Public Opinion of Physicians vs. Nurses

[mk04447]

This is the exact wrong response.

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

But this is not enough

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

The problem is going to become more complicated unfortunately... As the economy continues to waiver more and more kids will become doctors because other lucrative career opportunities have disappeared. This means people with no higher calling to medicine will caring for more patients.

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[calvnandhobbs68]

The problem is going to become more complicated unfortunately... As the economy continues to waiver more and more kids will become doctors because other lucrative career opportunities have disappeared. This means people with no higher calling to medicine will caring for more patients.

Yeah because so many more people with a "higher calling to medicine" went to medical school for the last 30 years

 

[mk04447]

Yeah because so many more people with a "higher calling to medicine" went to medical school for the last 30 years

Well sarcasm aside, there will be "more" folks with no interest in medicine, patient interaction, and compassion becoming doctors. Their stock broker, realtor, or contractor parents will encourage it.

 

[TheWeeIceMan]

The problem is going to become more complicated unfortunately... As the economy continues to waiver more and more kids will become doctors because other lucrative career opportunities have disappeared. This means people with no higher calling to medicine will caring for more patients.

THE HORROR!

Maybe physicians wouldn't be getting their butts kicked in the court of public opinion if we started dropping this whole "higher calling, martyr, mother teresa" stuff that seems attached to becoming a physician.

 

[mk04447]

THE HORROR!

Maybe physicians wouldn't be getting their butts kicked in the court of public opinion if we started dropping this whole "higher calling, martyr, mother teresa" stuff that seems attached to becoming a physician.

Well, I for one like that stuff... and I won't have any issues in that court.

 

[calvnandhobbs68]

Well sarcasm aside, there will be "more" folks with no interest in medicine, patient interaction, and compassion becoming doctors. Their stock broker, realtor, or contractor parents will encourage it.

Based on what exactly? Your anecdotes?

 

[alpinism]

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


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We actually had a whole lecture on this during M2…

If I remember correctly, the average hospital pt in the US reads at a 8th grade level, with a significant percentage (roughly 1/4) reading below the 5th grade level.

A ridiculously high percentage of pts w/ HTN or DM also can't even explain what it means to have a high BP or A1c.

 

[mk04447]

Based on what exactly? Your anecdotes?

How old are you? You obviously don't or haven't been in the workforce long. Most industries are becoming so burdened by regulatory oversight, skyrocketing costs and diminishing compensation. Automation and computers aren't helping. The elimination of standards has broadened the number of college degrees offered and are obtained; a crappy bachelors degree is yesterday's high school diploma. Entrepreneurs cannot compete with larger corporations stealing market share. Pilots and lawyers are a dime a dozen. The only truly solid careers remaining these days are in the hard sciences, doctors included in this. If you aren't steering your kids to microbiology, biochem, organic, etc. undergraduate degrees in preparation for medical school or a doctorate you are doing them a huge disservice.

 

[TheWeeIceMan]

How old are you? You obviously don't or haven't been in the workforce long. Most industries are becoming so burdened by regulatory oversight, skyrocketing costs and diminishing compensation. Automation and computers aren't helping. The elimination of standards has broadened the number of college degrees offered and are obtained; a crappy bachelors degree is yesterday's high school diploma. Entrepreneurs cannot compete with larger corporations stealing market share. Pilots and lawyers are a dime a dozen. The only truly solid careers remaining these days are in the hard sciences, doctors included in this. If you aren't steering your kids to microbiology, biochem, organic, etc. undergraduate degrees in preparation for medical school or a doctorate you are doing them a huge disservice.

Wut?

What about the vast majority of pre-meds that don't make it to medical school? A bachelors in micro, biochem, and organic or pretty much worthless and getting a PhD isn't that much better. There are still plenty of UG majors that lead to good careers, and they aren't all in the sciences. The idea that medicine is somehow the only good career available (mostly prevalent in pre-allo) is pretty grating IMO.

