Are you in denial ?

[Thule]

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http://m.us.wsj.com/articles/the-u-...ve-1409325361?mobile=y&ru=yahoo?mod=yahoo_itp

 

[NickNaylor]

This will not be surprising to anyone who is halfway observant when they're on the other side of things as a trainee. Idealistic premeds can hem and haw about it all they want, but they fail to understand just how deeply and powerfully interests which don't care about physicians or patients influence the lives of both.

 

[Holmwood]

I'm sure many pre-meds are aware of these issues.
It's just that they haven't been on the receiving end. Awareness is not the same as understanding.

Rather than discourage people from entering the profession, wouldn't it be more productive for physicians to counsel people into staying in the profession?
Additionally, find solutions to address "impatient, occasionally indifferent, at times dismissive or paternalistic" tendencies.

 

[BrCo]

Call me crazy but I know these things and still want to be a physician. Every profession has its share of problems. I'd rather have a hand in trying to fix the problems of medicine than any other profession.

 

[NickNaylor]

I'm sure many pre-meds are aware of these issues.
It's just that they haven't been on the receiving end. Awareness is not the same as understanding.

Rather than discourage people from entering the profession, wouldn't it be more productive for physicians to counsel people into staying in the profession?
Additionally, find solutions to address "impatient, occasionally indifferent, at times dismissive or paternalistic" tendencies.

I'm not sure it's the role of anyone to encourage people to do one thing or another with the rest of their lives. Instead, I think what people can do is offer information and insights that you do not have access to which you can then use however you want.

As far as not being impatient et al, this is much easier said than done. Very few people come into medical training hating patients. Everyone in my class cares about the people they interact with and play a part in treating. However, something happens over the course of training and practice that starts to change those attitudes and behaviors. This isn't just an issue of "bad apples" (inb4 "I know doctors that love their job," "these guys didn't go into it for the right reasons," etc.). This is a documented phenomenon in medical education literature that has been consistently demonstrated. Empathy and other similar traits increase during the first two years of medical school and gradually decline throughout the remainder of training.

It's easy to say that you're not going to be that way. I hope you aren't and I hope I don't become that way. However, the data says otherwise, and I'm not sure that being hopelessly optimistic and denying that aspect of the career is a good idea. It's a lot like divorce. Obviously you wouldn't get married to someone if you didn't love them and care about them at least initially. Sometimes **** happens and things change, though. All you can do is the best you can do to stave off of those negative influences, but that doesn't necessarily mean you'll be successful.

 

[Holmwood]

I'm not sure it's the role of anyone to encourage people to do one thing or another with the rest of their lives. Instead, I think what people can do is offer information and insights that you do not have access to which you can then use however you want.

The kind of information and insight you choose to share will influence/bias the other person's decision making. That's the issue I had with this article, because it is geared towards discouraging people from entering the profession rather than be objective and informative.

They could have included the other side of the story such as...
1) The opinions of physicians who show high job satisfaction.
2) How physicians who were faced with the aforementioned hurdles found a way to overcome it.
3) Steps being made to improve the mental health of health practitioners.

As far as not being impatient et al, this is much easier said than done. Very few people come into medical training hating patients. Everyone in my class cares about the people they interact with and play a part in treating. However, something happens over the course of training and practice that starts to change those attitudes and behaviors. This isn't just an issue of "bad apples" (inb4 "I know doctors that love their job," "these guys didn't go into it for the right reasons," etc.). This is a documented phenomenon in medical education literature that has been consistently demonstrated. Empathy and other similar traits increase during the first two years of medical school and gradually decline throughout the remainder of training.

The question is, why are third year medical students suddenly exhibiting a reduction in altruistic characteristics?
It could be hostile treatment by authority figures, inadequate stress management skills of students, and maybe external factors such as debt. Those are not exactly related to the profession itself.

Maybe medical students just don't know how to deal with certain kinds of patients due to ill preparation from the institution for proper physician-patient interactions. Your classmates may love and care for some patients they've encountered in the past. But can they love and care for a cankerous patient with a penchant for sexual harassment and death threats on a daily basis? Few people are gifted enough to handle those types of situations naturally, but most would just fall into despair. And you won't see that kind of despair until after the second year, when students actually meet with patients. But that doesn't mean that we can't prep students for these types of situations.

TLDR
It's not hopeless optimism to talk about potential solutions. To deny that there are solution to the problems listed in the article is a fatalistic attitude. And I think fatalistic attitudes only impede progress in the medical field.

