ForbiddenComma

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Now I cannot say such a thing out loud in real life because I would likely be charged with heresy. A torch-bearing mob would drive me out of class and then out of the town. I would have to change my name and be a drifter until I wind up as a male stripper in Weeds, Nevada. So I must make do here, safely ensconced in my anonymity.

Now then, I will say it again: I am going to be treating the disease and not the patient.

Patients come to the doctor's office or the hospital because they are sick and want to become better. Not because they want to be talked through it. Not because they want someone to nod and understand. Not because they want me to be best buds with them.

They will want me to make their disease go away, and that is what I will try to do for them.

This is not to say bedside manner is irrelevant. Anyone would rather go to a nice doc than a mean doc. Similarly, I would rather go to a nice mechanic than the guy who spits tobacco at me.

But on the other hand, if the tobacco-spitter is the only guy who can keep my car from breaking down on the interstate... then I guess I better wear cheap clothes when I go in for a tune-up.

So, when a patient gets admitted to my service, I will be concerned with what I can do to fix their problem. I will not be at their bedside all night, holding their hand, nodding at their concerns and marveling at how in touch with our emotions we are. I'm going to be hitting the books and the journals, trying to figure out what is making them sick. The responsibility to make them comfortable lies with the nurses or the shrinks or *gasp* maybe even their own friends and family!

In addition, you are damned sure I am going to be keeping my emotional distance. There's a reason why doctors *used* to be told to do this. It is because they need to stay on their game for the next patient and the one after that, even if this one croaks. Patch Adams needed a boot to the ass if you ask me. I was the jerk in the back who was actually rooting for the stiff Establishment administrators in that movie to take his self-righteous self down a peg. If the sick children want a clown, I am not going to be dressing up as a clown. I am going to be getting ready for the Meckel's the next day that might actually fix their problem. If they really need a clown then the hospital can just hire a damn clown!

Now some might say this makes me emotionally... remote. Perhaps. But let's face it, if you spent your undergrad years studying O-chem and physics, then you probably don't have quite the same emotional connectivity as a French Poetry major... or, for that matter, a Nursing major. It's just the way it is. I'm not saying I'm going to be the most skilled doc ever, but I am striving to be. And I know to do so, I might have to sacrifice some of the personal connection. So be it.

Thank you for letting me get that off my chest. I feel oh so much better now. And in summary, I would like to state my belief that this man has the right idea:

 
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ForbiddenComma

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Oh, by the way, did I mention that I hope to be a surgeon? I'm not sure if that came out at all in my post.
 
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ForbiddenComma

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MirrorTodd said:
I thought you were going to be an ID/Neph.
House has his underlings do the surgeries. He's too cool to get his own hands dirty.

But I can't ever be that cool
 
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Where did I say anything about money?

Reading comprehension = good
 

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The analogy regarding the automechanic is ridiculous.
The best physician is the one that not only fixes the current problem but can foresee the upcoming problems. Would you prefer the mechanic who just fixes your problem, or the one able to see another coming and clue you into it so that you can watch out? Maybe you've been changing your oil infrequently...is it so silly to point that out?

You make a good point but are getting caught up in the novelty of it. Basically, you're spouting off bumper sticker logic.
 
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ForbiddenComma

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No more bumper-sticker-logic than the usual refrain of "treat the patient, not the disease."

I should have been more clear. I would definately try to work on long-term risk factors such as weight, smoking and the usual. But it would be to improve their long-term health, not because I'm trying to be their best buddy.



I admit that I am playing devil's advocate here, and I usually don't feel so, uh, "extreme." I suppose I got sick of the endless preaching about holistic medicine at my school. It's easy to lose sight of the basics.
 

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ForbiddenComma said:
Oh, by the way, did I mention that I hope to be a surgeon? I'm not sure if that came out at all in my post.
you are aware that surgeons get patients REFERRED to them and you do know patients and FPs/IMs talk all the time . . . so in the end it might be in the best interest ($$$$) to be less outspoken
 

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ForbiddenComma said:
Now I cannot say such a thing out loud in real life because I would likely be charged with heresy. A torch-bearing mob would drive me out of class and then out of the town. I would have to change my name and be a drifter until I wind up as a male stripper in Weeds, Nevada. So I must make do here, safely ensconced in my anonymity.

Now then, I will say it again: I am going to be treating the disease and not the patient.

