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Public Opinion of Physicians vs. Nurses

Discussion in 'Allopathic' started by pathologyDO, 12.17.13.

  1. pathologyDO

    pathologyDO

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    In order to spark some discussion over the public perception of physicians vs. nurses, I wanted to share something I recently read online. I will not divulge the individuals name, but I would like to share the Facebook post. To keep things in context, here is the link to the original post by 41 action news in KC MO - http://www.kshb.com/dpp/news/local_news/nurses-protest-proposed-contract-changes

    The article is about nurses pay going down due to recent changes in healthcare legislature, I assume from the Affordable Care Act. The local nurses are part of a union and are currently on strike. In response to the facebook article and a few other comments, here is what one lady had to say:

    "Unions started because of deplorable working conditions. Some of those conditions still exist. As with any corrupted organizations, the beginning was a meant to help. I've seen more nurses than doctors in ALL my medical visits. The doctor didn't give me a warm blanket, the nurse did. The doctor didn't clean up my vomit, the nurse did. All you people complaining about other people complaining, STFU. You'll want someone to care for you one day. You want a callous DR. with a God complex or someone who's hands on?"


    :eyebrow:

    Now, the kicker is she had 12 likes for that comment, while the other 20 odd comments were not "liked" at all.

    Is this really the public perception? Do people really believe that physicians are just behind the scenes and that the nurses really run the show? I've heard similar things before and the more times I hear it, the more it makes me cringe.
    Last edited: 12.17.13
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  2. Nasrudin

    Nasrudin Member

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    Yes. This is the case. One reason is obvious: a nurse has a handful of patients and does all the things mentioned. A physician has many more patients to cover and has a very defined clinical decision making role that may not require constant interaction with the patient. So face time is a key point of perception for the patient.

    Other, more complex reasons include a history of professional subjugation and misogyny. The context of American class war fare--we are further up the SES ladder than nurses and thus further from the patient. Clinical medicine emanates from the decision making of the attending--->residents---->nurses in a way that can be construed as god like. And in fact because of the clinical hierarchy many physicians do mis-extrapolate that clinical importance to personal importance in a very egotistical way.

    So some of the god-like complaints are accurate.

    But what the public doesn't know is physicians work longer, harder, faster, and more furiously than nurses for the benefit of patients. That may not be a popular opinion with nurses. But it's true, generally. Particularly with residents. Who for the most part do not benefit from public sympathy and strong @ss-kicking unions.

    Our work is invisible to them. And our interactions are rushed and terse and unsatisfying due to the above.

    It's a very interesting topic that plays rights into our losing propaganda efforts in the NP independence vs physician debate.

    Addendum: the public is also generally very stupid. And easily susceptible to emotional manipulation and simplistic child like thinking. Something nurses have exploited brilliantly in their political fights for high wages and better job conditions and now clinical independence.
    Last edited: 12.17.13
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  3. sonofva

    sonofva

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    Just look up the gallup poles on profession most trusted by the general public. nurses always outrank docs.
  4. notbobtrustme

    notbobtrustme Crux Terminatus

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    To the patient, face time is work time. They don't really understand what happens behind the scenes, but they see the nurse working in front of them and listening to their needs (eg more blankets, water, some food, etc etc). The doctor comes in once a day for maybe 10 minutes to check up on them.

    If it's outpatient, it's even worse. Nurses greet you when you enter, escort you to the exam room, talk about what's going on, do all the physical exam stuff (HR/BP/temp) and then the doctor gives you 5-10 minutes face time. Then the doctor diagnoses you, hands you a script, and tells you to be on your way. So while the patient saw the nurse for 15-20 minutes, they only saw the doctor for like 5 minutes.
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  5. prettyNURSEtoMD