 

[calvnandhobbs68]

How old are you? You obviously don't or haven't been in the workforce long. Most industries are becoming so burdened by regulatory oversight, skyrocketing costs and diminishing compensation. Automation and computers aren't helping. The elimination of standards has broadened the number of college degrees offered and are obtained; a crappy bachelors degree is yesterday's high school diploma. Entrepreneurs cannot compete with larger corporations stealing market share. Pilots and lawyers are a dime a dozen. The only truly solid careers remaining these days are in the hard sciences, doctors included in this. If you aren't steering your kids to microbiology, biochem, organic, etc. undergraduate degrees in preparation for medical school or a doctorate you are doing them a huge disservice.

So TL;DR-> Yes, your anecdotes

 

[mk04447]

Wut?

What about the vast majority of pre-meds that don't make it to medical school? A bachelors in micro, biochem, and organic or pretty much worthless and getting a PhD isn't that much better. There are still plenty of UG majors that lead to good careers, and they aren't all in the sciences. The idea that medicine is somehow the only good career available (mostly prevalent in pre-allo) is pretty grating IMO.

IMO you read horribly. All I've said is more people who only view medicine as a career will pursue slots in medical schools. That the smarter youth will gain educations in the hard sciences, which you think are worthless; FYI there are oodles of great careers desperate for people with these degrees but, you've forgotten the entire point of this thread, perception of doctors and nurses. So, thanks you have taken us is nowhere.

 

[TheWeeIceMan]

IMO you read horribly. All I've said is more people who only view medicine as a career will pursue slots in medical schools. That the smarter youth will gain educations in the hard sciences, which you think are worthless; FYI there are oodles of great careers desperate for people with these degrees but, you've forgotten the entire point of this thread, perception of doctors and nurses. So, thanks you have taken us is nowhere.

heh heh

It seems that you don't recall what you type. Let me assist you.

The only truly solid careers remaining these days are in the hard sciences, doctors included in this. If you aren't steering your kids to microbiology, biochem, organic, etc. undergraduate degrees in preparation for medical school or a doctorate you are doing them a huge disservice.

The assertion that the only remaining solid careers were in the hard sciences was what I was responding too. Let's not move the goal posts here.

 

[mk04447]

heh heh

It seems that you don't recall what you type. Let me assist you.



The assertion that the only remaining solid careers were in the hard sciences was what I was responding too. Let's not move the goal posts here.

That was because you already digressed. You (and some other genius) were foolish enough to believe that a poor economy and limited job opportunity won't result in increased medical school application submissions.

 

[TheWeeIceMan]

That was because you already digressed. You (and some other genius) were foolish enough to believe that a poor economy and limited job opportunity won't result in increased medical school application submissions.

Please point out to me where I said that. It seems that you are the one who doesn't read so good.

Oh, and for the record, you were the one to take the thread off track onto other careers.

 

[circulus vitios]

I suppose I could cut out medicaid participation and spend more time with each patient, but that seems more callous...

Why do people have this mindset? Demanding fair compensation for your services is not a bad thing.

 

[Beargryllz]

Why do people have this mindset? Demanding fair compensation for your services is not a bad thing.

And people here wonder why nurses strike

 

[circulus vitios]

The only truly solid careers remaining these days are in the hard sciences, doctors included in this. If you aren't steering your kids to microbiology, biochem, organic, etc. undergraduate degrees in preparation for medical school or a doctorate you are doing them a huge disservice.

LOL what in the hell are you talking about. Science in America is a DEAD END career. Look at the thousands of doctorate level organic chemists who were laid off in the pharmaceutical industry downturn (2000-present), who cannot find a job. Look at the quality of entry level chemistry jobs: mindless quantitative/instrumental analysis garbage that pay $10/hour on a perma-temp contract with no benefits.

 

[calvnandhobbs68]

That was because you already digressed. You (and some other genius) were foolish enough to believe that a poor economy and limited job opportunity won't result in increased medical school application submissions.

Unfortunately, you don't have the logical thinking necessary to realize that increased number of medical school applications in no way reflects the reasoning behind why people are applying to medical school. Increased numbers of applications to medical school does not equal "people with no higher calling to medicine caring for more patients."

 

[Nasrudin]

Edit.

 

[HopefulReapp]

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

I have no idea where this hostility is coming from. Were you drunk when you posted this?

Perhaps I should have quoted your original post as my logic is much in line with your own-- There is nothing offensive about recognizing the level of education that your patients will have on the wards. In fact, it is quite necessary in order to provide the best quality level of care possible.