Patients come to the doctor's office or the hospital because they are sick and want to become better. Not because they want to be talked through it. Not because they want someone to nod and understand. Not because they want me to be best buds with them.

They will want me to make their disease go away, and that is what I will try to do for them.

This is not to say bedside manner is irrelevant. Anyone would rather go to a nice doc than a mean doc. Similarly, I would rather go to a nice mechanic than the guy who spits tobacco at me.

But on the other hand, if the tobacco-spitter is the only guy who can keep my car from breaking down on the interstate... then I guess I better wear cheap clothes when I go in for a tune-up.

So, when a patient gets admitted to my service, I will be concerned with what I can do to fix their problem. I will not be at their bedside all night, holding their hand, nodding at their concerns and marveling at how in touch with our emotions we are. I'm going to be hitting the books and the journals, trying to figure out what is making them sick. The responsibility to make them comfortable lies with the nurses or the shrinks or *gasp* maybe even their own friends and family!

In addition, you are damned sure I am going to be keeping my emotional distance. There's a reason why doctors *used* to be told to do this. It is because they need to stay on their game for the next patient and the one after that, even if this one croaks. Patch Adams needed a boot to the ass if you ask me. I was the jerk in the back who was actually rooting for the stiff Establishment administrators in that movie to take his self-righteous self down a peg. If the sick children want a clown, I am not going to be dressing up as a clown. I am going to be getting ready for the Meckel's the next day that might actually fix their problem. If they really need a clown then the hospital can just hire a damn clown!

Now some might say this makes me emotionally... remote. Perhaps. But let's face it, if you spent your undergrad years studying O-chem and physics, then you probably don't have quite the same emotional connectivity as a French Poetry major... or, for that matter, a Nursing major. It's just the way it is. I'm not saying I'm going to be the most skilled doc ever, but I am striving to be. And I know to do so, I might have to sacrifice some of the personal connection. So be it.

Thank you for letting me get that off my chest. I feel oh so much better now. And in summary, I would like to state my belief that this man has the right idea:

A-friggin'-men. I hate all of that "empathy" crap they try to shove down our throats in medical school and some residency programs (Duke...cough..cough). It's not that I object to empathy and good-bedside manner, it's just the general smarminess of how these things are taught and how they are force-fed to those of us who don't need the instruction.
 

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ForbiddenComma said:
...I suppose I got sick of the endless preaching about holistic medicine at my school. It's easy to lose sight of the basics...
The ones preaching it are usually not physicians or are trying to make their specialty (Family Medicine...cough...cough) more relevent by making up a skill-set which they believe gives them some advantage over the rest of us who apparently just look at patients as meat.
 

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Some docs just crack me up with their hamhanded attempts to empathize with patients clearly outside of their own socioeconimc realm.

That being said, I don't recall the empathetic/holistic mumbo jumbo being preached all that much in med school. Of course, sounds like it was much worse at Duke from Panda's blog.
 

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Panda Bear said:
The ones preaching it are usually not physicians or are trying to make their specialty (Family Medicine...cough...cough) more relevent by making up a skill-set which they believe gives them some advantage over the rest of us who apparently just look at patients as meat.
I don't think this is all that unique to family medicine. These kinds of docs are in all specialties (except surgery) and seem to share a generalized disdain for keeping up with current evidence based concepts in medicine. I do think some docs "focus on the patient" as they neglect the actual disease. This mentality seems to come into play alot in the diabetic patient, where some docs seem to constantly be walking on eggshells around patients with out of control A1C values.
 

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Panda Bear said:
It's not that I object to empathy and good-bedside manner, it's just the general smarminess of how these things are taught and how they are force-fed to those of us who don't need the instruction.
Don't be so sure about that. Usually, the people who complain the most are the ones who do need it the most. ;)
 
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ForbiddenComma said:
Patch Adams needed a boot to the ass if you ask me. I was the jerk in the back who was actually rooting for the stiff Establishment administrators in that movie to take his self-righteous self down a peg.
:thumbup: Patch sucked, he should've been the one to get shot in the end

Panda right on as usual. Docs, or anyone, will pull things out of thin air to make themselves feel more special and important than others. It's just human nature, might as well let them as long as they don't get pushy and preachy. That's when it gets annoying. Or if they're interviewers--blasted gatekeepers
 

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In general, I agree with the OP. However, remember that it is worthwhile to take an extra minute or two to let the patient know you care. Many of you probably forget how scared patients are, especially those about to have surgery. Think back to when you or your child was hospitalized. I'm not saying you have to spend 10-20 minutes with them empathizing but at least 1-2 minutes is worthwhile and won't destroy your day. Also, if you are in private practice, word of mouth through the community is huge for your business.
 

