Obama on nurses, physicians
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Actually Obama is none of those things. He's a complete *****. He's mastered the art of reading off two teleprompters which sadly passes for being "articulate" these days. Watch him unscripted some time. He can barely cobble together a sentence.
Despite his complete cluelessness, however, he's more than willing to offer his opinion and dictates to a wide variety of issues.
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Perhaps his mistake was giving physicians and student physicians too much credit and not realizing how fragile their egos were and how much they needed to be stroked, too. Come on, you guys, look at the context. He was trying to be sympathetic to the nurses so he said what they wanted to hear; that they are appreciated and that people realize how hard they work. He wasn't trying to discredit physicians in any way.
You all are incredibly sensitive and read way too much into things that just aren't there.
You all are incredibly sensitive and read way too much into things that just aren't there.
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Uh did you actually read what he said? If all he wanted to do was be nice to nurses then why even mention doctors at all? He coulda just said a bunch of bland stuff about how nurses are the "backbone" and "caregivers" of the medical field or whatever. But he chose not to do that. He made not one, but two specifically derogatory comments against physicians, implying that nurses are the more valued/superior team member in healthcare.
He deliberately mislead the audience into thinking that the physician doing the LP was superficial while the nurses provided the "real care."
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exactly. If he wanted to be nice to the nurses in the forum why mentioned that the doctor was there for 15 minutes and the nurses all the time, or why mentioned that during the LP the doctor was nowhere to be found. Obama is a very good speaker and if he wanted to be nice to nurses w/o blasting on MD's he would have done it very easily.
Bottom line: Obama is a lawyer, lawyer hates doctors. is that easy.
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Uh, yes, I did. He didn't make derogatory comments against physicians, he stated facts. Obstetricians aren't around except for the final minutes of a delivery. The nurses do provide 95% of the routine care. He didn't chastise the OB for that. You must be the one who thinks it is a wrong practice if you see what he stated as accusatory.
In the second case he did, in fact, say the physicians did a great job when caring for his daughter with meningitis. He said the nurses were there "with us when she had to get a spinal tap, and all sorts of things that were just bringing me to tears." To me, he is saying they were there to help comfort the family through the tough times (like the spinal tap). If you actually read what he was saying, you'll understand that the whole point of his statement was to agree that nurses are necessary and that they are their patients' advocates, which they are. He never said physicians aren't, and I can't believe the lot of you are so uptight about it that you see his omission of praise for the "great doctors" as some sort of attack on what we do and how we behave. He was addressing a nurse and her concerns, so he talked in terms of the nurse. Nothing more.
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I think that nurses are underappreciated, especially the good ones. But it doesn't make any sense to pit the doctors against the nurses. I'd say good doctors are working their butts off and extremely underappreciated as well.
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If you read the actual transcript, the president really didn't say anything bad about physicians at all. I think the title and description of the AP article made it sound a lot worse than it was; if anything, the AP writer was the one who was making the slam against doctors and twisting Obama's words.
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Obama is a politician, hes not just gonna come out and say things, he knows better. You have to read into what hes saying, and its quite obvious which way hes leaning. His comments show no understanding of what the doctors end up doing. The fact that you hear him say the obligatory "doctors were great" and then miss the " but the nurses were always there for me" shows you're just taking his words at face value. Never trust a politicians words at face value.
People arent being too sensitive. Obamas trying to push massive reforms in the healthcare system. Thus when it comes down to it, hes gonna be looking out for the nurses interests, because he happens to see the nurses more. The isnt about ego and hurt feelings. This is about the future of healthcare.
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What are you talking about? Do you see secret messages in the stone carvings of free-masons? There is no conspiracy here. He never said anything bad about physicians, he just said good things about nurses. Does every compliment for one have to come with a compliment for the other to be unbiased. Are nurses and physicians diametrically opposed such that to be for one you must be against the other? It simply isn't the case.
And what, exactly, will he do to specifically benefit the nurses and not the physicians? Let them have their own hospitals that do not have physicians at all? Let them operate without a surgeon? Give them permission to discharge patients without asking the admitting physician? Give them a raise?
Talk about paranoia...
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not the surgery part but yea. Nurses are pushing for primary care, he'll make it easier for them to take, etc.
If you wanna trust whatever politicians say go right ahead
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In this situation, though, it's not about trusting what he said, as he didn't say anything, positive or negative, about us. The fear expressed on this thread would have been as justified as if he had answered a question about his opinion on professional basketball by saying his favorite player was Julius Erving. It would have as much to do with his opinion of physicians as the statement quoted here.
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What?
Uhh, if he had a nurse performing the LP....
As for "setting the nation's health policy" -- that's akin to letting the UAW take over corporate... I'm sure that would work out well, too. I'm surprised that the new administration has been so slow in suggesting that....
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Its quite clear what he was saying. And this doesnt seem very neutral. Its positive for nurses and negative for physicians, but thats the way it should be as the nurses are doing everything afterall 🙄.
In fact he blatantly says
"I'm biased toward nurses, I just like nurses -- (laughter). When Michelle and I went in and Malia was being born, the OB/GYNE was a close friend of ours and so was much more attentive than the usual OB/GYNE might be. But the fact is, we only saw her for like 15 minutes. The rest of the time, it was nurses who were doing everything. When Sasha, our little precious pea -- (laughter) -- she got meningitis when she was three months old -- very dangerous. The doctors did a terrific job, but, frankly, it was the nurses that were there with us when she had to get a spinal tap, and all sorts of things that were just bringing me to tears."