 

[meatie]

I think the article brings up a lot of good points and working in the ER made me very familiar with a lot of the statements he made. At my particular hospital, the physicians are becoming increasingly aggravated by our administration, patient demands (which is understandable when you have to wait 8 hours to be seen), and the overall healthcare system. Clearly, taking in a lot of the author's statistics, this is not an isolated issue at just my work. Don't get me wrong, I want so badly to be able to look at myself as a visionary going into medicine to make positive changes, but I don't think you can truly understand just how mind-numbingly complex and disastrously shoddy the U.S. healthcare network is without being neck deep in it (ie: not a pre-med). Observing in the ED has made me acutely aware of just how frustrating medicine can be and I'm not even in med school yet!

I admit reading articles like this do make me scared. Will I be able to handle the stress of having to deal with case managers, 4 hour delays on urine dips, and constant scrutiny from patients, administrators, and insurance companies? Can I wade through the oceans of bull**** paperwork, tedious charting, and malingerers while still holding onto that optimistic belief that I am genuinely helping others and learning something while I'm at it?

I think a lot of pre-meds don't really consider that these physicians that are being polled, surveyed, and suffering under the burden of modern medical practice were not much different from you or I when they themselves were applying. Many had the starry eyed hopes and dreams of practicing for the benefit of others that we share.

There are serious problems with the way we run medical services in this country, but to change it requires an almost divine amount of patience and determination. If you have ever led a large scale organization or been involved with planning events you know just how difficult it can be to assert what you may think are the right changes.

Few things, however, are absolute and medicine is no different. The profession will continue to grow or it may continue to spiral downwards. It really is up to the new blood and current participants to effect change. I also want to highlight that the author states the best group of people to combat this growing issue and change the attitude of medical practice are current medical students. I love that he mentions recalibrating your expectations and continuing to do so throughout your career because it's a very realistic suggestion to future practitioners. The "good old days" are gone, but people like the author who have ideas of how to better incentivize medicine and combat the burnout of working in healthcare are what this profession needs. The next step is actually doing something with those ideas.

When reading what I wrote, I must admit I am not a very smart person because I'll still be joining you all in the thick of it. At least I've always been pretty good at complaining 😉

 

[NickNaylor]

The kind of information and insight you choose to share will influence/bias the other person's decision making. That's the issue I had with this article, because it is geared towards discouraging people from entering the profession rather than be objective and informative.

They could have included the other side of the story such as...
1) The opinions of physicians who show high job satisfaction.
2) How physicians who were faced with the aforementioned hurdles found a way to overcome it.
3) Steps being made to improve the mental health of health practitioners.



The question is, why are third year medical students suddenly exhibiting a reduction in altruistic characteristics?
It could be hostile treatment by authority figures, inadequate stress management skills of students, and maybe external factors such as debt. Those are not exactly related to the profession itself.

Maybe medical students just don't know how to deal with certain kinds of patients due to ill preparation from the institution for proper physician-patient interactions. Your classmates may love and care for some patients they've encountered in the past. But can they love and care for a cankerous patient with a penchant for sexual harassment and death threats on a daily basis? Few people are gifted enough to handle those types of situations naturally, but most would just fall into despair. And you won't see that kind of despair until after the second year, when students actually meet with patients. But that doesn't mean that we can't prep students for these types of situations.

TLDR
It's not hopeless optimism to talk about potential solutions. To deny that there are solution to the problems listed in the article is a fatalistic attitude. And I think fatalistic attitudes only impede progress in the medical field.

Your points are well-taken but, unfortunately, I don't think you're really taking into account the pragmatic reality of practicing medicine and dismiss it as "fatalism." You're right that medical training =/= practice in the rest of your career, but medical training is at least 7 years of grinding on you, which is not insignificant. It will fundamentally change who you are - hopefully for the better, but not always. There's also the reality that you trade some negatives about training for others in practice.

I agree that a cultural shift would be beneficial to all in medicine and is a necessary thing. Unfortunately, such things do not happen overnight or even within a few years. Things will very likely not be any different by the time you get into the game, so its somewhat of a moot point. I expect the next generation of physicians will have an easier go of things as our generation tends to put a much stronger emphasis on quality of life over work achievement. However, that won't really do much for those of us in the now.

Your optimism is great, and I hope you retain it. But at the end of the day, you haven't even begun medical training yet, so you will have to forgive me my cynicism.

 

[Holmwood]

You're right that medical training =/= practice in the rest of your career, but medical training is at least 7 years of grinding on you, which is not insignificant. It will fundamentally change who you are - hopefully for the better, but not always. There's also the reality that you trade some negatives about training for others in practice.

I'm confused. 😕 I didn't make an argument that medical training doesn't translate to actual practice. What I was implying was that poor preparation during training in dealing with adversities (such as non-cooperative patients, "eating the young", medical malpractice, etc) may be the reason why 3rd year medical students begin showing a reduction in altruistic characters, and continue to show reduction throughout training. We both agree on the bolded point, that medical training may fundamentally change who you are. The difference between our point of views is that I believe there is a practical solution to addressing this reduction in altruism, while you believe it is a natural and inevitable outcome (which defines fatalistic). Correct me if I'm wrong.