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Whatever behavior maximizes profit should be done. I don't think it's a subjective issue. Word of mouth and satisfaction are accounted for.
 

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Also some docs just want to solve the problem when there is an underlying cause to the problem. Therefore, they might be solving the wrong problem and just putting on a bandaid. If you don't talk to your patient and find out what's been going on you might not find out this information ...
 

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Margaritaville said:
Don't be so sure about that. Usually, the people who complain the most are the ones who do need it the most. ;)
And sometimes the people who complain the most have functioning bull**** detectors, weren't born yesterday, and can smell a scam a mile off.

You're looking at it the wrong way. I complain about "empathy training" because it's ridiculous and a waste of time. It is stupid and promulgated by worthless idiots with nothing to do with their equally worthless but expensive degrees.
 

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Panda Bear said:
And sometimes the people who complain the most have functioning bull**** detectors, weren't born yesterday, and can smell a scam a mile off.

You're looking at it the wrong way. I complain about "empathy training" because it's ridiculous and a waste of time. It is stupid and promulgated by worthless idiots with nothing to do with their equally worthless but expensive degrees.
Ah yes, the ol' twiddling thumbs syndrome.
 
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[/QUOTE]
In general, I agree with the OP. However, remember that it is worthwhile to take an extra minute or two to let the patient know you care. Many of you probably forget how scared patients are, especially those about to have surgery.
Yes, there is some merit to bedside manner, like I said. I have as my preceptor a surgeon who is remarkable in his ability to soft-cushion the bad news, as a patient's attitude about their sickness probably does make a measurable difference in the outcome.

However, that should not be the *focus* of what the doctor does. The doctor is there to find a physical solution to their physical problem. It's the whole point of the M.D. degree. Everything else is just gravy... and should be thought of as such.

The ones preaching it are usually not physicians or are trying to make their specialty (Family Medicine...cough...cough) more relevent by making up a skill-set which they believe gives them some advantage over the rest of us who apparently just look at patients as meat.
now that you mention it... it IS an FP (and his MPH minions) behind all the holistic stuff at my school. He treats medicine more as a social cause, and less as a science. A nice enough guy, but totally wrongheaded IMO.
 

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ForbiddenComma said:
Yes, there is some merit to bedside manner, like I said. I have as my preceptor a surgeon who is remarkable in his ability to soft-cushion the bad news, as a patient's attitude about their sickness probably does make a measurable difference in the outcome.

However, that should not be the *focus* of what the doctor does. The doctor is there to find a physical solution to their physical problem. It's the whole point of the M.D. degree. Everything else is just gravy... and should be thought of as such.



now that you mention it... it IS an FP (and his MPH minions) behind all the holistic stuff at my school. He treats medicine more as a social cause, and less as a science. A nice enough guy, but totally wrongheaded IMO.
1. Never soft-cushion, sugar-coat, or minimize bad news. That way when things turn south the patient or their loved ones can never accuse you of leading them on.

2. Bedside manner is important. However, it can't be taught except by practice with real patients. The medical schools and residency programs think that a few encounters with standardized patients and a lecture here or there will outweigh your experience from thousands of patient encounters. I think I saw 2000 patients last year. I also had a few standardized patient encounters to teach me empathy which were nothing at all like seeing real patients.

Plus I'm not an actor and I hate performing for a camera and observers like a trained ****ing monkey.

3. You hit the nail on the head. Many in FP do look at medicine as a social cause and this irritates the hell out of me because I'm not interested in their social causes.
 

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I don't have the study at hand, but I remember a couple of years ago that the single factor best protecting a physician from being sued was how much time he/she spent listening to their patients.
 

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Lindyhopper said:
I don't have the study at hand, but I remember a couple of years ago that the single factor best protecting a physician from being sued was how much time he/she spent listening to their patients.
I don't have the link, but the time was 1-2 minutes.