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Exactly. That's how much sense this thread makes to me.
Uhh, he didn't, nor did he ever say he did. He said the nurses were present when the LP was done, just as they were there for everything else that was being done that "brought him to tears." He didn't say they were performing those things. They are supportive, and it goes along with what the nurse initially said about being a patient advocate. He was trying to show that he agreed with her by giving specific examples from his life of nurses being advocates and being supportive.
Now it is my turn to ask if you actually read the article.
nurse said:
He said they would be present at the health care summit, not that they would be setting health care policy. They will be there with hospital administrators, physicians, etc... It won't be just nurses and Obama setting the healthcare policy. 🙄Obama said:
For starters, I don't think you have a very realistic or accurate grasp as to what happens on the hospital wards. Nurses provide 90-95% of patient care. To argue otherwise just shows your complete lack of experience on the subject. I would drop this if I were you because you are wrong. Obama never said nurses do "everything." However, he is right that nurses provide a majority of patient care.niranjan162 said:
Re:"I'm biased toward nurses, I just like nurses..."Again, you assume that nurses are on one end of the scale and physicians are on the other, a belief that you may hold but that isn't correct. It is a team effort. He is biased toward nurses instead of being biased against nurses. It isn't that he is biased toward nurses and, therefore, against physicians.
Nurses are the more compassionate of the two groups (nurses and physicians). They are the ones on the front lines, changing linens when a patient loses bowel control in their bed, comforting patients when they have another hour before their next dose of pain medication, yet still hurt, etc... They are the ones who do the dirty work that you don't want to do. They are a vital component of the healthcare team, and, believe it or not, they are on our side. They do provide a majority of the daily care and they should be allowed to have an input into the health care summit as they have a different perspective and will have something to offer.
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I actually don't agree that nurses, as a group, are more compassionate than doctors. Just because that is the conventional wisdom, does not mean it is true. I have seen some not very compassionate nurses, although many are compassionate. I get tired of hearing nurses, politicians and others holding up nurses as ideal, compassionate health care professionals who "do everything" while the doctors sit around in the doctor's lounge drinking coffee. Now, I like Obama in general and I voted for him, but I saw that town hall meeting and I do think what he said came across as political pandering and that it made it sound like nurses are the only ones "doing everything" in the hospital. In reality, it's the patient care techs working below the nurses who do a lot of the really "dirty work", at least in the hospitals where I have worked. And in addition to docs and nurses, you have respiratory techs, pharmacists, physical therapists, etc. all working hard for the patient. Yet you never hear someone lauding a physical or occupational therapist or a physician for "compassion" and patient care skills. Nurses seem to have a lock on that in the minds of some of the public and politicians.
I find that the folks who went through IM residency with me were, as a group, extremely compassionate and dedicated. It actually takes a lot of dedication to repeatedly work 30 hrs in a row in the hospital Q3 and Q4, updating the patient and family multiple times/day about the patient's condition and plan of care, etc. I agree that nurses provide a lot of important patient care, and as a group are highly educated professionals. I disagree that nurses do "dirty work that I don't want to do". I have actually done a lot of things that some nurses did not want to do...like getting an IV on a patient, helping do enemas on the patient, etc. There are a good number of nurses who will sign out at the end of their shifts, no matter what is going on. I don't know any residents in my program who would do that. I think compassion is an individual characteristic, more than one possessed by only one particular profession in the health care team.
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No offense, but whether or not you agree with it or whether or not I'm right about it has nothing to do with whether or not Obama was against physicians in his statement, which is the focus of this thread and is what I've been arguing against. Of course there was political pandering; he is a politician and, like I initially said, he was addressing a nurse and trying to answer her concerns. My point is that at no time did he ever do so at the expense of physicians. I'm just trying to prevent this thread from becoming derailed. I will address the rest of what you said because I need a break, but, in the end, it is a sidebar.
I agree (although I do hear a lot of patients praising the PT/OT therapists) and I think most of that stems from the fact that the nurses are the common group and don't come in for a 30 minute treatment or a 1 hour session and then bounce for the rest of the day. They see their patients for 8-12 hours/day and are, essentially, their primary caregiver while in the hospital. It is a lot like the military; physicians are the officers creating the battle plans behind the scenes but with little true "combat time" while the nurses are the infantry that get their hands dirty on the front lines.
I never said physicians weren't compassionate and I never challenged their dedication, so let's not confuse or integrate the two, especially since they can be mutually exclusive.
Helped who do the enemas? The nurses? Then you really weren't doing something they didn't want to do, were you?
Look, I've started my fair share of IVs, placed numerous NG tubes and foley catheters that the nurses "couldn't get," etc... I've also helped the nurses clean linens, change filthy dressings (aside from the standard dressing changes), transported stable patients and a whole host of things that they would normally be able to do themselves. However, I would say they do well over 50% of these things without me, so for me to cite my minimal contribution on the matter as evidence that I do the same "dirty work" they do is a bit misleading, don't you think?
I agree that compassion is an individual characteristic and I concede that there are some nurses that do not have compassion in the conventional sense (you can't clean someone coated in their own crap without having compassion, of that I am certain). That said, on the whole, I think they are appropriately considered the more openly compassionate group, as there are more physicians that are distant or awkward with their feelings than there are nurses and nurses are the ones on the team who interact with the patient most.