    prettyNURSEtoMD

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    I am a Registered Nurse at a Level One ER so I would like to give my opinion from the opposite side. As an aspiring physician myself I agree that doctors do have more patients than nurses as we are usually a 4:1 ratio and our docs are 15:1, so no doubt they do work hard. As far and who works "faster or harder" I can't see how that be accurately measured. I've seen several doctors read a chief complaint order labs and meds and sit and read a book at the desk. Now this could be through repetition and experience but that hardly seems as "working harder", when we pull the meds, start the line, get labs, clean vomit, bed pan after bed pan...on days where you're like if that call light goes off ONE MORE TIME etc list goes on based on a certain patient and condition. But hey that's the job we signed up for right? The population and demographics of our patients I think plays a role in perception of our physicians as well. I have had to explain multiple times that "Dr SuchandSuch is with another patient/ critical patient at this time and he/she will be with you as soon as possible but is there anything that I can do for you at this time?" (Although he/she is with a difficult intubation and said current patient is eating Cheetos requesting more phenergan and dilaudid and doesn't think she needs to "wait") That very statement alone shows that we (nurses) care more because as someone stated earlier it's all about face value but we all know that isn't true!! The majority of patients are entitled and like to feel important and RNs just happen to "spend more time" with them. We have to hourly round on these patients, and most doctors only go see the patients upon disposition and even then I'm here going over route and time of medicine, and not to drink and drive and signs to look out for to alert someone to come back into the ER, and after all that is about 15-20 mins. So at the end of the day it's the nature of the beast. I don't think physicians don't care nor do I think they don't work hard but most do not follow up with their patients as frequently as they like or as they could. Want a good doctor, ask to see your nurse... Haha CALM down it was a joke. I saw that on an episode of Trauma Life in the ER. But I don't think that the public is "stupid" as I find that a very inappropriate thing to say but they are definitely unaware of the "behind the scenes". We have one provider who makes it known that it takes about 3 hours for all your results to come back and before I can review them and have a diagnosis. And once I get those results and diagnosis I will come back and talk to you. Those patients I don't hear complaints about how the "doctor doesn't spend time with me or he's never around" because they understand oh okay it will be a while he's not ignoring me. I think as clinicians there should be more accountability and less pointing fingers. That's just my opinion.
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  6. WGB

    WGB Sprodj

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    ruh roh.
  7. southernIM

    southernIM

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    Physicians have an image problem.

    Some of it is our own fault. For too many years the stereotype of the rich doc taking Fridays off to go to the Country Club was all too accurate.

    The public has no sense of how much financial investment is required of student-doctors these days, nor of the opportunity cost of training until you are 35 years old, nor of the diminishing reimbursements.

    And we don't do a very good job engendering sympathy. Even when we try to talk about the above, we generally come across as arrogant whiners who want our golden spoon back.
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  8. Mace1370

    Mace1370

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    Please don't feed the troll.

    I agree that physicians have an image problem. Some of it is our fault and it isn't an easy thing to fix. Educating the public on what goes on behind the scenes could help.
  9. pathologyDO

    pathologyDO

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    So this is definitely an issue that we all understand to exist, given the responses. It really makes me wonder how much this negative public perception accounts towards physician burnout rates? It would chap my ass to hear this stuff for 20-30 yrs and still be treating people that don't even like me or think I'm just a lazy overpaid bloke
  10. circulus vitios

    circulus vitios

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    The public is incorrigibly retarded. They cannot understand the distinction between doctors and nurses and what their purposes are. Stop caring about what they think and redirect your anger and disappointment toward someplace that will make a difference: politics. Not 'strongly worded letters' to representatives, but political donations (bribes.)
  11. pathologyDO

    pathologyDO

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    As per my post just before yours, I wonder how much this negative public perception fuels the ever growing physician burnout rates? I can see it being a big factor
  12. circulus vitios

    circulus vitios

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    Burnout is a symptom of employment, regardless of industry, pay, prestige, personal satisfaction, etc.
  13. pathologyDO

    pathologyDO

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    Well aren't you the conversation killer. Seriously, it has to play a role and that makes it something worth caring about
  14. EMDO2018

    EMDO2018 Account on Hold

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    I think people REMEMBER emotional interactions they have had with others. A female patient will think a nurse who took the time out to give her warm blankets and comb her hair is a nicer person than the doctor who diagnosed and treated whatever illness she had. Humans are emotional creatures.
  15. Amazingmuzmo

    Amazingmuzmo

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    People are stupid.