PandaBear is right about not sugar coating bad news. Also, patients seem to react better to it. On my oncology rotation, the oncologist was always straight up. Of course she spent extra time with the patient when she gave bad news, but nothing was sugar coated. While the patients were very upset about the bad news, they seemed to appreciate the straight forwardness. I think it also gave them leave to speak directly with family members. Patients come to us for answers. We don't do them a favor by talking around the diagnosis and prognosis.
 
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It seems to me that everyone here is in agreement that to a certain degree a presentable bedside manner and amount of empathy is a necessity to any professional doctor. It is more an argument of the time spent instructing med students on the importance of such characteristics. It seems like the type of topic which would only matter to someone who is significantly deficient in this particular area, and tired of being surpassed by their fellow students in an area they deem unworthy of instruction. It seems to me that this person would mostly likely benefit the most from this training. It's kinda like, you never hear biochemists b****ing about their biochemistry course in med school.

Dr. Roket
 

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I understand the sentiment from the OP...I'll add a couple of points.

1) Sometimes the medical solutions you can offer a patient are limited, and you have to remember when you have no further options for "treating the disease" you can't forget to "treat the patient." As an example I had a patient with crohns--he's had it for 30+years, has had 15 surgeries (his abd is just full of cobwebs), and was in the hospital for severe abd pain, no BM, and N/V. Worked him up for obstruction, no dice. No surgeon wants to touch him and honestly what would they do? We just try to manage pain and N/V, but really the biggest thing with him is just to listen to him everyday and be empathetic. When you can't treat the disease you shouldn't stop treating the patient as some of the GIs and surgeons seem to do (writing notes w/o stopping in to see him...) cheesy I know, but true

2) Its silly to the point of obsurdity to think that doctors have some power to fix "people." We have the ability to diagnose, treat, and occasionally cure disease. But a lot of people have lives that are in a mess for completely non-medical reasons. Its not our responsibility to fix their lives. We should be aware of how these issues impact on their medical management and their overall well-being, but its their own responsibility to get their lives in order. We can advise them how to do this and we can offer resources when we have them. But we are not some parental figure that is here to fix every problem in their lives.

3) House is very entertaining, but public opinion polls clearly show that while the public enjoys watching House, they would not want him as their doctor. Don't make the mistake of making House your role model
 

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ForbiddenComma, I completely understand but I think you will change your opinion after you become an attending in surgery someday (not a resident.... an attending)... After a couple of lawsuits hopefully you'll see the otherside (Well maybe if I was more polite and cared a little they wont sue me for the failed fundoplication...) There is no way in hell you wont botch up an operation sooner or later.... Even if you don't botch them, you will get patients who hate you anyway (for all kinda wonderful unrelated reasons) and express it in some wonderful ways... (I see feedback replies daily by patients in the surgery practice I am doing research at now.) How much they like you can be the difference between a lawsuit or not...

Even a lawsuit that you win or settle is a loss. It sucks but medicine is what it is..... a customer service business...
 

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YES!!!!!!!!!!!!!!

Medicine is a business. You are providing a service. Due to the consequences of bad service, medicine has to be provided in a manner that often takes into account one's moral code in ways that other jobs might not, but it is still a service. If a patient wants someone to hold his hand, that is your job. If the patient wants someone to cut him open and fix him, that is also your job. One does not hold moral superiority over the other, and the two are not mutually exclusive.

I will say this. A doctor who totally neglects his patient will MISS SOMETHING. This really is no better than the doctors who have all sorts of opinions on national healthcare without any idea how a beta blocker works.

By the way. House, who is an interesting work of fiction, always treats the patient. He is capable of reading a patient and understanding a likely diagnosis from the actions and history of a patient. You will either have to elicit this information yourself, or have a team of really nice surgeon/internist/radiologist/pathologists working under you (Ever seen house).
 

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velo said:
2) Its silly to the point of obsurdity to think that doctors have some power to fix "people." We have the ability to diagnose, treat, and occasionally cure disease. But a lot of people have lives that are in a mess for completely non-medical reasons. Its not our responsibility to fix their lives. We should be aware of how these issues impact on their medical management and their overall well-being, but its their own responsibility to get their lives in order. We can advise them how to do this and we can offer resources when we have them. But we are not some parental figure that is here to fix every problem in their lives.
As usual, you've hit the nail on the head. That's why it doesn't pay to get to much into the "social history" with a patient. If you start asking them about their personal life they will expect you to do something about it even if there is nothing you can do.