I agree that a cultural shift would be beneficial to all in medicine and is a necessary thing. Unfortunately, such things do not happen overnight or even within a few years. Things will very likely not be any different by the time you get into the game, so its somewhat of a moot point. I expect the next generation of physicians will have an easier go of things as our generation tends to put a much stronger emphasis on quality of life over work achievement. However, that won't really do much for those of us in the now.

But that's the issue I see. We really don't need to overthrow an entire system to make significant changes for ourselves and for our coworkers. It's sort of the problem with the "war on drug addiction". Have we as a nation made any significant progress addressing the nation's drug problem? No, not even close. Yet, we can still educate members of our own small community and provide assistance to those susceptible to engaging in illicit drug trades. The impact we make is negligible when it come to the scale of the problem on a national level. Even so, any positive outcome remains significant for the small community we engage with.

Your optimism is great, and I hope you retain it. But at the end of the day, you haven't even begun medical training yet, so you will have to forgive me my cynicism.

I admit that there are alot of things I do not know about the profession. And I respect your experience as a medical student.
I do not think you are being cynical. I understand that you are a person that errs on the side of caution, and optimism can be a liability.

However, I do not want to give the impression that I'm optimistic for the sake of being optimistic. I'm generally a pessimistic individual and have been on the butt end of having to appease hospital administrators, abusive nurses, and manipulative patients as an ED volunteer. Yet, while veteran volunteers who served for 20+ years left when conditioners soured, I stayed. Not sure why. Perhaps I'm a glutton for punishment. But I stayed. As a result, I got to see conditions improve for volunteers as the hospital administrators yielded to the requests of clerical employees and abusive nurses softened their egotistic shells. Can't say patients stopped being manipulative, but I've learned to better sympathize with them after talking with homeless patient who feigned having psychological problems in order to be admitted and taken care of.

Things can get better, and I'm sure they have been getting better elsewhere. Not in a statistically significant way, but on a hospital by hospital basis. And therein lies my source of optimism.

 

[Cyberdyne 101]

Things can get better, and I'm sure they have been getting better elsewhere. Not in a statistically significant way, but on a hospital by hospital basis. And therein lies my source of optimism.

My personal experiences as a patient (in various settings) have been more than enough to give me a cynical and pessimistic outlook. Although, I also prefer to be optimistic. And at least in some regards, I've actually witnessed improvements in some of my neighborhood hospitals. Obviously, I wish these practices were in place when I needed them, but at least tangible efforts are being made to improve treatment for current and future patients.

 

[zzxxzz]

Don't work in the ED as a scribe, but I can tell you guys that many scribes who train for the ED quit shortly after. My head scribe told me working in the ED made her hate patients...

 

[Ace Khalifa]

I see the negatives all the time as an ED scribe. And I know how much it sucks. Every physician I've worked with has told me their views, both positive and negative. I'm glad I can see the reality, tho. It gives me the information to make the best informed decision possible about continuing down this path. I refuse to believe that all hope is lost for current and future physicians. I know that we in the younger generation of healthcare professionals will be able to make a difference someday.

"Be the change that you want to see." This was one of the most important lessons I've learned while I was an undergrad. That's why I devoted so much of my time to volunteerism and being altruistic. Positive change won't happen unless you work to make it happen.

 

[Thule]

Unless they lower tuition ...

 

[sat0ri]

http://www.npr.org/blogs/health/201...ign=npr&utm_term=nprnews&utm_content=20140819

Here's a NPR interview based off the same book--the interviewer (who's a bit fumbling and frustrating at times) makes the topic more personal, about his experience, and it somehow has the effect of easing the mood a bit. When you focus the story on not entirely the societal problems but how people in the society dealt with the problem, it not only humanizes the issue, but also shifts the focus from hardship to perseverance. This might be important for certain premeds with certain dispositions for neuroticism who might be disheartened or made more stubborn in their naivety

 

[DermViser]

I'm sure many pre-meds are aware of these issues.
It's just that they haven't been on the receiving end. Awareness is not the same as understanding.

Rather than discourage people from entering the profession, wouldn't it be more productive for physicians to counsel people into staying in the profession?
Additionally, find solutions to address "impatient, occasionally indifferent, at times dismissive or paternalistic" tendencies.

No, they actually aren't. I guarantee you most premeds don't even know what's in the Obamacare bill even though the bill will completely transform how they practice and how they get reimbursed. Why should physicians counsel people to stay in the profession? Why would you want them to lie?

 

[DermViser]

Call me crazy but I know these things and still want to be a physician. Every profession has its share of problems. I'd rather have a hand in trying to fix the problems of medicine than any other profession.

I don't know what's worse: That you actually believe what you're saying and that you actually got 6 likes, while @NickNaylor's realities of the situation gets no likes (although I'm not surprised). You'll feel much differently when you're 6 figures in debt and have no choice but to continue.