    Also, the fact that nurses even go on strikes is pretty exemplary of how much some of them really care about patients. How can nurses justify that with themselves ethically? When is the last time you heard of physicians going on strike in a hospital?
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  16. MeatTornado

    MeatTornado

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    As someone said earlier it's all about the face time with the patient. It is true though that nurses are on the front lines and deal with lots of sh*t (figuratively and literally) that you couldn't pay me enough to have to deal with. On the other hand a patient may think I'm completely ignoring them because I only saw them in the morning then in the late afternoon and doesn't realize that in the interim I was obtaining their records, going down to radiology to look at their scans, discussing their case for 20 minutes with the attending, reading up on their condition, calling a couple of consultants for them, etc. A lot of a doctor's work does happen behind the scenes and is completely unappreciated by some patients.
  17. circulus vitios

    circulus vitios

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    All the time in Europe. Maybe they're on to something because this Mother Theresa complex that's expected of contemporary physicians is getting us absolutely nowhere.
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  18. Amazingmuzmo

    Amazingmuzmo

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    Never seen it in the US. They'd be crucified if they did, yet nurses get away with it all the time.
  19. notbobtrustme

    notbobtrustme Crux Terminatus

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    Doctors aren't employees, so they can't strike. There are also fewer worker protections in the US.
  20. circulus vitios

    circulus vitios

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  21. circulus vitios

    circulus vitios

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    Aren't many physicians employed by a hospital? Practice supervisors and groups of independent practitioners are legally prohibited from forming a union, but hospital employees can absolutely unionize and strike, as can residents. http://blog.medicaljustice.com/can-doctors-form-a-union/
  22. Slack3r

    Slack3r Sicker than your average

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    Prepare for a severely chapped ass then.
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  23. StephanieZ

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    I work with alot of nurses and I'll be the first to applaud them for all they do, but the attitude of "The doctor didn't bring me a blanket when I was cold, the nurse did." is mind-boggling. It's like saying the waiter is more valuable than the cook because the cook wasn't the one to refill your iced tea.

    Don't worry, though, nurses are just as underappreciated most of the time. I couldn't put up with what they put up with for the money they make.
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  24. AlexMack12

    AlexMack12 I have no idea what I'm doing.

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    I was premed in college, and it was exactly this misguided perception (on my part) that caused me to attend nursing school after getting my bachelor's with the intention of eventually becoming an NP. I wanted to be able to spend more time with patients and all that jazz. Long story short, I found nursing just wasn't for me and will be attending an MD school next year.

    However, being on the "other side," I learned a few things. Firstly, many nurses have to grapple with high patient loads considering the type of care they're supposed to be providing. On busy medical-surgical floors, nurses may have 8 or so patients each, leaving them little opportunity to spend significant amounts of meaningful time with each patient. On psychiatric units this can increase to 10-11 patients per nurse. I've heard a number of nurses complain about not actually being able to spend more time with patients than literally running from room to room giving medications and checking IV lines.

    Secondly, public perception be damned- the nursing profession has one of the highest, if not THE highest, rate of intraprofessional conflict/bullying. A simple google search of "horizontal violence" will return the suggestion of "horizontal violence in nursing." I was told on numerous occasions that I needed to "be a bitch" if I was going to "make it" in the nursing profession (thankfully, I'm not planning on doing so).

    I've met some tremendous nurses who really care about their patients- and many doctors who convey the same concern and compassion. I've also met too many nurses and doctors who couldn't be bothered. My advice? Be the best practitioner you can be in whichever role you fulfill- most patients don't care about generalities, but will absolutely remember how kind and empathetic you were at a time when they are most frightened and vulnerable.
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  25. Nasrudin

    Nasrudin Member

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    Cool. Very interesting term "horizontal violence." Having worked many years for nurses I think that description is deliciously accurate.

    But I don't feel the need to walk around with the disclaimer that nurses are amazing and underappreciated and so forth. Let's talk grown up work place politics and public marketing as the OP implores us. It's incredibly inane to come to these discussions with just be nice and hugs and kisses and everybody's a winner or some other corporatey hallmark slogan for teamwork. This is sort of common sense. They have just as many malevolent personalities as we do. But workplace politics and public strategies are very separate and unique to each profession.