This is under the general theory of not opening the can of worms, especially if it's not indicated. Never, for example, under any circumstances ask a patient about domestic abuse unless it is germane to the chief complaint. All of a sudden you will metastasize a visit for a cold into a ultimately useless and dreary slog through the social service bureaucracy of your city.
 

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“A surgeon does not slip from his mother’s womb with compassion smeared upon him like the drippings from his birth. It is much later that it comes. No easy shaft of grace this, but the cumulative murmuring of the numberless wounds he has dressed, the incisions he has made, all the sores and ulcers and cavities he has touched in order to heal. In the beginning it is barely audible, a whisper, as from many mouths. Slowly it gathers, raring from the steaming flesh until, at last, it is a pure calling.”

-- Richard Selzer

The OP closes his post with a picture of Hugh Laurie, introduced to support his concept of the rude, distant, but technically competent doctor. Real doctors with real patients have for thousands of years recognized the importance of treating the whole person, but never mind them, when we can fasten on to a hyperbolic fictional character. And here's hoping US Special Forces ditch their curriculum and base their training on the Rambo movies.

Medicine is the practice of assisting in the repair and good functioning of the human organism. As such, the patient's subjective experience and personality cannot be separated from "what is wrong with them." This is neither a new idea, nor a controversial one, so it cannot be laid at the feet of "political correctness." Skilled physicians since Hippocrates have been reminding their students that they must consider the patient as a whole, not simply a set of symptoms or a "disease process."

What brings most people to a doctor is the need for relief from their suffering. This suffering is related to a disruption of homeostasis, but it is largely a function, in the final analysis, of things going on in the patient's brain. Both the experience of illness, and the process of healing, are to a large extent governed by the brain.

Those who limit their interventions to cuts they can make with a scalpel or relief they can achieve with a drug are, quite simply, not as effective as those who use good communication, underlayed with kindness and respect, to interface with the most important subsystem in the human body -- the brain.

While support and empathy from family and friends is vital, there is no substitute for a kind and respectful caregiver.

It seems the OP is resigned to being an inferior physician, and hopes to compensate for his inadequacies with a greater command of pathophysiology and surgical technique. He may be professionally successful with this approach, but, until and unless he learns how (and why) to practice in a loving way, he will not be a great or even a very good physician.
 

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As of right now, its common sense that almost all successful doctors are nice to each patient, during the time they spend together. Ive shadowed physicians before, even the best. After that patient leaves, do you think they keep up the facade? Some of them make some interesting comments. Ive heard even worse from certain big shot surgeons when their patient is under the knife.

The reality is just as the OP says. We are here to make the patient feel better physically. Not being a jerk helps the patient trust you and come back to you. But youre not the patient's mother. Youre not going to hold their hand, comfort them, etc.

I admit, I am currently a naive med student myself. But even I have realized this. All that 'bedside manner' crap is what admissions officers love to hear. But how many doctors actually practice this? I have a feeling that even when I start my rotations, Ill already be fed up with the lip that some of my patients will be giving me.
 

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prazmatic said:
The reality is just as the OP says. We are here to make the patient feel better physically.
* There is no such thing as making the patient feel better physically. Pain is a subjective event in the brain. Things like the patient's attitude, presence or absence of distractions, anxiety and fear can cause the amount of pain experienced under a given stimulus to vary wildly.

* Love and compassion can coexist with frustration and black humor. Because you see them in sequence, do not assume that one is the reality and the other is fiction. I can feel wretched at a patient's plight and also highly amused at their own contribution to it. It's complicated, but emotions are.

* No one is saying you are forced to care. Some doctors don't. They are simply bad at that aspect of their jobs. You can follow in their footsteps in you like.

To all frustrated with the hard sell being put on compassion, let me explain the state of affairs from my own perspective:

a) Most people are yammering idiots.

b) Much of the time, a good idea that has proven itself over and over, like aseptic surgery or the IED, will be widely accepted and become conventional wisdom.

c) Conventional wisdom is what most people believe (whether or not they believe it for the right reasons) so;

d) Good ideas that have proven themselves over and over end up being advanced by yammering idiots. They get damaged by association. But they are still good ideas.