You may "know" these things but you have yet to experience them. You as an individual can't "fix" the problems in medicine. You won't be the first person to have that viewpoint.

 

[DermViser]

I'm generally a pessimistic individual and have been on the butt end of having to appease hospital administrators, abusive nurses, and manipulative patients as an ED volunteer.

😆😆😆

 

[DermViser]

I see the negatives all the time as an ED scribe. And I know how much it sucks. Every physician I've worked with has told me their views, both positive and negative. I'm glad I can see the reality, tho. It gives me the information to make the best informed decision possible about continuing down this path. I refuse to believe that all hope is lost for current and future physicians. I know that we in the younger generation of healthcare professionals will be able to make a difference someday.

"Be the change that you want to see." This was one of the most important lessons I've learned while I was an undergrad. That's why I devoted so much of my time to volunteerism and being altruistic. Positive change won't happen unless you work to make it happen.

Hope you remember that when you're being pounded into the ground with residency.

 

[jakeislove]

Hope you remember that when you're being pounded into the ground with residency.

That's the price of admission.

 

[DermViser]

That's the price of admission.

My point is by the time he's way deep in med school or residency, he'll see how much ability he has to "make a difference". When you as a doctor say that a certain treatment should be started, and an Obamacare plan says , "no", but you have to be the one to tell the patient and take the anger, then we'll see how much he feels he's "made a difference". It's any wonder med schools are looking at non-traditionals with actual life experience.

 

[Mad Jack]

I'm confused. 😕 I didn't make an argument that medical training doesn't translate to actual practice. What I was implying was that poor preparation during training in dealing with adversities (such as non-cooperative patients, "eating the young", medical malpractice, etc) may be the reason why 3rd year medical students begin showing a reduction in altruistic characters, and continue to show reduction throughout training. We both agree on the bolded point, that medical training may fundamentally change who you are. The difference between our point of views is that I believe there is a practical solution to addressing this reduction in altruism, while you believe it is a natural and inevitable outcome (which defines fatalistic). Correct me if I'm wrong.


But that's the issue I see. We really don't need to overthrow an entire system to make significant changes for ourselves and for our coworkers. It's sort of the problem with the "war on drug addiction". Have we as a nation made any significant progress addressing the nation's drug problem? No, not even close. Yet, we can still educate members of our own small community and provide assistance to those susceptible to engaging in illicit drug trades. The impact we make is negligible when it come to the scale of the problem on a national level. Even so, any positive outcome remains significant for the small community we engage with.


I admit that there are alot of things I do not know about the profession. And I respect your experience as a medical student.
I do not think you are being cynical. I understand that you are a person that errs on the side of caution, and optimism can be a liability.

However, I do not want to give the impression that I'm optimistic for the sake of being optimistic. I'm generally a pessimistic individual and have been on the butt end of having to appease hospital administrators, abusive nurses, and manipulative patients as an ED volunteer. Yet, while veteran volunteers who served for 20+ years left when conditioners soured, I stayed. Not sure why. Perhaps I'm a glutton for punishment. But I stayed. As a result, I got to see conditions improve for volunteers as the hospital administrators yielded to the requests of clerical employees and abusive nurses softened their egotistic shells. Can't say patients stopped being manipulative, but I've learned to better sympathize with them after talking with homeless patient who feigned having psychological problems in order to be admitted and taken care of.

Things can get better, and I'm sure they have been getting better elsewhere. Not in a statistically significant way, but on a hospital by hospital basis. And therein lies my source of optimism.

Volunteers are usually more in the way than anything in the ED- we literally just didn't even know what to do with them back where I worked. Uh, fold some blankets or something I guess? And we all knew that the volunteering thing sucked and the only reason they were doing it was to look good on their medical school application (not a single ED volunteer WASN'T a premed) so we were very "meh, feel free to stand around for 100 hours over the next few months so your app looks shinier I guess." Why anyone would stick around to be a volunteer in an abusive environment where they don't provide any real necessary service is beyond me.

 

[jakeislove]

My point is by the time he's way deep in med school or residency, he'll see how much ability he has to "make a difference". When you as a doctor say that a certain treatment should be started, and an Obamacare plan says , "no", but you have to be the one to tell the patient and take the anger, then we'll see how much he feels he's "made a difference". It's any wonder med schools are looking at non-traditionals with actual life experience.

You have stated or implied on many occasions that I'm quite naive. It should come as no surprise that I feel approaching patients from a good place makes a difference.

Treatments are based upon defensive medicine, protocols, evidence, etc... How they're implemented and explained can affect a patient's feelings.

