fish89

10+ Year Member
Aug 16, 2008
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Pre-Medical
i thought this was a good read.

http://www.kevinmd.com/blog/2010/11/doctors-quietly-opting-medicine.html

Doctors are quietly opting out of medicine

5 COMMENTS
in PHYSICIAN PRACTICE

by Nancy Pando, LICSW

Dr. Ryan Flesher was working his usual shift in the Emergency Department that night in July of 2006. The hospital was short-staffed, per usual, and patients continued streaming through the revolving doors. Neither the people at the front desk nor the nurses saw Dr. Flesher slip quietly down the hall that night.

The following is a true story that occurred well before healthcare moved to its national platform, leaving uncertainty in its wake. The main character’s name could be substituted by half of the physicians across the country. But, for now, we will start with Ryan Flesher, MD.


His chapter one

The youngest of 6 in Huntington, West Virginia, Ryan’s Dad was a foreman at a truck body shop and his Mom was a homemaker. Ryan was an above average student with a mind for science and a simple desire to help people. Compassion, according to any study ever conducted, is the number one reason why individuals choose careers in medicine.

What happens to these young, altruistic people who enter the field of medicine? We toss them into medical schools and residency programs, many of which are run like medieval tournaments designed to undermine the confidence of each player and destroy all sense of collegiality. Med students and residents most commonly describe their medical training as follows: “They beat the good stuff out of us”.

In a recent commencement speech at Stanford University, Atul Gawande, MD, MPH acknowledges, “There is no industry in the world with 13,600 different service lines to deliver. It should be no wonder that you have not mastered the understanding of them all. No one ever will.” But the world will expect of them nothing short of mastery and perfection.

Free falling

Newly licensed to practice medicine, Dr. Ryan Flesher joins his fellow colleagues as they step onto a conveyor belt that is heading straight for a cliff. Whoops. Nobody built a fence.

Stumbling to their feet, young doctors often find themselves confronted by administrative and regulatory officials armed with clipboards. New hires come to discover that one’s training in the art of medicine and bedside manner pales in comparison to one’s business acumen. The plans they had of sacred time they would spend building relationships and caring for patients. Imagery, dreams.

When one has sacrificed 14 years of one’s life in pursuit of a concept, not a reality…there seems no turning back. Resigned, Dr. Flesher joins the legion of other physicians in white coats with bulls eyes emblazoned across their backs.

A sense of disillusionment began to slowly curl itself around him and creep upward like a deadly vine.

Imperfect storm

Cognitive dissonance is a dangerous mix of chemicals when buried. That’s just what happened to Dr. Ryan Flesher on that infamous night in the small, tiled room.

Years of forbidden emotions erupt and spill across the floor like shards of glass. “I hate being a doctor,” he says to himself. These are words no physician ever wants to say out loud. Panic surges through him; “What will I do? What will my family say? Have I wasted my life? Is there something wrong with me? Is there something wrong with medicine? Do I Leave? Stay? Fight? Go?”

The exodus

Doctors are quietly opting out of medicine or they are leaving this life altogether. According to Medscape Medical News, as recently as March 2010, “The United States loses the equivalent of at least one entire medical school class (approximately 400 physicians) each year to suicide”. In other words: one, sometimes two, a day.

People often respond to reports of physician dissatisfaction by saying, “Well, I don’t like my job either.” But the role of a physician cannot be paralleled by any other. They have the least amount of rights of any profession; they must sacrifice approximately 14 years of their lives to the study and practice of medicine and they are held to a standard of perfection that simply does not exist here on earth.

Cradle and all

One of the most dangerous things people can do is to question the integrity of honorable human beings. The repercussions can be prolific. Physicians, in general, are good people. They are daughters, fathers, sons and mothers. Loathe to the notion of pity, they simply want what is fair and just.

An entire healthcare industry profits off the backs of doctors and patients. Without them, there is no industry. Problem is this unsettling shift in the foundation of medicine has caused cracks to form. How is it nobody thought to look at the structural problems before they built the skyscraper?

Our children, loved ones, all of us; we are falling through those cracks. And when the bough breaks … who will be left to take care of us?
 

Algophiliac

Someday...
10+ Year Member
Sep 4, 2008
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I just have to say...this is REALLY well written, imo.

It's also quite frightening, but frankly, not unexpected. My main lack of understanding concerning medical training procedures and onwards, is why--if medicine is such a perfection-based field--so few doctors that I've seen are actually...well, good? If there isn't a test to diagnose it--they often can't or simply don't diagnose it. This makes me think that perhaps more rigor in medical education isn't the answer.
 