When you are explaining your future treatments, you need to convey it in a manner that can best be understood by the patient with terms that are at their level. Instead of "bowels" say "gut", instead of "trendelenberg" say "your feet up", etc. Otherwise it is wasted time and you won't have great patient compliance. It all comes down to social awareness/emotional IQ. "Stereotyping" is quite necessary in medicine at points.

 

[mcloaf]

[...]becoming so burdened by regulatory oversight, skyrocketing costs and diminishing compensation. Automation and computers aren't helping.

Yes, I see how these things are in clear opposition to what's happening in medicine.









Wait what?

 

[pathologyDO]

Guys, I hate to be that guy who tries to break up post wars in his thread to save it from completely derailing, but...

I think as physicians we should/are smart enough to learn how to market ourselves as a group - much like the nurses are doing. Wouldn't it be nice to see patients that by default have some respect for you unless you give them a reason not to?

That would be a world where the patient trusts us, which I've heard makes treatment more successful. Maybe there's a huge hurdle to overcome before that could ever happen, but we didn't get to being in this profession without dreaming and setting goals.

 

[mk04447]

I have no idea where this hostility is coming from. Were you drunk when you posted this?

Perhaps I should have quoted your original post as my logic is much in line with your own-- There is nothing offensive about recognizing the level of education that your patients will have on the wards. In fact, it is quite necessary in order to provide the best quality level of care possible.

When you are explaining your future treatments, you need to convey it in a manner that can best be understood by the patient with terms that are at their level. Instead of "bowels" say "gut", instead of "trendelenberg" say "your feet up", etc. Otherwise it is wasted time and you won't have great patient compliance. It all comes down to social awareness/emotional IQ. "Stereotyping" is quite necessary in medicine at points.

You are referring to common sense, the previous poster had a superiority complex; not sure how you were confused.

 

[mk04447]

Guys, I hate to be that guy who tries to break up post wars in his thread to save it from completely derailing, but...

I think as physicians we should/are smart enough to learn how to market ourselves as a group - much like the nurses are doing. Wouldn't it be nice to see patients that by default have some respect for you unless you give them a reason not to?

That would be a world where the patient trusts us, which I've heard makes treatment more successful. Maybe there's a huge hurdle to overcome before that could ever happen, but we didn't get to being in this profession without dreaming and setting goals.

I don't think ours is an issue of trust. Being old enough to remember rotary phones, in the past references came from friends and family, a chance encounter in a grocery store, or perhaps a local newspaper article. Now anyone who takes five minutes can discover who is reputable and who isn't. I'm not sure what you mean by nurses marketing themselves though?

 

[Nasrudin]

Edit

 

[mk04447]

I'm not sure what's difficult to conceptualize. It doesn't matter how old you are, the question is your familiarity with healthcare and the variety of professions therein. There is a history of labor and labor management relations in every sector of the economy. There is a social contract stricken between the public and each of these. Manipulation of these is what professional organizations are about to a large extent.

I suggest working it out or ignoring amongst your own cohort. Until you're on the boat and it's left the harbor, your professional commitment, understanding of where you are and the consequences of your choices to that point, and what we share in terms of common interests is....frankly....suspect and highly conjectural.

You sound like Obama, you said nothing at all.

 

[Smokemont]

You sound like Obama, you said nothing at all.

And you sound like Palin, joining a conversation in which you do not belong.

You sound like the typical older premed that comes in here and attempts to tell m3 and m4s how it works with a condescending tone. It's very similar to how residents and attendings feel about med students making naive comments in their section of SDN, so don't take it personally.

 

[mk04447]

And you sound like Palin, joining a conversation in which you do not belong.

You sound like the typical older premed that comes in here and attempts to tell m3 and m4s how it works with a condescending tone. It's very similar to how residents and attendings feel about med students making naive comments in their section of SDN, so don't take it personally.

No condescending tone here, heck I applaud you fellas for getting here minus the 20 year detour. You guys are a bit cocky and full of **** sometimes, but, for the most part there's still hope for ya. ...for the record though his post was unintelligible.

 

[notbobtrustme]

nm wrong thread

 

[Siggy]

Baseball players did it.