I'm not a hippie or anything weird like that. I've just come to believe that how a person feels when they/you leave is more important than how they feel. Did the doctor interrupt? Did you get to ask questions? Was she/he in a hurry? Did it seem like they were confident? Did it seem like they gave a poop?, etc... are as much a part of the patient's experience than whatever therapy was prescribed.

In terms of people being disillusioned?! It's a good thing that people are getting a dose of reality and lowering their expectations. I'm personally tired of hearing 3rd/4th year students complain about hating medicine but either being in too much debt or afraid of disappointing their spouse, parents, dogs, kids, etc... to move in a different direction. Aside from the fact that hearing them whine gives me agita, patients deserve better.

 

[235009]

I'm not a hippie or anything weird like that. I've just come to believe that how a person feels when they/you leave is more important than how they feel. Did the doctor interrupt? Did you get to ask questions? Was she/he in a hurry? Did it seem like they were confident? Did it seem like they gave a poop?, etc... are as much a part of the patient's experience than whatever therapy was prescribed.

This paragraph is a good example of your naïveté. Do you think I WANT to rush patients when I'm in clinic? Are you implying I get off on interrupting them when they aren't getting to the point so I can get to the bottom of their vague symptoms and try to make sense of them? Am I an inadequate doctor in your premed world for not engage too much when they're showing me pictures of their grand kids or telling me about their recent trip? Do I let patients sit in the waiting room for half an hour because I'm evil and heartless?

You obviously have no idea what the reality of medicine is like. As a resident I have 15-20 minutes per patient. In that time I have to wait for the nurse to bring the patient into the room and take vitals, see the patient (pleasantries/history/physical), and precept the patient with the attending who may want to come into the room to repeat some things or simply to bill at a higher level. Oh and did I mention the first patient of the day showed up 15 minutes late so I'm already running a whole appointment behind. Oh and the printer refuses to work and the EMR is being a b*tch today. Oh one of the patients doesn't speak one of the languages I speak...gotta wait 10 minutes for the interpreter to come (a likely temporary LUXURY at my clinic paid for by a grant) or god forbid use the interpreter phone where the sound and interpreter quality can vary to a comical degree.

And it only gets worse as an attending when your schedule is double and triple booked.

So as you can see it's all a moral failing on my part and the system works flawlessly. Did I mention you've also gotta deal with prior authorizations, documentation, mountains of paperwork, reviewing results, etc all on your own time?

 

[meatie]

My question to current residents and attendings is do you imagine healthcare in this nation getting more physician friendly? What direction do you think it will go? What are people that are truly passionate about healthcare and medicine supposed to do in this kind of climate?

 

[BrCo]

I expected such a response, and was honestly waiting for it. Look. There's a huge divide between us, mainly the fact that you've gone through a grueling process that I can only begin to imagine. Naturally our actions and motives will be different. It is not that I'm optimistic about the field of medicine. I do not feel immune to being jaded later on down the line. Nor I am under the impression that I will be able to move and shape the forces that control me as a cog in a wheel. We are all cogs in a wheel to some degree, and I would rather be in the wheel called medicine. Take a look a biomedical scientists, with the declining funds from NIH and an academic system that pushes PIs to use grad students as slaves. Unlike medicine, the characteristics of the field were not enough to keep me interested. By "fixing", I do not mean controlling and shaping the uncontrollable. I mean that I believe quality patient care can still be provided in the midst of this climate.

It's just, for me, as an individual, hearing how gruesome the medical field can be is not enough to dissuade me from this path. I have done nearly everything a premed can do to assess the lives of physicians, yet I still feel this way. I have seen miserable physicians and happy physicians. I have watched physicians work well past the 80 hours, become mentally and physically drained, and lose their families. About 70-80% of physicians have told me never to pursue medicine, yet here I am. I'm here because nothing in life has come close to the feeling I get when I've seen patients lives be saved. To me, it makes all the nuisances worth it.

Like I said, call me crazy.

I don't know what's worse: That you actually believe what you're saying and that you actually got 6 likes, while @NickNaylor's realities of the situation gets no likes (although I'm not surprised). You'll feel much differently when you're 6 figures in debt and have no choice but to continue.

You may "know" these things but you have yet to experience them. You as an individual can't "fix" the problems in medicine. You won't be the first person to have that viewpoint.

 

[DermViser]

I expected such a response, and was honestly waiting for it. Look. There's a huge divide between us, mainly the fact that you've gone through a grueling process that I can only begin to imagine. Naturally our actions and motives will be different. It is not that I'm optimistic about the field of medicine. I do not feel immune to being jaded later on down the line. Nor I am under the impression that I will be able to move and shape the forces that control me as a cog in a wheel. We are all cogs in a wheel to some degree, and I would rather be in the wheel called medicine. Take a look a biomedical scientists, with the declining funds from NIH and an academic system that pushes PIs to use grad students as slaves. Unlike medicine, the characteristics of the field were not enough to keep me interested. By "fixing", I do not mean controlling and shaping the uncontrollable. I mean that I believe quality patient care can still be provided in the midst of this climate.