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fish89

10+ Year Member
Aug 16, 2008
124
1
Status
Pre-Medical
My main lack of understanding concerning medical training procedures and onwards, is why--if medicine is such a perfection-based field--so few doctors that I've seen are actually...well, good?
IMO, the problem lies with the expectations placed on students and residents. Trainees are measured by how much they "know" via tests, scores, etc, whereas the touchy-feely things that most patients use to rate a 'good' doctor - initiative, kindness, customer service, touch - can't be quantified, assessed, or even taught. Because we can't measure and reward human qualities of a good doctor, these qualities are not reinforced. Unquantifiable but essential qualities are left unemphasized, and thereby pushed to the wayside and left underdeveloped. This creates of culture of one-upping knowledge-based learning which ignores the humanistic side. I'm not even in med school yet, so that's my uninformed preliminary opinion.
 
Dec 21, 2008
1,291
14
Status
Attending Physician
I just have to say...this is REALLY well written, imo.

It's also quite frightening, but frankly, not unexpected. My main lack of understanding concerning medical training procedures and onwards, is why--if medicine is such a perfection-based field--so few doctors that I've seen are actually...well, good? If there isn't a test to diagnose it--they often can't or simply don't diagnose it. This makes me think that perhaps more rigor in medical education isn't the answer.
Tell me exactly how, from a scientific viewpoint, one is supposed to proceed in an evidence-based manner with treating a patient if there's no confirmation that your diagnosis is correct, especially if "the pressure to be perfect" is so high.
 
Dec 21, 2008
1,291
14
Status
Attending Physician
IMO, the problem lies with the expectations placed on students and residents. Trainees are measured by how much they "know" via tests, scores, etc, whereas the touchy-feely things that most patients use to rate a 'good' doctor - initiative, kindness, customer service, touch - can't be quantified, assessed, or even taught. Because we can't measure and reward human qualities of a good doctor, these qualities are not reinforced. Unquantifiable but essential qualities are left unemphasized, and thereby pushed to the wayside and left underdeveloped. This creates of culture of one-upping knowledge-based learning which ignores the humanistic side. I'm not even in med school yet, so that's my uninformed preliminary opinion.
Trust me, you'll get enough cultural competence and sensitivity training shoved in your face during your clinical skills classes; the problem is that it's often done in the most patronizing manner possible, as if you couldn't possibly have known how to be sensitive/culturally competent before stepping foot in their institution.
 

Dr Oops

10+ Year Member
Feb 13, 2009
470
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Medical Student
I just have to say...this is REALLY well written, imo.

It's also quite frightening, but frankly, not unexpected. My main lack of understanding concerning medical training procedures and onwards, is why--if medicine is such a perfection-based field--so few doctors that I've seen are actually...well, good? If there isn't a test to diagnose it--they often can't or simply don't diagnose it. This makes me think that perhaps more rigor in medical education isn't the answer.
What exactly is the criteria/ training that allows you to classify what they are doing as good or Bad?
 

Algophiliac

Someday...
10+ Year Member
Sep 4, 2008
844
0
Status
Pre-Medical
Tell me exactly how, from a scientific viewpoint, one is supposed to proceed in an evidence-based manner with treating a patient if there's no confirmation that your diagnosis is correct, especially if "the pressure to be perfect" is so high.
I'm not sure, but reliance on technology has increased exponentially recently. Is there no way to gather "data" in an evidence-based manner without running tests? I realize this is basically impossible because "the pressure to be perfect" is matched with lawsuits.

I don't have experience or training, but it seems "good" doctors can diagnose me and others without sending me for 5 x-rays beforehand. Maybe this is just based on experience for them? They seem to have some sort of inherent intuition in terms of diagnosis. For those of you who are going to attack me for this, I am honestly wondering. I have read several books by physicians, and it's almost amazing to "see" them think--how they reach conclusions is very different from simply running tests and saying oh, yes, positive for this or that, but then again, the books were about the more interesting cases. Guess I'm just afraid of medicine becoming a cookbook series of tests.
 
Dec 21, 2008
1,291
14
Status
Attending Physician
I'm not sure, but reliance on technology has increased exponentially recently. Is there no way to gather "data" in an evidence-based manner without running tests? I realize this is basically impossible because "the pressure to be perfect" is matched with lawsuits.

I don't have experience or training, but it seems "good" doctors can diagnose me and others without sending me for 5 x-rays beforehand. Maybe this is just based on experience for them? They seem to have some sort of inherent intuition in terms of diagnosis. For those of you who are going to attack me for this, I am honestly wondering. I have read several books by physicians, and it's almost amazing to "see" them think--how they reach conclusions is very different from simply running tests and saying oh, yes, positive for this or that, but then again, the books were about the more interesting cases. Guess I'm just afraid of medicine becoming a cookbook series of tests.
...you still have to know WHAT you're looking for before you order the test to begin with. A good doctor will know exactly what the lab results should look like to confirm/rule out each of his/her differentials.

You're still being awfully vague when it comes to what your idea of a good doctor is. Good doctors don't formulate a single diagnosis and run with it; they make a list of the top three or so conditions that fit your symptoms (aka "the differential") and order the labs to rule in/out/confirm their suspicions.

PS Realize that you're reading firsthand (read: one-sided) accounts of doctors' most successful/interesting cases; don't make the mistake that because they've written a book that other doctors' methodologies must pale in comparison.