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You're right im sorry. I thought healthcare was a team effort, but if nurses are doing 90-95% of work it sounds like doctors are a pretty poor part of the team.
I also thought things like doing LPs, physical exams and such were part of the "front line".
Also i didnt know that nurses were more compassionate, I guess they must learn that during their DNP courses. I thought it was person dependent, i.e. there are people who are jerks and people who are kind.
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I'm glad you are here to perpetuate the misinterpretation of his words, your incorrect medical knowledge (nurses don't do LPs!) and the "holier than thou" attitude towards nurses (see bold to understand why I inferred that from what you said; something more blatant than anything said by Obama against physicians). I'll now continue this conversation with the wall in front of me because if I yell loud enough into the corner it will actually repeat back to me what I'm saying, suggesting at least it registers something...🙄
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The fact that you voted for Obama proves you have no idea what you are talking about.
The only man who made any sense in the presidential election was Ron Paul.
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First of all ive never said nurses arent important in healthcare. Ive also never said that doctors are better than them. I have said that they are different and do different things.
I know nurses dont do LP's, and thats exactly my point. Everyone says that nurses are the "front line" of healthcare, well arent things like LP's part of the front line? Isnt doing a surgery the front line? Lets look at it this way. Its been said in this thread that the techs and pharmasists, etc. do alot of patient centered work and are also part of the front line. So the techs are doing alot of the dirty work, so theyre part of the front line. The nurses are administering medication (which takes alot more knowledge than changing linens) and doing other things so theyre part of the front line; but doing a surgery isnt? Why not, telling the patient's family whats happening etc. isnt part of the front line?
I can see the delineation between researching a condition and doing an LP. The research is cerebral and doesnt require any patient interaction, i.e. your general in your military example formulating a plan. But the resident doing the LP? he would be a second Lieutenant i guess, right there in the trenches with the rest of the platoon, on the front lines.
The DNP thing was to point obvious polticial motives. In the hospital everyone has the same goal, get the patient better and earn your keep while doing it.
However outside the hospital nurses have a different agenda and physicians have a different agenda. Why wouldnt they? they are two different groups and they are gonna both be vying for whats best for their own group, and this is where what obama said is important.
You say talking to me is like talking to a brick wall, but you havent provided me with anything to think about. All youve said is that I dont understand how it works in the hospital, I get it, people work together in the hospital, but that doesnt stop them from having their own political agenda for the betterment of their profession outside of the hospital. This is the point i was trying to make.
You say that obama being pro nurse doesnt mean that he is pro physician, but if nurses are trying to expand into other specialties than that is anti-phyisician, and since he is biased towards them he will be supporting their agenda whether he knows it or not.
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No, they aren't. Front line, to me at least (and, as a result, my usage of the phrase this thread) means the people who are doing all of the little things for patient care. The front line is the "grunt work," not the glamorous, life-saving surgery or performing the diagnostic intervention. Being on the front line means you are interacting with the patient constantly (much as being on the front line in the military means you are interacting with the enemy), not that it is the initial intervention (like an LP for diagnostic purposes in the ED) or the dropping of the bomb to end the war (like an appendectomy after the diagnosis of appendicitis is made).
I basically addressed this above, but I'll make special note to tell you that, oftentimes (particularly in private practice), it is the nurse that does this far more than the physician (because nurses interact with the family more [that "front line" thing again] and serve as liasons and because we physicians are not always around to update the families due to rounds, being in the OR, etc...).
What I've asked you to think about is that you can be pro-nurse without being anti-physician, yet you continue to argue the same points of "he's pandering to the nurses which means he's against us, etc..." I don't know how else to say it.
That's all well and good, but it doesn't mean Obama said anything anti-physician in anything he said, and that is the only argument I've been championing on this thread. Everyone was making his "I like nurses" comment out to mean "I hate physicians," which is a stupid and incorrect extrapolation that suggests either (a) animosity towards nurses (the nurses good = physicians bad argument I've been making), (b) a sad, fragile ego or (c) an irrational fear of change that people as intelligent as those in this field should not have.
This is a flawed assumption.
1. You are again assuming that being biased towards nurses means being biased against physicians rather than being biased against nurses.
2. You are overlooking the fact that other health care professionals (including physicians) will be at the health care summit to offer a "checks and balances" system against these terrible nurses who are looking to extend their grasp on health care.
3. Nurses trying to expand into other specialties isn't anti-physician, it's pro-patient. There is a shortage in primary care that U.S. medical school graduates don't want to fill, so there is a market and an opportunity to improve patient care. Do I think it will do much harm? Not so long as there is adequate supervision (the NPs and PAs with whom I've worked have, on the whole, been a great addition to the team and have allowed residency training to continue without being in violation of the 80-hour work week). Furthermore, I'm in no place to complain about the loss of "our territory," as I am one who chose to go into a non-primary care specialty, thus contributing to the health care problem that exists and thus creating this primary care market for them. But again, I don't see this as anti-physician; they will not be "takin' 'er jebs!" because there are more patients than physicians and recent trends suggest this will only worsen as time goes on due to fewer grads going into primary care and an increasing (elderly) population in the United States.
So, in short:
- I think coming to the conclusion that Obama's statements were anti-physician is paranoid.