Ultimately, as Selzer says, it is patients that teach us the absolutely centrality of caring and compassion. The Catch-22 of the OP's perspective is that if you don't value the ability to communicate with your patients, you may shield yourself from the experiences that will teach you that lesson.
 

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I don't know if anyone said it but I'm sure we all heard it "patients don't sue doctors they liked".
 

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I'm reminded of the story about the Oriental Medicine doctor who was the envy of other physicians. It seems his patients did better than anyone else's and the other physicians were determined to find out why.

They observed the master physician for a while and discovered several interesting things. First, the master physician didn't really enjoy being a physician. Secondly, he did very little for his patients, usually just talking and laughing with them. He might occasionally insert a few acupuncture needles or prescribe a few herbs, but that was all.

The other physicians were dumbfounded! It seems they were doing as much as they could for their patients, inserting many needles and prescribing many herbs and other remedies. Why didn't their patients do better than his?
 
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Like I said and I continue to say the same thing.... after residency when you are an attending... when you are the one standing infront of the big lawsuit cannons..... that's when you start asking yourself... are they happy with me?

It's not when you are a resident who is sleep, sex and food deprived and in a year or so you move to a different state and don't care about who did you see in residency while under Dr. XXXX.....

It's not when you are a student who doesn't have to worry about the patient coming back after 2 years and suing you because you would have moved on to a different rotation...

It's when they are your patients and your name is first on the lawsuit.

Here is an example of orthopedist who practices the science without the art of medicine.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=12567124&query_hl=5&itool=pubmed_docsum
 

footcramp

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zenman said:
The greatest carver
does the least cutting.
- Tao Te Ching

I'm reminded of the story about the Oriental Medicine doctor who was the envy of other physicians. It seems his patients did better than anyone else's and the other physicians were determined to find out why.

They observed the master physician for a while and discovered several interesting things. First, the master physician didn't really enjoy being a physician. Secondly, he did very little for his patients, usually just talking and laughing with them. He might occasionally insert a few acupuncture needles or prescribe a few herbs, but that was all.

The other physicians were dumbfounded! It seems they were doing as much as they could for their patients, inserting many needles and prescribing many herbs and other remedies. Why didn't their patients do better than his?
if i'm ever undergoing surgery i'd rather have a world class surgeon rather than roseanne barr or dave chappelle
 

QuikClot

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I suggest this exercise: take 20 case of dramatic, catastrophic breakdowns in care, resulting in massive lawsuits, and look for common denominators. Those I have seen follow a stereotypical pattern. Someone makes a mistake, whether it is the doctor or someone the doctor is responsible for. Then someone -- sometimes the patient, sometimes the family, sometimes a nurse or other mid-level -- notices something. They say to the doctor, “Something isn’t right here” (or they say nothing, because they know by bitter experience that the following will happen) and the doctor says, “DARE YOU QUESTION ME, OZ THE GREAT AND POWERFUL? EVERYTHING IS FINE. I HAVE SPOKEN!” There follows death or crippling injury.

There is no such thing as a first-class doctor that doesn’t have empathy and doesn’t know how to listen. Having those skills is part of being “the best,” not an optional add-on seperate from their performance, like spinning wheels.
 

velo

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I think we're all talking about different things here, thanks in large part to the OP putting that damn picture of House at the end of his post.

Everyone knows the drill about malpractice cases and their relationship to the quality of doctor patient relationships. Its understood, no one's arguing it, we don't need a 5th post about it.

But when you start seeing patients you'll realize very quickly that many of them have medical problems and personal problems, and you have neither the power nor the responsibility to fix their personal lives. You're not their mother, you're their doctor. Now I disagree with P-Bear about the domestic violence issue. I think if you uncover evidence of serious abuse you have a responsibility to flesh it out and get social work involved. But like I said in my longer post, you don't have the power or responsibility to fix someone's messed up life--you should help them in any way you can, but only they can turn their lives around.

and, again, House is a terrible role model. He's entertaining as hell, but public opinion polls show people who like House still wouldn't want him as their doctor.
 

Faebinder

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footcramp said:
if i'm ever undergoing surgery i'd rather have a world class surgeon rather than roseanne barr or dave chappelle

See this shows how little you know about surgery outcomes.... Of course you would rather have the BEST scientific surgeon.. but we are not talking about what would the patient rather have... we are talking about what would the surgeon rather be towards the patient..... An average surgeon with dave chappelle personality will get sued less than a great surgeon with the personality of rock...