    We are very different animals who are a part of very different cultures and systems of education. Frankly, I'm fascinated that they have been kicking physician @ss up and down the block uncontested in the public arena for a good 20 years that my historical imagination is capable of taking a shot at assessing. And, like the OP, I wonder what, if anything, could turn it around.
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  26. KnuxNole

    KnuxNole Sweets Addict

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    I find it funny that nurses who freely want to strike still advocate quality patient care
    "Nurse, what will happen to all the patients if you guys go on strike...you can't just abandon them?"
    "Honey please, we need respect up in this biatch. Until then, they'll just have to go somewhere else!"
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  27. Nasrudin

    Nasrudin Member

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    I think it's high time we started playing dirty. Big time bribes quietly in back rooms--as was suggested. Maybe some sophisticated counter intelligence moves like funding propaganda to pump up the reputation of LVN's and other types of competition for nurses.

    This sheep like thing they do--cloyingly talking about valuing everybody on the team and yadda yadda--is part of their political brilliance. This stuff is always going to be adversarial. We're all eating from the same kills in this jungle. It's foolish to think otherwise. I can't wait until we exhaust the co-dependent liberalism of our camp's upbringing and start acting like lions again.
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  28. StephanieZ

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    I don't think that striking for one's best interests is patient abandonment. It begs the question, is one responsible for sick people simply because they hold the title of a medical professional? Do they have the ethical responsibility to continue to work and care for patients in consistently poor working conditions? I don't think so, otherwise quitting would be patient abandonment. Not that all nurse strikes are totally justified, but surely some are. Striking puts pressure on the hospital to increase the value they place on nurses. If the hospitals can find people to do the job for less compensation, than the strike in moot, but if they can't than it's justified.

    And sometimes, striking is advocating for quality patient care, like better nurse-patient ratios. In a situation that is unsafe, continuing to come in, earn one's paycheck and go home would be close to patient neglect.
  29. StephanieZ

    StephanieZ

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  30. Nasrudin

    Nasrudin Member

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    Your opening question is a great one. I don't buy that striking is unethical. Walking off the job without notifying the hospital of your plans to strike and what your demands are in the case of patient care duties, is, in my opinion. But these aren't exactly open markets. Powerful nursing unions are as such because of their relative density being able to dictate that if business is to be done is has to be done with the union. A union in an unrestricted free labor pool is a pointless bureaucratic waste for dues payers. You pay your union dues to make sure the market is restricted so that you can drive home your end of the bargain. The employer's goals are the opposite. But they play nice when they have to.

    Nursing demands being patient care centered is ridiculously fraudulent. Patients don't pay union dues. Everyone tries to scramble for patient concerns to be attached to their agenda. The fact that nurses do it so unconsciously and self-righteously without irony or cynicism portrays both the power and intellectual simplicity of their cultural mind.
  31. jdh71

    jdh71 si vis pacem, para bellum

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    I still plan to take most friday's off though. But I don't golf. So I'll mostly be sleeping in and then doing whatever the hell I want.
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  32. notbobtrustme

    notbobtrustme Crux Terminatus

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    yea, that's the new trend. There's a big stigma attached to striking, especially professions that are extremely well off like physicians.
  33. HopefulReapp

    HopefulReapp

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    On behalf of PCA's everywhere, we thank you!
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  34. mk04447

    mk04447

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    Why do most of you believe this negative perception of doctors comes from patients or nurses? I would be almost willing to bet as the economy has slowly declined over the past two decades that public perception of all handsomely compensated professions has declined. Simply class jealousy and a lack of confidence in the general public to aim higher.

    As for nurse pay... Compensation is usually tied to liability. As the world of medicine becomes more complicated and litigious, more responsibility and oversight will be shifted to the safer bet and in this case, it's the person with 8-10 years of college behind them. Combine this fact with over commercialization of the university system in America... In other words, it's easy to whip together a nursing program to satisfy minimal nurse licensing requirements of most states. The nursing shortage of the 80's is over, as more and more nurses flood the system, compensation will decline. The hospital I volunteer at doesn't even guarantee them 40 hours a week.

