I tell them they have a choice and give them as much info on the consequences as I can. And yes, I had to apologize to many patients and families because I had to answer an urgent page/trauma etc but then tried at least to oome back and talk to them.
As for my claim about how many people would recognize what I have, or that I have anything at all, its pure stats. Working in a level 1 trauma center as well as private offices, I was recognized as having some medical issue (even when they didnt know what it was at all) by only 4 physicians. That includes my neurologist.
sorry for the long windedness.
and I fully support and agree with your anger towards patients who game the system or throw fits of “im my own boss). In the end , there is the AMA form and the “refused medical care and advice when the consequences, being ______ _______ ______ and DEATH were explained.

The buck does not stop with you Dr. Leap, It does not stop with me. Dr .Somerandomresident,
It stops with the patient. Period. We all have a right to terminal stupidity.
regards, and respectfully

Dr. Somerandomresident

Physician X

2008-12-13 15:08:05 Reply

I agree with much of what has been said here. Practicing medicine is frustrating and much of the points made are true. The fact is though that “we are the doctor” and the buck does stop with us. There is a lack of respect today. As a physician you seem to be constantly resented because you earn a good living for working 80-100 hour work weeks and go days without sleep. I have come to the conclusion that many resent the fact that they did not have the desire or drive to go to college then medical school then residency. I hear many that say they could not go to medical school because they could not afford it. That really is a bunch of crap. I came from a poor family that did not pay for any of my college or medical school. I have $3000.00 in loan payments every month, I have to prove to the loan programs every year I am still a primary care physician for the low interest loans to continue, and I had to commit to practice in a rural medical shortage area for 4 years to have the state help a little with the tuition of medical school. The truth is many people just don’t want to make the commitment. I have unfortuntely ran into some PA’s and nurse practicioners that feel they are doctors. This cheapens all of the MD’s investment in their education, all the time, and putting off many things in life till the training was done like family and children. My wife (a DDS from a poor family) and I did not have our first child until my last year of residency in my thirties. Some PA’s and nurse practicioner unfortunately feel that they took the smart road. Go to school for 1-2 years and you are a “doctor”. Why commit the 12 years to your training? Well you learn alot and experience a lot in those “extra years”. Many PA’s and nurse practicioners do know their limits and to me they are worth their weight in gold though. Many nurses that have been in the profession for years also are invaluable and have led my diagnosis in tough cases in the right direction many times. What I am saying is that we need to continue to respect each other and our collective training but also know our limits. I call a specialist when I am stumped and the orthopedist calls me when he sees an EKG or when the patient crashes in a surgery. Ultimately though the doctor/MD/DO is the “medical management” or “the boss” like any other profession. They are not god’s and I wish people would quit thinking of physicians as god’s. This concept makes people think we are not human and are infallable and untouchable. It drives lawsuits because people feel that we should never screw up. We screw up. Can you say you never screwed up on your job and everything you do is perfect? I bet not. We have bad days and bad moods. We went to school for many years to learn medicine. That is what we do. So when you come to see us respect our opinion on what is wrong and how to treat it. When the heating and cooling guy says that my furnace is not working because of a specific problem I do not go on the internet and reasearch it then tell him he does not know what he is doing or make comments like do you really know what is wrong or are you just making it up because the guy at the grocery store said it was this or that. I have a few patients that do question and make me explain why something is happening to them. I love this as it shows they are taking an interest in their health care. We should work as a team but as the physician let me drive. Respect the physicians ability and knowledge. There are poor physicians out there yes. I have ran into a few in my training unfortunately. In this country we have choices though. If you do not trust a physician or what he/she says go somewhere else. Get another opinion. Don’t make the apppointment or come into the ER in the first place. You have a choice. Unfortunately sometimes insurance makes your choice for you. Patients need to complain to their insurance company when they cannot get a certain test or a medication not the physician if the physician recommended it. If I do not trust or like a certain mechanic that I take my car to I can go to another. In addition modern medicine does not know everything or how to treat every illness. If that was the case their would be no need for continued research, new medication, new proceedures, or new anything. We did not make the body so we have to try to solve the mystery of how it works the best we can with our limited human brains. Another point I would like to make is medicine is not fast food or Wal-Mart. Thise mentality seems to drive many today. Do you really want your health care as fast as you can. Making the physician quickly jump to a quick diagnosis to keep the flow going, or have time to fully think about your problem and possible treatments? In medicine the customer is not always right. Yes they want to be treated efficiently, effectively, and respectifully but what you read on the internet or hear from your freinds may not be what is really your medical problem. Leave it to the professionals and if you don’t agree get a second, third, fourth opinion. Challenge your doctor but not in an angry deeminging or demanding way. Finally, if you see a physician you know on the street that looks tired and haggard from being up all night in the ER and had to work all day seeing many more patients that he/she should because he/she did not have time to really adequately ponder and think about a patients problem because many patients wanted to be seen “right away” and insurance payments were so low that quantity proceeds quality to be able to pay the nurses, secretaries, coders, administrators, loan companies, and keep the heat and lights on, just say “thanks doc”. It means a lot.

Jose

2009-04-01 06:35:50 Reply

You sound like a good doctor.
But, in the interest of putting out a good product or service, it is a well established fact that we need the input of all affected parties. There is always a captain or boss, but for best results, the captain allows, no – demands input from everyone. This applies to the flight deck of an airliner or a business mgt meeting.
The more stubborn we become the bigger the “slap-down.” Just ask “the decider.”

Edwinlea

2009-04-01 11:35:49 Reply

Jose,

Thanks for writing! You’re correct. However, even as I have a right to certain expectations of the airline industry (like not dying in fireball on approach), I don’t go to the flight-deck and try to tell the pilot how to interpret his gauges, or lecture him on avionics and the physics of flight.

Edwin

Frever t.

2009-04-08 23:50:08 Reply

Hey, is there a section just for latest news

Annie Riffle

2012-01-13 01:59:46 Reply

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Paul Reddy

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biżuterii srebrnej

2012-06-22 09:14:08 Reply

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