It's just, for me, as an individual, hearing how gruesome the medical field can be is not enough to dissuade me from this path. I have done nearly everything a premed can do to assess the lives of physicians, yet I still feel this way. I have seen miserable physicians and happy physicians. I have watched physicians work well past the 80 hours, become mentally and physically drained, and lose their families. About 70-80% of physicians have told me never to pursue medicine, yet here I am. I'm here because nothing in life has come close to the feeling I get when I've seen patients lives be saved. To me, it makes all the nuisances worth it.

Like I said, call me crazy.

You realize physician isn't the only pathway to achieve what you've seen right? PAs do, NPs do. And yet w/o fail you only want the physician label. Why? Also depending on the specialty not everyone is a "cog in a wheel" for some corporate hospital.

 

[SlowCodeToChina]

You realize physician isn't the only pathway to achieve what you've seen right? PAs do, NPs do. And yet w/o fail you only want the physician label. Why? Also depending on the specialty not everyone is a "cog in a wheel" for some corporate hospital.

By the cog in the wheel metaphor, he answered your question. "I would rather be in the wheel called medicine."

Also depending on the type of PA or NP, you can't achieve the same things as physicians do.

 

[idm6]

As a non-trad myself, I feel like physicians sometimes lack perspective as a result of the relative insularity of the field (i.e. the fact that most medical professionals have never really experienced professional work outside of the medical field). Maybe I'll feel differently once I've worked in the medical profession myself, but for now, it seems like disenchanted physicians tend to trot out issues that are true of most high salary professions as if they are unique to medicine.

For example: Tell any non-medical professional that "U.S. doctors spend almost an hour on average each day...dealing with the paperwork of insurance companies," and they will take your statement as a ringing endorsement of the field. Doing only an hour of mindless paper shuffling would be a drastic improvement for most. While many complain about the "mountain of paperwork" involved in medicine these days, I still can't think of many high paying professions that would be better than medicine for a person who doesn't like paperwork.

 

[BrCo]

I want to be the end of the line for my patients - the person entrusted with the full care and ultimate responsibility of others. I want to attend more than two more years of school. I want to be able to understand the science and medicine on a detail NPs and PAs do not. I want to be a leader who guides nurses, NPs, etc.

You realize physician isn't the only pathway to achieve what you've seen right? PAs do, NPs do. And yet w/o fail you only want the physician label. Why? Also depending on the specialty not everyone is a "cog in a wheel" for some corporate hospital.

 

[Theseus]

I expected such a response, and was honestly waiting for it. Look. There's a huge divide between us, mainly the fact that you've gone through a grueling process that I can only begin to imagine. Naturally our actions and motives will be different. It is not that I'm optimistic about the field of medicine. I do not feel immune to being jaded later on down the line. Nor I am under the impression that I will be able to move and shape the forces that control me as a cog in a wheel. We are all cogs in a wheel to some degree, and I would rather be in the wheel called medicine. Take a look a biomedical scientists, with the declining funds from NIH and an academic system that pushes PIs to use grad students as slaves. Unlike medicine, the characteristics of the field were not enough to keep me interested. By "fixing", I do not mean controlling and shaping the uncontrollable. I mean that I believe quality patient care can still be provided in the midst of this climate.

It's just, for me, as an individual, hearing how gruesome the medical field can be is not enough to dissuade me from this path. I have done nearly everything a premed can do to assess the lives of physicians, yet I still feel this way. I have seen miserable physicians and happy physicians. I have watched physicians work well past the 80 hours, become mentally and physically drained, and lose their families. About 70-80% of physicians have told me never to pursue medicine, yet here I am. I'm here because nothing in life has come close to the feeling I get when I've seen patients lives be saved. To me, it makes all the nuisances worth it.

Like I said, call me crazy.

I hear these viewpoints have a tendency to turn in the opposite direction during rotations and intern years.

 

[DermViser]

As a non-trad myself, I feel like physicians sometimes lack perspective as a result of the relative insularity of the field (i.e. the fact that most medical professionals have never really experienced professional work outside of the medical field). Maybe I'll feel differently once I've worked in the medical profession myself, but for now, it seems like disenchanted physicians tend to trot out issues that are true of most high salary professions as if they are unique to medicine.

For example: Tell any non-medical professional that "U.S. doctors spend almost an hour on average each day...dealing with the paperwork of insurance companies," and they will take your statement as a ringing endorsement of the field. Doing only an hour of mindless paper shuffling would be a drastic improvement for most. While many complain about the "mountain of paperwork" involved in medicine these days, I still can't think of many high paying professions that would be better than medicine for a person who doesn't like paperwork.