- I think assuming that since Obama is biased towards nurses, he is going to let them have their way with primary care is absurd.
- I think that a lot of people choose to complain about nurses encroaching on "their" territory, yet match into radiology, dermatology and other specialties instead of primary care, creating a bigger void in the provision of primary care and opening the door for nurses, PAs and the like to move in on that much needed aspect of health care.
I find that practice a bit hypocritical and liken it to your favorite celebrity owning a Prius for the environment and then flying on a personal jet from NY to LA for the premiere of a movie.
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"it was the nurses that were there with us when she had to get a spinal tap, and all sorts of things that were just bringing me to tears."
Does he mean there were only Nurses present during the LP, or did he mean they were the only ones "there" for him. Kind of like "I broke up with my boyfriend because he wasn't 'there' for me". 🙂
I think he was pandering to a demographic, but whether or not that pandering ends with talk or continues to policy, we'll have to see.
Does he mean there were only Nurses present during the LP, or did he mean they were the only ones "there" for him. Kind of like "I broke up with my boyfriend because he wasn't 'there' for me". 🙂
I think he was pandering to a demographic, but whether or not that pandering ends with talk or continues to policy, we'll have to see.
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...posted two weeks ago in another forum. BHO was most certainly pandering to his organized labor base.
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Physicians have a strong presence in Obama's healthcare reform. I'm not worried about it. Clinton was far, far scarier. Remember Clinton's mommy is a CRNA and he did more than anybody else to open the doors wide for nurses.
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agreed. everybody's reading too much into his statement.
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Ok, my opinion is that anything where youre interacting with the patient (the enemy as you put it) is the front line. Perhaps you could explain why only grunt work is considered the front line.
I see what you are saying. Perhaps its nothing to worry about, I just think about when it comes time to make concessions, if the nurses are being favored it is inherently anti-physician (simply because it does not favor them).
I dont think its hypocritical. I also think that having nurses move to PC is anti-patient. You've consistenly said how important the nurses are and how they are the front line, which i agree with (i just think the front line is more pervasive). So since there is already a nursing shortage, wouldnt letting them go into PC make the shortage even worse?
Addressing the hypocracy issue, I think its important for medicine as a profession to stand together whether it be radiology, dermatology, etc. The way I see it, alot of what nursing organizations are doing is to try to practice medicine and claim it is nursing. The DNP for example is farce to trick people into thinking that nurses are equivalent to physicians. If they take over PC whats to stop them from moving into other fields, this is already happening in anesthesia.
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I think that what 'bama said is crap, but i think some of you should rethink what you are saying about nurses. I dont know how you think you can do your job as a physician if you don't respect them as colleagues. Maybe some of you are why people talk about arrogant doctors.... And this isnt coming from a nurse, but from a future doc. (im not trying to start a fight or call anyone out, but just trying to get respect for a very important profession)
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Lets see you put your money where your mouth is. There's a shortage of gen surgeons in rural areas. I'm sure you're all for allowing PAs or NPs to do "simple" surgeries solo since there is no access to care in these areas, right?
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Because if everyone that interacted with the patient was on the front line, there would be no middle or back line.
platon20 said:
Perhaps it is a result of where I train (or, perhaps, the reason why I chose to train where I am), but I'm a fan of specialty surgeons. I think they have better results. As such, I don't think every town of <50,000 needs an HPB surgeon, a surgical oncologist, a cardiothoracic surgeon, a colorectal surgeon or even a vascular or "MIS" surgeon. I struggle to buy the surgeon shortage that they've been talking about for the last 30 or so years, particularly in rural areas (A study [Arch Surg. 2005;140:74-79] found that the number of general surgeons in rural areas was static over the last decade. Furthermore, the population is shifting from rural to urban [I think last year was the first time the urban population outnumbered the rural population in the US], so the rural population is ever declining, lowering the overall population "underserved."). What you have is a shortage of surgeons willing to operate in the middle of the night (as evidenced by the insane number of patients we get referred for mundane things [i.e. "complicated" appendicitis] by community surgeons) or a shortage of hospitals willing to take on burdensome patients (intra-abdominal catastrophes that have been in the unit for a week and are "stable for transfer" but only to an ICU because they are still on a vent; you may know of these as the "Friday afternoon special"). Yes, the wait to have your elective hernia repaired might be 3 weeks at our hospital, but you get your pancreas cancer treated within 7 days. To me, that isn't a surgeon shortage.
Furthermore, if you look at the definition of "general surgery," it includes GI, vascular and pediatric. Vascular is rapidly becoming its own branch of surgery, removed from "general surgery," and increasing in popularity. You can remove that patient population from the general surgeon's call entirely.
The shortage numbers I've seen proposed are 5 surgeons per 100,000 patients in 2020, down from 7 per 100,000 in 1990. The best article I could find looking at number of general surgical admissions per 100,000 patients is from England in 2002. It lists them as following (I've edited out the non-general surgery emergencies and the things that I wouldn't consider surgical admits, at least at the hospitals where I work):
Gallstone disease: 158
Cutaneous abscess: 61
Diverticular dz: 88
Pilonidal sinus: 32
Appendicitis: 227
Obstruction (non-malignant): 92
Ano-rectal abscess: 50
Carcinoma of colon/rectum: 63
Femoral hernia: 22
Inguinal hernia: 54
Rectal bleeding: 37
=====================
884 surgical emergencies per 100,000 patients per year.