Being a skilled surgeon helps a lot.... but it's not hte only factor when it comes to surgery outcome because both surgeons will mess up sooner or later (yes high world class super surgeons do mess up YES THEY DO. They mess up at different rates but THEY BOTH EVENTUALLY DO.) But the average nice surgeon will get away with the mess without a lawsuit versus the SUPER surgeon who is an ass to the patient who will get sued.
 

QuikClot

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velo said:
But when you start seeing patients you'll realize very quickly that many of them have medical problems and personal problems, and you have neither the power nor the responsibility to fix their personal lives. You're not their mother, you're their doctor.
Things are not so clear-cut. Any serious medical problem is also a personal problem -- What do I do about my pain? What is going to happen with my job? Why is this happening to me? and so on.

Equally, a plan of care will live or die over what happens in a patient's "personal life." Will they take their meds? Do their PT? Come in for wound checks? Maintain the attitude of hope, optimism and determination that we all know is critical to long-term recovery? If not, a world-class surgery won't help for ****.

Helping answer those questions, and encourage the right "personal" behavior, is also part of a doctor's job. Of course there are boundries. Of course a doctor's responsibility is not unlimited. Of course family, spouse, friends, and community should and often do lend support. Of course you have to be able to focus on doing what is right (which is under your control) and letting go of the final outcome (which is not). But that is not the same thing as saying that compassion, empathy, and emotional support are not a part of a doctor's job. Unless you are a pathologist or a radiologist, they are.
 

McDoctor

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Panda Bear said:
As usual, you've hit the nail on the head. That's why it doesn't pay to get to much into the "social history" with a patient. If you start asking them about their personal life they will expect you to do something about it even if there is nothing you can do.

This is under the general theory of not opening the can of worms, especially if it's not indicated. Never, for example, under any circumstances ask a patient about domestic abuse unless it is germane to the chief complaint. All of a sudden you will metastasize a visit for a cold into a ultimately useless and dreary slog through the social service bureaucracy of your city.
Yeah, but its just sheer laziness when a patient comes into your office or clinic for a cold and you only address the cold. This practice of only addressing the chief complaint is exactly what leads the public to assume that a PA or CRNP is equivalent to a family doctor. You need to go beyond the chief complaint in some area during the visit.

I tend to agree, though, that too much emphasis is put on the social history. As a student, an attending once gave me a hard time after taking a history from a patient who listed PTSD on her medical history (not part of her chief complaint) for not delving into her "trauma" further. I can't imagine most patients would appreciate that level of unsolicited intrusiveness on a regular basis from a family doc.

But I don't think that routinely asking about domestic violence is out of line. How hard is it to ask someone if their home environment is safe and to provide them with some info where to go if it isn't? Takes less than a minute.
 

velo

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QuikClot said:
Things are not so clear-cut. Any serious medical problem is also a personal problem -- What do I do about my pain? What is going to happen with my job? Why is this happening to me? and so on.

Equally, a plan of care will live or die over what happens in a patient's "personal life." Will they take their meds? Do their PT? Come in for wound checks? Maintain the attitude of hope, optimism and determination that we all know is critical to long-term recovery? If not, a world-class surgery won't help for ****.

Helping answer those questions, and encourage the right "personal" behavior, is also part of a doctor's job. Of course there are boundries. Of course a doctor's responsibility is not unlimited. Of course family, spouse, friends, and community should and often do lend support. Of course you have to be able to focus on doing what is right (which is under your control) and letting go of the final outcome (which is not). But that is not the same thing as saying that compassion, empathy, and emotional support are not a part of a doctor's job. Unless you are a pathologist or a radiologist, they are.
well, obviously

that's why when you read my first post you see that it says...

We should be aware of how these issues impact on their medical management and their overall well-being
but goes on to say...

but its their own responsibility to get their lives in order. We can advise them how to do this and we can offer resources when we have them. But we are not some parental figure that is here to fix every problem in their lives
 

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I don't know if this is totally in the area of family medicine but could you imagine how far someones primary could get if they only asked what hurt? They would fit in the 15min they were given for each patient, but no nothing about anyone they saw that day. You don't have to be Dr. Compassion but part of being a Doc to my understanding is a professional relationship with your patients, follow up care, on going care, etc. Saving lives is great and very important but not every aspect of the job will have to do with that.
 

footcramp

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Faebinder said:
See this shows how little you know about surgery outcomes.... Of course you would rather have the BEST scientific surgeon.. but we are not talking about what would the patient rather have... we are talking about what would the surgeon rather be towards the patient..... An average surgeon with dave chappelle personality will get sued less than a great surgeon with the personality of rock...