Except other professions don't have the level of investment with respect to money and time to get to where they are at. On top of that, all the malpractice is on you. Medicine isn't a "job" where you get to clock out when the work is done. Even when you get home you're still thinking about it. Paperwork is the least of your worries.

 

[SlowCodeToChina]

Except other professions don't have the level of investment with respect to money and time to get to where they are at. On top of that, all the malpractice is on you. Medicine isn't a "job" where you get to clock out when the work is done. Even when you get home you're still thinking about it. Paperwork is the least of your worries.

Paperwork may be the least of his worries, but that's the example he chose to expound upon to illustrate his point.

Also there are plenty of other jobs that you continue to think about once you get home. Medicine is no way special in that.

 

[DermViser]

I want to be the end of the line for my patients - the person entrusted with the full care and ultimate responsibility of others. I want to attend more than two more years of school. I want to be able to understand the science and medicine on a detail NPs and PAs do not. I want to be a leader who guides nurses, NPs, etc.

I want to be the end of the line for my patients - the person entrusted with the full care and ultimate responsibility of others.

And all the liability and malpractice that comes along with that as that will ultimately be yours as well.

I want to attend more than two more years of school.

Wish granted. You'll have 4 years of medical school + 3-7 years of residency + years of fellowship. Hopefully you're ok with > decade of delayed gratification.

I want to be able to understand the science and medicine on a detail NPs and PAs do not.

You will get it to you heart's content. As long as you have the paycheck to pay for six figures of it, that's all your med school will care about. Whether it will actually help you in your eventual specialty, it depends.

I want to be a leader who guides nurses, NPs, etc.

Yeah good luck with that. Nurses won't be taking orders from you and NPs are fighting (and have been successful at obtaining) independent practice. They don't want you over them and they have studies that show they can do just as good, if not better job than you as a physician with better outcomes.

 

[DermViser]

Paperwork may be the least of his worries, but that's the example he chose to expound upon to illustrate his point.

Also there are plenty of other jobs that you continue to think about once you get home. Medicine is no way special in that.

Without the medical malpractice, that can destroy you financially and all your assets. "Paperwork" is the tip of the iceberg when it comes to the frustrations of medicine. Physicians don't commit suicide bc of too much paperwork.

 

[DermViser]

...

 

[jakeislove]

You're making a big deal about a relatively small point (namely: we should try to develop a good, supportive relationship with patients). The majority of patients we see are not in distress, have relatively small or routine problems, and can be dealt with very quickly. This is true regardless of your specialty. The trick is to identify the very small proportion of patients who need the "personal touch" you are advocating.

If you go into every clinic visit talking about feelings and being overly caring, all you're going to do is creep out your patients and get yourself a couple of sexual harassment complaints.

Sorry, I didn't have a way to be more clear. I wasn't implying we/you talk about feelings or waste time, simply asserting that we should be aware of how our delivery of care affects patient perceptions.

Does that make a little more sense?

I'm not great at multi-quote and don't feel it's a "moral failure", as MeatTornado wrote.

 

[SlowCodeToChina]

I want to be the end of the line for my patients - the person entrusted with the full care and ultimate responsibility of others.

And all the liability and malpractice that comes along with that as that will ultimately be yours as well.

I want to attend more than two more years of school.

Wish granted. You'll have 4 years of medical school + 3-7 years of residency + years of fellowship. Hopefully you're ok with > decade of delayed gratification.

I want to be able to understand the science and medicine on a detail NPs and PAs do not.

You will get it to you heart's content. As long as you have the paycheck to pay for six figures of it, that's all your med school will care about. Whether it will actually help you in your eventual specialty, it depends.

I want to be a leader who guides nurses, NPs, etc.

Yeah good luck with that. Nurses won't be taking orders from you and NPs are fighting (and have been successful at obtaining) independent practice. They don't want you over them and they have studies that show they can do just as good, if not better job than you as a physician with better outcomes.

Everyone knows doctors have to deal with malpractice, long years of training, and tons of memorization in medical school. You think he hasn't already considered before making his career choice?

While some nurses/NPs won't, a lot of them will be receiving some form of supervision from physicians.

Without the medical malpractice, that can destroy you financially and all your assets.

Malpractice isn't endemic to medicine, either.

 

[235009]

My question to current residents and attendings is do you imagine healthcare in this nation getting more physician friendly? What direction do you think it will go? What are people that are truly passionate about healthcare and medicine supposed to do in this kind of climate?

Definitely less physician friendly. Pay for performance means that your pay gets docked because your patients are noncompliant and the onus will be on you to prove that it's not your fault the patient's diabetes is out of control. With the new ICD10 codes have become so absurdly specific and will lead to lower reimbursements if you don't wade through to find the more specific complicated code that applies to your patient and fully document that in your note. Patient satisfaction ratings being tied to reimbursement basically means that you have to give in to unreasonable patient demands and will be a public health disaster by increasing the already epidemic opiate abuse/dependence in this country and worsening antibiotic resistance (let's just hope they come up with an oral carbepenem before that time comes)

 

[demayette]

The doom and gloom of medicine is always alive in every @DermViser SDN post... @Cyberdyne 101 I don't think it's wise to have an argument with @NickNaylor after he suggested they should not bring back that physician to Atlanta for treatment and let him die in Africa after he got infected with Ebola virus...