If you have 7 surgeons, there are a little over 126 emergencies per surgeon. If you have 5 surgeons, there are 176 emergencies per surgeon. That equates to less than one extra surgical emergency per week per surgeon and I wouldn't call those numbers overwhelmingly disturbing (at least, in my mind, not worth the Washington Post's doomsday picture).
If anything, the shortage is in pediatric surgeons, and I'm doing my best to fill that void and plan (group permitting) to spend one day a week in a "rural hospital," seeing patients for elective procedures and operating on them the following week.
To specifically address your "money where my mouth" is, I think teaching rural FPs to do appys and choles is a better place to start than letting NPs and PAs do them (this is all assuming the "acute care" or "hospitalist" surgery options don't fill the void). However, if the FPs or other physicians don't want to learn, maybe letting NPs and PAs lessen this supposed shortage (if it truly pans out that there is one) is a viable option. You've brought up the fact that there is a problem, but you and the rest of the physician community don't seem to want to be a part of the solution, so perhaps it's time to call in those who do, even if they don't have an MD or DO after their names. If anything goes wrong, we only have ourselves to blame because we are the ones who set this ball in motion (choosing other specialties, choosing to sub-specialize,etc...), but at this time it is hard to say what is worse, having to travel 100 miles for treatment, being treated by someone who isn't a surgeon or not being treated at all.
Look, I don't want to turn this into a DNP vs PA vs MD/DO debate, which is where it's headed. I just think that, in the area of primary care, ANPs and PAs can help to fill a void. I never said they should be independent, I just said they can help lessen the shortage in primary care. I'm not willing to say they should be able to operate, but that is because I think the training is different (and why it takes 5 years to become a general surgeon), and (please don't take this as a knock, those of you in FP or other primary care specialties, because it isn't) while it is easy to learn the basics of FP in a compressed length of time, the same isn't true for surgery. However, if you want to take a PA or DNP, put them in a 3-year surgery "residency," I think they would be okay to do the basic appy, chole, etc..., much as I think they are okay to take care of the run-of-the-mill stuff you see in a general practice clinic. As long as they recognize their limitations and know when to bump things up, PAs and DNPs are as good as residents and can handle the same level of autonomy.
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I don't know why anybody is ever shocked that nurses do all of the "nursing".
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\I don't know why anybody is ever shocked that nurses do all of the "nursing".
because they are now qualified medical doctors or at least are pushing this preposterous idea
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Stop. This is a re-hashed gripe. If you feel passionately about this, write your state medical board, the AMA, or congress. Organize a grand rounds on the topic or write to a major journal. Or better yet, undertake a broad based outcomes study comparing the two groups so that those who legislate for physician groups can have some data.
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This was VERY discouraging for me to see this professionally and personally. My heart really dropped in my chest.
Physicians may very well be the single most misunderstood element of modern society. No one truly understands how hard the training is, how much sacrifice it takes or what type of responsibility lays in our hands. There is a good reason the physician suicide rate is so high.
I strongly feel all physicians should just not show up to work for like a month. See what America would be like. End the taking for granted of the skill set once and for all!
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fwiw, my mom is a nurse and I have a lot of friends that are nurses.. I think nursing if done right is an awesome job with great education/pay ratios and pt contact, etc.. but technically nurses are not "colleagues" of physicians. Colleague = associate in profession. Medicine is a profession, separate from engineering just like it's separate from nursing. Not to nitpick but I see this attitude more and more and I think it's an important distinction to make. I really wish people would be happy just doing nursing because it's absolutely necessary but there's a stigma about "practicing medicine" that makes it seem attractive to people who haven't gone to med school.......
just last night I was talking with an NP in a totally non-work setting and she asked about med school and I said something like, "it's a lot of work and a long road but I really like it and having this opportunity is amazing and etc.." and she responded verbatim, "Well I'm glad I get to practice medicine without going to med school." Those exact words.. you'll see this attitude a lot.. it's just disrespectful towards the whole idea that the opportunity to prolong quality of life through the comprehensive understanding of human science is worthy of a lifetime of diligent study, which is something I absolutely believe and is why I'm studying medicine. You know I wanna be cool with everyone and avoid drama but every time I hear someone outside medicine talk about "those stupid doctors" and how the training is "unnecessarily long" and "all those stupid details" and blah blah blah it just makes me sick.. that is all.
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It sounds like he's just sucking up to nurses to me! You kinda have to with nurses... It just reminds me of Scrubs second episode "My Mentor" with Carla and Elliot and what Kelso says.
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I hate to say it, but physicians (as a group) are doing this to themselves.
As someone who has recently had a family member admitted to one of the top hospitals in the US (per US News rankings; and yeah, we know that's a load of b*llcarp, but does Joe Shmoe?), I can attest that I was appalled at the "service" that the physicians provided. Without going into details, let's just say this person had a procedure of moderate complexity, luckily without complications. Still, except for immediately post-op, they did not see a physician till 24 hrs later, and it was a resident who stopped in for all of 30 seconds. The attending came by some time later, but the entire visit took less than 1 minute. And this continued for the next few days. The nurses, on the other hand, were great, always available at the push of a button.
Comparing the two would be apples and oranges.