    Who cares more? This is a bit of a stinker concept... There are thousands of great doctors and nurses, just as there are an equal number of terrible, uncaring, and worthless examples in both fields. Face time has nothing to do with perceptions, it is first impressions, you don't suddenly like a nurse's bed side manner because you see her more often. People know and accept doctor/patient interactions last 10-15 minutes on average. It's how you sell yourself, now I will say nurses have more opportunities to shine. After all we don't skip the roller coaster because it only lasts 60 seconds in favor of the 30 minute gondola ride very often.
  35. punkedoutriffs

    punkedoutriffs

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    Baseball players did it.
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  36. pathologyDO

    pathologyDO

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    I respectfully disagree. The lady in my original post was grouping all nurses as being the ones on the front lines doing everything. All the while, she claimed that physicians were just callous and have God complexes (maybe because she never sees a physician doing things like she sees nurses? That seems to be what she was implying). I think if people are writing those kinds of comments on facebook and who knows where else - twitter, reddit, whatever - then obviously people are going to be reading it. If people are downing on physicians but always praising the nurses because they supposedly are superior to physicians (again, according to the lady in my original post) then tell me this - who would a person subjugated to that kind of thinking be more inclined to like when they go to the hospital? Obviously what I'm trying to get at is that people, especially those whom aren't very intelligent, will follow the crowd rather than think on their own because it's easier and they don't know better.

    As physicians I believe we should be worried about how society views us. After all, we live in a country where voting is a primary means to accomplishing changes in legislature and that includes healthcare.
  37. sidefx

    sidefx I need your clothes your boots and your motorcycle

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    Physicians do a lot of things that are not as apparent as what nurses do, and will often receive little thanks for it since they are not the ones on the front lines directly interacting with the patient the most... It's not fair, or reflective of reality, but that's just the nature of the beast. However, if you've been around doctors much you'll realize that a disproportionate amount of them do indeed have god complexes (or at the very least a high level of smug arrogance), and are very callous with horrible bedside manner.

    I've interacted with quite a few doctors who were amazingly kind and down-to-earth human beings. I've also interacted with many, many physicians who had some of the most obnoxious god complexes I've ever seen. Stereotypes are not created without an inkling of merit.
    Last edited: 12.19.13
  38. michaelrack

    michaelrack All In at the wrong time SDN Advisor

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    Patient abandonment is a complex topic, and quitting a job doesn't suddenly end all of the responsibilities to your patients
  39. mk04447

    mk04447

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    You've made my point for me... "Especially those whom aren't very intelligent"... I wonder how you'll present to your incompetent and inferior patients?
  40. Nasrudin

    Nasrudin Member

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    Edit.
    Last edited: 12.21.13
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  41. Nasrudin

    Nasrudin Member

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    We need to learn to manage our public relations problem. A good starting point seems to be doing what the OP is doing--sort of focus grouping public opinion about us. We should do the same with our new clinical adversaries. Figure what it is that is so liked about nursing that they can gobble clinical ground with adamant public support.

    As class war fare intensifies in the world around us, professional turf wars will intensify. It's not going away. Team work sloganeering is the work of the people who write our checks, in the effort to keep us all working hard and producing sound billing. This does not mean we shouldn't play nice in the sand box. It just means we should increase our awareness of the pressures going on in the adult economic world around us to make sure playing in the sand box is sustainable for those who will come after us.

    I still believe, with all its faults, physician training is the model of excellence in producing clinicians.
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  42. prettyNURSEtoMD

    prettyNURSEtoMD

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    I honestly didn't know he was trolling. My bad. But I still think my point was valid.
  43. HopefulReapp

    HopefulReapp

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    Do you know what the average level of reading and understanding your patients will be at in the hospital? At mine the level of overall education is a fourth grade level and their reading level is at a second grade level. I think you need to readjust your public perception.


    Sent from my iPhone using Tapatalk - now Free
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  44. KnuxNole

    KnuxNole Sweets Addict

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    Damn, that's higher than a good amount of places :p
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  45. Armadillos

    Armadillos

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    The fact that we are having a conversation about how to scheme to improve our public image is kind of sad. If you care for patients as people instead of cases/conditions they will notice. Its amazing how well patients respond to the attendings who really care. It was almost jaw dropping to see just how good of a personal connection the best attendings can make in a 5 minute encounter on rounds.

    (And at the same time it's also sad once you can see which attendings are just going through the motions for a lot of patients and their thoughts/focus aren't really dedicated 100% to the patient at hand)
  46. Coffee Machine

    Coffee Machine

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    As an aside, I generally think that it isn't acceptable for doctors to go on strike. Just my opinion, though.