Yea, but sports players are viewed more as employees than independent contractors. Also, the only people more well off than sports players are the team owners.

 

[punkedoutriffs]

Yea, but sports players are viewed more as employees than independent contractors. Also, the only people more well off than sports players are the team owners.

Huh? Don't players sign "contracts?" Doesn't that de facto make them "independent contractors?" And what if team owners are richer than the players? Aren't hospital CEOs richer than the docs? I don't understand the point here.

 

[Siggy]

Huh? Don't players sign "contracts?" Doesn't that de facto make them "independent contractors?" And what if team owners are richer than the players? Aren't hospital CEOs richer than the docs? I don't understand the point here.

Reality isn't always how people view it and more people can name at least the manger, if not the owner of their local professional sports team of choice than their local hospital CEO.

 

[michaelrack]

Huh? Don't players sign "contracts?" Doesn't that de facto make them "independent contractors?" .

Interesting question. The players (in most team sports) do have a union, which is more typical of an employee. Also, players don't have control over their working conditions (when they are going to play, etc); so I am guessing that the IRS would classify them as employees

 

[DrBodacious]

Why do people have this mindset? Demanding fair compensation for your services is not a bad thing.

In reference to my previous comment about cutting out medicaid being "callous... " that depends on what the medicaid population's other options are in your geographic location. I am a specialist and there is no public hospital system in my state or county. There would be a lot of patients with serious health consequences if I refuse to see them. I do limit how many medicaid visits I have in my day, and I participate with about half of the medicaid plans, otherwise I would get overwhelmed with it. If you live in a place with little to no medicaid, then you are probably going to competing pretty heavily with other doctors, and not really filling a need as much as catering towards your own lifestyle. Docs have to do that to some extent, there is a trade off there.

 

[PTPoeny]

There is also the problem of patients having no idea when they are talking to a doctor versus a nurse. Especially if the whole team is female and the attending is young. It doesn't matter if you introduce yourself as a doctor and write your name on their board as Dr. X and wear a name badge with a hangtag that says physician in 1 inch tall letters, many patients think that you are a nurse. Or they assume anybody nice was a nurse and anyone they thought was stuck up is a doctor. I think isolation makes it worse... Can't see the clothing or the faces or the name badges.

 

[Instatewaiter]

People are stupid.

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

A few points:

It's a pity that nursing/doctoring relations have come to an us versus them mentality for both sides.

I also think it's a pity NPs want complete autonomy.

It is ridiculous how NP chart reviews are done where an off site doc will review like 5-10% of charts.

I agree with Nasrudin, it is all about face time. Patients don't realize that the work I spend on them is ten times the amount of time they see me for. In the end, they assume I'm off golfing rather than working 90 hours a week. I'm often in the hospital for the entirety of 4 different nursing shifts.

It is illegal for physicians to go on strike in the US unless they are employees which is why you don't see doctor strikes.

 

[notbobtrustme]

Baseball players did it.

It's that old adage. If you owe the bank 100,000 dollars, you have a problem. If you owe the bank 1 billion dollars, the bank has a problem.

Sports players are close to 90% of the reason why people get invested in sports. The backlash to the owners would be immense if they let all their players go and hired a bunch of replacements from the minors, much more so than negotiating with the striking players and coming to a compromise.

 

[Nasrudin]

This is an interesting tangent to the original question which perhaps I can tack back on thusly:

We seem to be stuck in an eddy of public opinion that doesn't like us for our failures Or our successes. I mean has there been any field that has had more success in decreasing mortality in the last 100 years than obstetrics? And yet juries will crush careers therein if baby that should've have died historically has something go wrong in childbirth. That's a public image problem if you ask me.

I have an overarching question, may it please the court--are we harmed or helped by maintaining a self-sacrificing system of ethics such that striking is shudderingly vulgar? It seems to me we've been holding up our end of the social contract with the public to practice medicine in their behalf but they've done consistently nothing in upholding their end. Did we take it too far in our heyday--make too much money, treat the downtrodden with contempt? What happened exactly.

As the OP points out: people will jump to support our competition with righteous indignation as if we've done them wrong some how and as if our sacrafice in training and education and expenses never mattered.

