Wednesday, June 3, 2015

The Steady Domination/Destruction of Medicine

Doctors (and nurses for that matter) can be as tough as the nail that holds up the shingle hanging over the office door.  
Up all night with no sleep… “No problem”  
No help from partners or other doctors..“I’ll just have to work harder”  
No weekends off for [insert a number] months… “It builds character”
Haven’t seen my spouse or kids in a couple of days… “I’ll try to see them this weekend”

Let’s face it.  By most accounts, the healthcare lifestyle is not ideal for a social life nor for a family life.  Spouses and significant others tend to run in packs due to lack of maintenance and kids don’t always recognize the doctor parent for lack of attentiveness.  Although not all practice situations are the same, the average physician is overworked by the American standard.  Days and on-call nights are long, weeks and months can grind on in perpetuity, and it takes a toll on the body/mind/soul.  Yet medical and nursing schools are still seeing adequate applications and residency programs are still cranking out hard-working men and women after their apprenticeships.  

The issue is that not only are the newbies kept in the dark about this trade until well past the point of no return, it is also ingrained into them to like this lifestyle and are praised in training and after for a hardcore work ethic.  Very little thought is given to burnout and ways to avoid it.  Doctors and nurses are expected to push through tough times and weather storms that others are not.  Then there is the subject matter to which we are exposed- the 3 Ds…death, dying, and disease.  Not all physicians and healthcare workers deal with death and dying but all have to cope with the diseases that populate their patients’ bodies.  It can be rewarding to cure, prevent, or at least patch up a potentially deadly event, but it can consume a person in the process.  Worry, doubt, and fear of failure can be overbearing.  

And this is just the start of the dilemma.  Think about dealing with these issues on a weekday basis from 9 to 5, then consider that most doctors only work bankers’ hours on their days off.  Call nights and weekends- the time when a single physician will cover a group of other doctors who are “off” call- are often considered a pestilence.  They can seemingly speed a physician’s demise and shorten his/her career.  The frequency of a call cycle (the rotation of doctors taking said call) can often determine how brutal the punishment is.  Call rotations can be as often as every other night and as rare as every two weeks or a month based on the population of available doctors.  Busy call nights and weekends can make for a weary next day and the cumulative effect of these calls can feel like the waves of an ocean, repetitively pummeling the body one after another.  

Please do not misunderstand this as a whining session.  Most doctors know that the lifestyle and call issues are inevitable and accept them for what they are.  However, if you thought that this was the end of the story, there is still more domination and destruction to explore.  Most patients think of doctors as primarily office based or primarily hospital based.  The truth is that a good portion of doctors split time between an office or offices and a hospital or hospitals.  Add to this the reality that some doctors have to round in nursing homes or long-term care units, and it can get overwhelming.  Early hours and late evenings can coagulate into a tornado of fatigue.  

For those of you who think this post is stretching the truth, I would suggest that you find a small town family physician and ask about his/her daily schedule the next time you run into them.  Most small town docs are expected to be available at the clinic from early until late, at the ER for any emergency, and at their own backdoor if you are lucky enough to know where they live.  The never ending rotation of hospital rounds, full day clinics, nursing home visits, frequent call nights (usually every two to four nights/weekends), occasional ER shifts (because the local ER cannot find anyone else to cover), and of course the expectation by the community that you will show up to support the football team or the local charity can be NAUSEATING and EXHAUSTING.   

Why stop there though because governmental regulation and scrutiny seem to be picking up lately.  Electronic medical records and “meaningful use” tasks dictated by non-physician federal employees have driven physician work satisfaction to an all-time low.  Obamacare and insurance preauthorizations (yes, doctors are now expected to speak to insurance company employees to explain to them why a test or medication is necessary for their patient) as well as insurance denials can cause anger amongst physicians.  All of the above force the doctor to spend less time with the patient and more time on the phone or in front of a computer.  

Add to this, doctors have taken cuts in reimbursement from Medicare (and in return, private insurers) and likely face more to come.  No doctor should ever argue that he/she is not adequately compensated, however the question is:  “at what point will the great parts of being a doctor be superseded by the downside(s)?”  Every person has different tolerance levels and abilities to adapt, doctors are no different.  I doubt there will be a huge shift away from medicine by capable young people as the draw to help people is as noble a calling as there is in the world.  

I hate to say it though the profession continues to undergo a steady domination and its minions are fighting a slow destruction.  

By David Jones MD, owner/blogger at (a healthcare ratings website with peer ratings of physicians) and a practicing adult cardiologist.  

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