As a physician, I know most of what goes on behind the scenes, however, on the "front-lines" that image is lost to the patients. What it comes down to, is that most physicians can't communicate compassion to save their lives. It's not easy, and generally not something they learn in med school or residency. And yes, it is something that can be taught and learned, but it takes time, effort, and appropriate role models; all the things that a lot of med school/residencies lack. So we, the poor MDs and MDs-to-be drudge on, learning the "art" and hard-science of medicine, and what we're mostly tested on (USMLEs, etc). Compassion, a.k.a empathy, are swept aside for "scientific knowledge". Any surprise? Most people, including on this forum, seem to believe that these are innate abilities that certain people "just" posses. I don't think that's true. Compassion and empathy are environmental traits, and therefore can be learned. They are not criteria that necessarily get you into med school and beyond. And once there, are hardly addressed in the educational process. I don't know how it is in nursing school, perhaps they do offer such courses. Someone care to comment?
So going back to the point I was trying to make, Joe the Plumber, Abe the Accountant, Larry the Lawyer, and Nance the Nurse go to the hospital as patients and see their doctor for all of 1 minute a day... while the nurses are always around... and who do you think has the more powerful lobbies when it comes to political movements... I'm guessing it's the plumbers, the accountants, the lawyers, the nurses, etc etc. So, in the end, they will make those decisions for us. Because we (ie. physicians) sure can't find a good way to band together, and we certainly are incapable of projecting a great image for ourselves.
I'm generalizing a bit, I know, but I have seen the above scenario played out on both sides of the fence, over and over again, and I'm just as guilty as most of you are, for not having the "time" to see patients and spend as much of it with them as they require. And if you're thinking "that's not me", there's plenty of studies out there that show that we physicians are disconnected from how we perceive our patients' perception of how they view they are being cared for (I hope what I just wrote makes sense). We have no idea. It all comes back to empathy, and our lack of it. So, you may "feel" compassion in yourself, but are you actually projecting that to your patients? I'm sure most of us are compassionate, whether we're nurses or physicians, but some of us (perhaps a lot of us?) are simply not good at projecting it.
If you don't believe me, wait till you're the patient.
As someone who has recently had a family member admitted to one of the top hospitals in the US (per US News rankings; and yeah, we know that's a load of b*llcarp, but does Joe Shmoe?), I can attest that I was appalled at the "service" that the physicians provided. Without going into details, let's just say this person had a procedure of moderate complexity, luckily without complications. Still, except for immediately post-op, they did not see a physician till 24 hrs later, and it was a resident who stopped in for all of 30 seconds. The attending came by some time later, but the entire visit took less than 1 minute. And this continued for the next few days. The nurses, on the other hand, were great, always available at the push of a button.
Comparing the two would be apples and oranges.
As a physician, I know most of what goes on behind the scenes, however, on the "front-lines" that image is lost to the patients. What it comes down to, is that most physicians can't communicate compassion to save their lives. It's not easy, and generally not something they learn in med school or residency. And yes, it is something that can be taught and learned, but it takes time, effort, and appropriate role models; all the things that a lot of med school/residencies lack. So we, the poor MDs and MDs-to-be drudge on, learning the "art" and hard-science of medicine, and what we're mostly tested on (USMLEs, etc). Compassion, a.k.a empathy, are swept aside for "scientific knowledge". Any surprise? Most people, including on this forum, seem to believe that these are innate abilities that certain people "just" posses. I don't think that's true. Compassion and empathy are environmental traits, and therefore can be learned. They are not criteria that necessarily get you into med school and beyond. And once there, are hardly addressed in the educational process. I don't know how it is in nursing school, perhaps they do offer such courses. Someone care to comment?
So going back to the point I was trying to make, Joe the Plumber, Abe the Accountant, Larry the Lawyer, and Nance the Nurse go to the hospital as patients and see their doctor for all of 1 minute a day... while the nurses are always around... and who do you think has the more powerful lobbies when it comes to political movements... I'm guessing it's the plumbers, the accountants, the lawyers, the nurses, etc etc. So, in the end, they will make those decisions for us. Because we (ie. physicians) sure can't find a good way to band together, and we certainly are incapable of projecting a great image for ourselves.
I'm generalizing a bit, I know, but I have seen the above scenario played out on both sides of the fence, over and over again, and I'm just as guilty as most of you are, for not having the "time" to see patients and spend as much of it with them as they require. And if you're thinking "that's not me", there's plenty of studies out there that show that we physicians are disconnected from how we perceive our patients' perception of how they view they are being cared for (I hope what I just wrote makes sense). We have no idea. It all comes back to empathy, and our lack of it. So, you may "feel" compassion in yourself, but are you actually projecting that to your patients? I'm sure most of us are compassionate, whether we're nurses or physicians, but some of us (perhaps a lot of us?) are simply not good at projecting it.
If you don't believe me, wait till you're the patient.
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kluver,
There is some truth in what you say. I think that as far as promotions and grading, attending physicians and med schools are guilty of generally rewarding only book knowledge and/or knowledge plus some degree of kissing up, sometimes to the detriment of actual patient care skills, and especially time spent with one's patients. I remember as a medical student wondering why trying to take really good care of my patients, and spending a lot of time with them and their families, was never something that seemed to attract any notice or positive comments from attendings or upper level residents or fellows who participated in grading students. I only got positive feedback for things like brining in more research articles for the team, or giving a good oral presentation, etc. Not that someone should get a good grade just for being "nice", but I do think bedside manner needs to be emphasized more.