    Back to the main topic of this thread, something that I haven't seen mentioned is the effect of so-called "collaborative care" on how patients perceive doctors. By collaborative, I'm referring to the idea that the patient and doctor should work together to make medical decisions. The utility of such an arrangement in terms of providing better care isn't really in the scope of this argument. I do think, however, that the idea that patients should "be their own advocates" has been taken to somewhat of an extreme by a fair number of people, to the point of them seeing the doctor-patient relationship as almost adversarial. This, coupled with the readily available medical information on the internet leading to patients thinking that they're more informed regarding standard medical care has greatly contributed to mistrust of doctors, in my opinion.

    I also agree with the point made above that patients don't really know what doctors actually do most of the time and (some) seem to assume that when the doctor isn't physically in their room he's golfing or something. I'm not sure what the answer to that one is, though.
  47. Nasrudin

    Nasrudin Member

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    That's a good point. It could be that we attract the personalities we get and that what we mold in the rest of us during our formative training isn't conducive to gathering public support patient by patient interaction by interaction. On the other hand we would still have certain problems: 1. Being the face time differential. 2. The rush to see more patients faster. An inpatient rounds context with a focused clinical question is very different from an outpatient visit with a whole host of vague complaints to fit in and still be considered congenial with a full waiting room. 3. Medicine is not practicable properly as a pure customer service venture. In psychiatry, for example, determining capacity to make medical decision and employing the legal system to garner an admission on a manic or psychotic patient isn't going to win you any new admirers under any circumstances. Or pain management questions etc. Given the loss of our traditional mojo in terms of respect, as was mentioned above, it getting harder to squeeze a positive interaction in those 5 minutes. I question whether just being kind and caring can answer this call. But still...your point stands. I can't defend the arrogance and callousness in our midst.

    Regardless, the patient comes to the counter under all sorts of cultural influences that determine whether our very short time with them is perceived as a good experiences. And nurses, whether by chance and alignment of the right conditions or design, have been winning this influence while we have lost it. I don't know what, if anything, we can do about it. But being more sensitive doesn't address the pressures on us in a way that employs our strength as a group of professionals with comparatively deep pockets. I am praised for being sensitive with patients but you have time for being exhorbitant with this as a med student. Attendings don't. I see problems with our profession with which exertion of power and influence is the answer not sensitivity. We'd be fools not realize both our employers and our competitiors are at the public relations game non-stop. Approaching it as individual super nice docs is a woefully inadequate response in my opinion.
  48. DrBodacious

    DrBodacious H-D Sportster 883C

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    The callous/god complex thing is usually a misrepresentation of the fact that docs rarely have time to pamper unreasonable patients. E. G. Yesterday, mom was unhappy that I had to discharge her daughter from the hospital, even after a half hour of going above and beyond trying to explain my reasoning, even calling the pediatrician. At that point it is time for me to go to clinic and see the 40 other patients that are going to be waiting on me. The nurses job is to try to smooth things out, not that it will make the Mom any happier about me, she will probably bad mouth me, but at that point I have to cut my losses. It's not a god complex, just because a lot of people need me. I suppose I could cut out medicaid participation and spend more time with each patient, but that seems more callous...
  49. southernIM

    southernIM

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    This is the exact wrong response.

    Look I'm gonna be blunt - my patients all freaking love me. I get hugs. I've held hands with a woman while she cried about her cancer diagnosis. I've come out of family meetings where we told a family a grim prognosis and had them tearfully thank me. I've had more positive patient experiences than I could list if I sat here all day and wrote them all down.

    But this is not enough

    Being liked by your patients at a micro level is not enough to address this VERY REAL, VERY WIDESPREAD problem, as at present it has huge political, financial, medico legal implications for all of our futures. Doctors need to aggressively work, as a group, to improve that public perception.
  50. mk04447

    mk04447

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    I'm so glad you were willing and available to save all the little people, without your guidance they would surely fail to thrive. Perceptions like this are more harmful than you know, this is the premise that a majority of liberal principles are governed and is leading our country to socialism. People are not incompetent, they are not stupid or ignorant either, they are different and are capable of the same things you are when left alone to manage their own lives. How do you expect to have a happy life if your superiority complex constantly forces you to live among cattle?

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