 

[DermViser]

Everyone knows doctors have to deal with malpractice, long years of training, and tons of memorization in medical school. You think he hasn't already considered before making his career choice?

It's one thing to "consider" it. It's another thing altogether to actually experience 4 years of medical school + 3-7 years of residency + 1-2 years of fellowship (or more), and that doesn't even include the emotional sacrifices, as well as sleep, and this is before you're even an attending.

While some nurses/NPs won't, a lot of them will be receiving some form of supervision from physicians.

Depends very much on the state in question. Supervision is hardly looking over the shoulder of the nurse/NP in question. Most attendings/residents hardly "supervise" nurses in a hospital setting.

Medical malpractice isn't endemic to medicine, either.

Yes, I realize dentistry also has malpractice but it isn't like your patient dies of a cavity.

 

[meatie]

I'm glad that all those hours I spent in customer service will come in handy then!

 

[DermViser]

The doom and gloom of medicine is always alive in every @DermViser SDN posts... @Cyberdyne 101 I don't think it's wise to have an argument with @NickNaylor after he suggested they should not bring back that physician to Atlanta for treatment and let him die in Africa after he got infected with Ebola virus...

Yes, bc premeds knowing the way medicine is actually practiced NOW and will be practiced, is a bad thing. Not knowing anything about Obamacare and change in payment models won't affect medicine at all. Nope, let's just continue the premed utopia of how medicine is like. I don't know what @NickNaylor said as I'll have to read context, but if you think an Ebola pandemic can happen here, you are greatly mistaken.

 

[SlowCodeToChina]

It's one thing to "consider" it. It's another thing altogether to actually experience 4 years of medical school + 3-7 years of residency + 1-2 years of fellowship (or more), and that doesn't even include the emotional sacrifices, as well as sleep, and this is before you're even an attending.


Depends very much on the state in question. Supervision is hardly looking over the shoulder of the nurse/NP in question. Most attendings/residents hardly "supervise" nurses in a hospital setting.


Yes, I realize dentistry also has malpractice but it isn't like your patient dies of a cavity.

How can you "experience" the medical education process before actually starting your training? That makes no sense.

 

[jakeislove]

Yes, bc premeds knowing the way medicine is actually practiced NOW and will be practiced, is a bad thing. Not knowing anything about Obamacare and change in payment models won't affect medicine at all. Nope, let's just continue the premed utopia of how medicine is like. I don't know what @NickNaylor said as I'll have to read context, but if you think an Ebola pandemic can happen here, you are greatly mistaken.

The ACA is going to drastically change how medicine is practiced and the lifestyle physicians enjoy.

 

[SlowCodeToChina]

Yes, bc premeds knowing the way medicine is actually practiced NOW and will be practiced, is a bad thing. Not knowing anything about Obamacare and change in payment models won't affect medicine at all. Nope, let's just continue the premed utopia of how medicine is like. I don't know what @NickNaylor said as I'll have to read context, but if you think an Ebola pandemic can happen here, you are greatly mistaken.

Where did he even remotely suggest that an Ebola pandemic could happen here?

 

[DermViser]

How can you "experience" the medical education process before actually starting your training? That makes no sense.

I didn't say you can - that's why I said knowing and actually experiencing it are 2 different things. There are some endpoints that can help get you there - volunteering at academic medical hospitals in inpatient settings, talking with inpatient medical residents, etc.

 

[DermViser]

Where did he even remotely suggest that an Ebola pandemic could happen here?

I DIDN'T SAY he said that.

 

[DermViser]

The ACA is going to drastically change how medicine is practiced and the lifestyle physicians enjoy.

You bet it is. And in true SDN premed fashion - nearly all of them don't actually know what is in it - and yet still support it. They've even polled a majority of med students as well who support it, but don't actually know what is in it.

Needless to say the ACA will DRASTICALLY change how medicine is practiced and not in good ways either. There's a reason why it's labeled the greatest change in medicine since Medicare.

 

[SlowCodeToChina]

I didn't say you can - that's why I said knowing and actually experiencing it are 2 different things. There are some endpoints that can help get you there - volunteering at academic medical hospitals in inpatient settings, talking with inpatient medical residents, etc.

And you assume that he hasn't done those on what premise?

 

[SlowCodeToChina]

I DIDN'T SAY he said that.

And you would have been wrong had you said it. My question is why would it even be relevant to mention this in the manner that you did?