However, I disagree with you that compassion and bedside manner, etc. are not taught at all in med school or residency. We had required teaching on this in med school, along with teaching about medical ethics, etc. and having a good bedside manner was also a focus in my residency (internal med...so I wouldn't doubt if there is less emphasis on this in certain specialties b/c IM tends to be one of the more "touchy feely" ones). I think sometimes med students and residents just get so tired that we feel like we are being bled dry, though, and sometimes there just isn't a lot of extra time to spend with our patients. This is particularly true now that there is draconian enforcement of the 30hr rule...speaking from personal experience, we had to do rounds fairly quickly in order to get done, get orders in and all notes in the chart, get to morning report and try to be done with everything by noon on a postcall day. House staff are never going to have the amount of time to spend with each individual patient that the bedside nurse has...
I do agree that a 1 minute postop doctor visit is inappropriate, though! Complaining to the surgical department is always an option. Most hospitals care A LOT about how the public perceives them. Doctors in private practice are being graded on this too.
There is some truth in what you say. I think that as far as promotions and grading, attending physicians and med schools are guilty of generally rewarding only book knowledge and/or knowledge plus some degree of kissing up, sometimes to the detriment of actual patient care skills, and especially time spent with one's patients. I remember as a medical student wondering why trying to take really good care of my patients, and spending a lot of time with them and their families, was never something that seemed to attract any notice or positive comments from attendings or upper level residents or fellows who participated in grading students. I only got positive feedback for things like brining in more research articles for the team, or giving a good oral presentation, etc. Not that someone should get a good grade just for being "nice", but I do think bedside manner needs to be emphasized more.
However, I disagree with you that compassion and bedside manner, etc. are not taught at all in med school or residency. We had required teaching on this in med school, along with teaching about medical ethics, etc. and having a good bedside manner was also a focus in my residency (internal med...so I wouldn't doubt if there is less emphasis on this in certain specialties b/c IM tends to be one of the more "touchy feely" ones). I think sometimes med students and residents just get so tired that we feel like we are being bled dry, though, and sometimes there just isn't a lot of extra time to spend with our patients. This is particularly true now that there is draconian enforcement of the 30hr rule...speaking from personal experience, we had to do rounds fairly quickly in order to get done, get orders in and all notes in the chart, get to morning report and try to be done with everything by noon on a postcall day. House staff are never going to have the amount of time to spend with each individual patient that the bedside nurse has...
I do agree that a 1 minute postop doctor visit is inappropriate, though! Complaining to the surgical department is always an option. Most hospitals care A LOT about how the public perceives them. Doctors in private practice are being graded on this too.
D
deleted21609
On an unrelated note, I don't see why people think computer scientists and electrical engineers are so smart. I never see them at all. My computer is really helpful though...
I've been to some great restaurants in my day and the waitresses do everything for me while the chef is nowhere to be found... great food, thanks waitress.
etc., etc.
Mockery aside, what Obama said demonstrates the two sides of medicine: the hand-holding and the medicine-medicine. Unfortunately for physicians, patients and their families (including Obama) care more about the hand-holding than the treatment. They are too ignorant of what goes on outside their room to make any judgement of it. Unfortunately they aren't aware of their ignorance so they judge away...
and it's not about bedside manner. It's all time. Nurses sit there for 12 hours a day. Doctors simpy cannot do that.
I've been to some great restaurants in my day and the waitresses do everything for me while the chef is nowhere to be found... great food, thanks waitress.
etc., etc.
Mockery aside, what Obama said demonstrates the two sides of medicine: the hand-holding and the medicine-medicine. Unfortunately for physicians, patients and their families (including Obama) care more about the hand-holding than the treatment. They are too ignorant of what goes on outside their room to make any judgement of it. Unfortunately they aren't aware of their ignorance so they judge away...
and it's not about bedside manner. It's all time. Nurses sit there for 12 hours a day. Doctors simpy cannot do that.
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Lets not get too carried away. A lot of people still appreciate what we do. However, it's true that people care A LOT about the hand holding stuff. It's been shown (research studies) that doctors who don't have a good bedside manner and don't get along as well w/other people get sued more often vs. docs who are "nice". In other words, you can suck a little as a doctor but if you are nice you might not get sued...if you're a great surgeon but you come across as not being warm, etc. you might get sued. Not that we should need that type of motivation to be "nice", but it's sobering to see those kinds of research studies. I'd personally rather have a surgeon who is a little gruff but knows what the heck he is doing, vs. a "nice" one who can't cut straight...
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To address student.ie: yes I agree there are plenty of professionals out there who aren't required to have any sort of face-time with their "customers" and you bring up two excellent examples. Medicine, however, as practice currently requires that face-time. For example, you can't bill for work performed by residents. Technically, the law requires that attendings see and examine their patients so that visits, services, procedures, etc. can be billed for. Whether that actually happens in actuality, is another matter.
But to take your argument one step further, you may be right, perhaps some day, with telemedicine and its variants, docs will no longer require the face-time, and will just fill prescriptions by e-mail or web, perform robot-assisted surgeries over satellite, and have anthropomorphic robot androids (wait, that's redundant) with a wide array of sensors perform physicals and patient interactions using semi-automated AI algorithms, while they (the docs) themselves sit cozy in their "office", in a bathrobe, playing puppet-master. Then again, it's the engineers who'll make that happen. So, that doesn't really help us.