Being a skilled surgeon helps a lot.... but it's not hte only factor when it comes to surgery outcome because both surgeons will mess up sooner or later (yes high world class super surgeons do mess up YES THEY DO. They mess up at different rates but THEY BOTH EVENTUALLY DO.) But the average nice surgeon will get away with the mess without a lawsuit versus the SUPER surgeon who is an ass to the patient who will get sued.
i'm sorry, i don't measure surgery outcomes by the number of times one gets sued :rolleyes:

besides, i don't even know why are you addressing me when the topic of your posts are completely different than mine. all i'm saying is that making me laugh won't take care of my problem. whereas the zenmaster was trying to convince us of some magical powers of laughter.
 

QuikClot

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velo said:
well, obviously
"To truth only a brief celebration of victory is allowed between the two long periods during which it is condemned as paradoxical, or disparaged as trivial."

-- Arthur Schopenhauer
The World as Will and Representation

I stopped reading when you admitted I was right and you were wrong . . . hope i didn't miss any good rationalizations. ;)
 

Larch

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QuikClot, I've just got to say I was really happy to see your posts. After reading the first page, I was getting the impression that everyone in here is horribly jaded. It made me start to wonder why anyone in this forum wanted to be a doctor if they didn't understand the importance of compassion and a genuine desire to be of service to others when it comes to being a doctor. Not to mention the constant FP-bashing, but that's another topic entirely.

Anyhow, you said everything I wanted to say only much more eloquently. It's always nice to see someone who is well-spoken on the internet.
 
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i'm sorry, i don't measure surgery outcomes by the number of times one gets sued

besides, i don't even know why are you addressing me when the topic of your posts are completely different than mine. all i'm saying is that making me laugh won't take care of my problem. whereas the zenmaster was trying to convince us of some magical powers of laughter.
Right... it's not a good idea of using lawsuits as an indication of how good you are as a doctor. Let's face it: if you don't want to get sued, then you picked the wrong profession to begin with.

Bedside manner is a wonderful thing to have. Of course it is. Nobody is denying that. And in a perfect world, all doctors would be brilliant as well as compassionate. But at the end of the day, if I'm forced to choose between being the mediocre doctor with a heart of gold, or else Dr. House... then I'm gonna have a real kick-ass cane.

After reading the first page, I was getting the impression that everyone in here is horribly jaded.
I'm sorry if I gave that impression. I'm one of those "painfully enthusiastic" types when it comes to medicine. In fact... I may be more committed to treating ailments than I am to holding the patient's hand. Which is my original point. This is medicine, not nursing.
 
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ForbiddenComma

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oh and if House is too extreme an illustration of the original post... I suppose there is also this guy too:



:cool:
 

velo

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QuikClot said:
I stopped reading when you admitted I was right and you were wrong . . . hope i didn't miss any good rationalizations. ;)
all I admitted was it is obvious you didn't read my first post :rolleyes:
 

QuikClot

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Larch said:
QuikClot, I've just got to say I was really happy to see your posts. After reading the first page, I was getting the impression that everyone in here is horribly jaded. It made me start to wonder why anyone in this forum wanted to be a doctor if they didn't understand the importance of compassion and a genuine desire to be of service to others when it comes to being a doctor. Not to mention the constant FP-bashing, but that's another topic entirely.

Anyhow, you said everything I wanted to say only much more eloquently. It's always nice to see someone who is well-spoken on the internet.
Thanks! I don't even see it as a matter of being jaded or not. I'm a paramedic, and in EMS being a little jaded is de rigueur. But even jaded medics, if they're smart, recognise that you don't get a nice, clean, sugical seperation between patient's personal lives and their medical problems (as velo claimed before he uncovered evidence of an earlier post indicating he believed the opposite) and that caring and an attitude of service are critical to the relief of suffering and successful recovery from illness.

Different people will put their boundries in different places, but that's different from saying that compassion isn't your job, surgery is (or whatever).
 
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