I saw a patient recently who was in her 80s.  She was a very active and healthy woman who enjoys the outdoors.

I asked her, ‘What medicine do you take?’

‘I don’t take any.’

‘Well, who’s your doctor?’

‘I don’t have one.’

Clearly it was working for her.

Many patients tell me, ‘I just don’t like doctors.’ Although I consider myself an ardent physician advocate, although I have spent decades writing in support of my colleagues, I’m inclined to agree.  While I love some physicians, all too many are just (what’s the clinical word?)  jerks.  I know, there are far more colorful and probably appropriate words but I’m trying to keep a Christian attitude here.

What is it that does this?  Sometimes I think it’s the competitive nature of the medical education process, in which we have to shine brighter than our fellow students in order to get into 1) college 2) medical school 3) residency and if we choose 4) fellowship.

Competition is beaten into us; and in a very real way, it’s probably genetic.  The competitive naturally compete well.  (Obviously.)

The problem is, it translates over into practice.  And then after the long, slow march through medical education, we find ourselves in practice and being endlessly watched, criticized, harassed and belittled by other physicians. Sometimes in our own specialties, often in others.  This may be a sensitive point, as those of us in emergency medicine are often at the bottom of the pecking order.  But I suspect others feel the same.

Our colleagues attack because we gave them extra work. Or because they were exhausted.  Sometimes because they themselves were recently berated. (It flows downhill…)

Physicians assail one another because one found something the other missed, and it makes them feel better to point out the error instead of educating anyone about it.  It elevates their professional capital to call someone out, to yell on the phone, to remind others of their mistakes.  There must be a deep sense of self-adulation to go home and say, into the mirror, ‘I told that doc a thing or two!’  Ah the satisfaction! In more extreme cases, physicians get reported to state medical boards for spurious reasons.

Sometimes, physicians financially abuse their colleagues for personal gain, or sell them out for new contracts. Hiring them, and firing them before partnership begins.  These days even replacing them with less qualified NPs and PAs.

Alas, the medical profession faces a host of adversaries.  We are in the cross-hairs of government agencies, hospital credentialing departments, regulatory bodies, insurers, medical boards, professional boards, satisfaction surveys, online reportage and all the rest.  And make no mistake, the growth in influence of nurse practitioners and physician assistants threatens to usurp our place in the medical community and in public consciousness.

It makes so much more sense for us to try and work together than to endlessly pull apart.

If only because the job is hard enough, and the burnout great enough, that roughly 300 physicians in America kill themselves each year.

Will that be enough to make us play nice?

Time will tell.  But I’m not holding my breath.




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