To get back to the point, patients do want, and do need the hand-holding. A lot of health-related issues are, at least on some level, psychological. Certainly for the "civilians". Hence, the continued popularity and billion$$$ growth of various "holistic" medicine paradigms . I believe this has been brought up in other threads, so I won't rehash the point further.
I agree with you dragonfly, I too would rather have a gruff angry surgeon who knows his stuff cut me wide open and do it right, then some half-wit who holds my hand, rubs my belly, and whispers sweet nothings in my ear. And in an informal poll of my peers, we all had a similar view. But there are things we know that the lay public simply does not, and never will.
But one thing is for sure, health-care has been transformed into an industry. And just like any other industry it requires a business model, customer service, and PR that, going back to st.ie's point, restaurants, and computer and engineering firms already posses. If you doubt it, ask around any larger hospital or medical center how often they file their TPS Reports.
Ok, joking aside, hospitals are being streamlined the way other industries were, with LEAN and sigma, and all sorts of other gobbledygook double-speak that MBA-types can come up with. The bottom line is, that patients demand a certain service, and we need to provided it to them in such a way that they stay happy, satisfied, pay their bills, and not sue our pants off. And we're simply not doing a good job of it. Again, I'm sure there are plenty of physicians who do go out of their way for their patients, I've certainly seen my share of them, too. But yes, for the most part, we are just trying to get through our day, to survive, and yes, hope that we don't violate our benignant uber-lord mandated work-hour limitations. And, in the end, I guess we all hope that finally, as attendings, we will no longer be bound by such lack of time, lack of knowledge/experience, and other limitations. But I am afraid, some of us will not be able to make that switch and will continue on in our ways, "knowing" that I know best, so... well you know the rest.
But to take your argument one step further, you may be right, perhaps some day, with telemedicine and its variants, docs will no longer require the face-time, and will just fill prescriptions by e-mail or web, perform robot-assisted surgeries over satellite, and have anthropomorphic robot androids (wait, that's redundant) with a wide array of sensors perform physicals and patient interactions using semi-automated AI algorithms, while they (the docs) themselves sit cozy in their "office", in a bathrobe, playing puppet-master. Then again, it's the engineers who'll make that happen. So, that doesn't really help us.
To get back to the point, patients do want, and do need the hand-holding. A lot of health-related issues are, at least on some level, psychological. Certainly for the "civilians". Hence, the continued popularity and billion$$$ growth of various "holistic" medicine paradigms . I believe this has been brought up in other threads, so I won't rehash the point further.
I agree with you dragonfly, I too would rather have a gruff angry surgeon who knows his stuff cut me wide open and do it right, then some half-wit who holds my hand, rubs my belly, and whispers sweet nothings in my ear. And in an informal poll of my peers, we all had a similar view. But there are things we know that the lay public simply does not, and never will.
But one thing is for sure, health-care has been transformed into an industry. And just like any other industry it requires a business model, customer service, and PR that, going back to st.ie's point, restaurants, and computer and engineering firms already posses. If you doubt it, ask around any larger hospital or medical center how often they file their TPS Reports.
Ok, joking aside, hospitals are being streamlined the way other industries were, with LEAN and sigma, and all sorts of other gobbledygook double-speak that MBA-types can come up with. The bottom line is, that patients demand a certain service, and we need to provided it to them in such a way that they stay happy, satisfied, pay their bills, and not sue our pants off. And we're simply not doing a good job of it. Again, I'm sure there are plenty of physicians who do go out of their way for their patients, I've certainly seen my share of them, too. But yes, for the most part, we are just trying to get through our day, to survive, and yes, hope that we don't violate our benignant uber-lord mandated work-hour limitations. And, in the end, I guess we all hope that finally, as attendings, we will no longer be bound by such lack of time, lack of knowledge/experience, and other limitations. But I am afraid, some of us will not be able to make that switch and will continue on in our ways, "knowing" that I know best, so... well you know the rest.- Joined
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I agree. I've found it's the incompetent nurses who baby the pt's who get the best da#ned press-gainey scores and all the kudos. So what if the post surgical pt didn't get walked, or if his painful dressing with packing didn't get changed as ordered, or if he can only get 4gms of tylenol in 24 hours, and you gave him 6 vicodin and 2 darvocets in your 12 hour shift. His family loved you. It's the oncoming nurse who is mean and rude, and will have to deal with the upset surgeon over getting a new order for pain meds, to coax the tired pt to walk, and to change the dressing at 2200. That's the mean, rude nasty nurse who deserves to be written up and complained about.
We have a surgeon who can't stand incompetent nurses, and I love him. I've never really had a problem with him. I have had to go to him a couple of times and say, "hey I'm late with this or that on your pt, I just came on shift and it wasn't done earlier, or I had/have another pt crashing," And he has never had a problem with that. He is trulyimpressive when he loses his temper, it's scary...Some residents hate, others love him. He'll even lecture pt's that give the nurses a hard time about post surgical rehab, and the pt's think he is an @ss. If I ever need surgery, he's my surgeon. He's the best at the hospital, he takes cases that other surgeons won't touch. He expects the best out of everyone, because he expects it out of himself.
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great post.
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