If the GOP can convince poor people to vote against their own best interests economically with the power of public relations wizardry, what is it about us that considers it some sort of dark art. That once tampered with will spread like Prometheus' fire through the Shire our timid, abject professional self regard.

 

[alpinism]

A few points:

It's a pity that nursing/doctoring relations have come to an us versus them mentality for both sides.

I also think it's a pity NPs want complete autonomy.

It is ridiculous how NP chart reviews are done where an off site doc will review like 5-10% of charts.

I agree with Nasrudin, it is all about face time. Patients don't realize that the work I spend on them is ten times the amount of time they see me for. In the end, they assume I'm off golfing rather than working 90 hours a week. I'm often in the hospital for the entirety of 4 different nursing shifts.

It is illegal for physicians to go on strike in the US unless they are employees which is why you don't see doctor strikes.

Heh I wish I could have their schedules…

On surgery we'd come in while the night shift was still there, stay for their entire day and swing shifts, then leave when the night shift was back on (not counting nights on call).

But of course as others have mentioned its all about face time with patients.

 

[Trogghunter]

I was hanging out with a doc who still had his pager the other day, and he was getting calls for stuff like, 'can I put a warm cloth on the patients neck'.
...and then they say that they can run the show in the hospital. I am an m4 and have been on ICU for 2 months, IM for at least 4, and I have yet to see the nurses who 'are amazing and can do just as good of a job as residents'...yet they all tend to have that mentality.

 

[BurberryDoc]

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

Off topic, but I notice that you used the word bloke....British?

 

[Elisabeth Kate]

I agree with Nasrudin, it is all about face time. Patients don't realize that the work I spend on them is ten times the amount of time they see me for. In the end, they assume I'm off golfing rather than working 90 hours a week. I'm often in the hospital for the entirety of 4 different nursing shifts

How is that possible, considering most nursing shifts are 12 hours? Even if they were 8 hours, four different shifts would put you at 32 hours. Unless your program doesn't follow the hour-restriction regulations.

 

[Instatewaiter]

How is that possible, considering most nursing shifts are 12 hours? Even if they were 8 hours, four different shifts would put you at 32 hours. Unless your program doesn't follow the hour-restriction regulations.

Oh little paduan. You have much to learn.

 

[Elisabeth Kate]

Oh little paduan. You have much to learn.

How about educating me then?

 

[calvnandhobbs68]

How about educating me then?

lol

First of all, the work hour restrictions after PGY-1 are 28 (used to be 30) continous hours anyway.

Second, it's absolutely not unusual for residents to go over work hours at least a few hours. It happened all the time on IM depending on how long rounding took and surgery is even worse about it. I do have to say I've seen the work hour restrictions for interns enforced pretty regularly though. I'm surprised you haven't seen this.

I also believe that the 5 x 8hr nursing shifts are becoming more common (although the 3 x 12hr shifts were pretty cushy). In our hospital at least, I've personally seen shifts change multiple times which makes me think they're 8hrs here (likely because medical students show up a few hours before the next 8hr shift starts and leave an hour or two after that shift ends).

 

[Elisabeth Kate]

lol

First of all, the work hour restrictions after PGY-1 are 28 (used to be 30) continous hours anyway

As I said, nursing shifts are usually 12 hours, which means four straight shifts would be 48 hours. That's way over the 28 continuous hours, so I fail to see what I said here that's wrong.

Second, it's absolutely not unusual for residents to go over work hours at least a few hours

Which is why I said "unless your program doesn't follow the hour-restriction regulations."

It happened all the time on IM depending on how long rounding took and surgery is even worse about it. I do have to say I've seen the work hour restrictions for interns enforced pretty regularly though. I'm surprised you haven't seen this

The places I did rotations were pretty good about getting residents out, but I know it goes on at other places. Again, that's why I said "unless your program doesn't follow the hour-restriction regulations."

 

[calvnandhobbs68]

As I said, nursing shifts are usually 12 hours, which means four straight shifts would be 48 hours. That's way over the 28 continuous hours, so I fail to see what I said here that's wrong.



Which is why I said "unless your program doesn't follow the hour-restriction regulations."



The places I did rotations were pretty good about getting residents out, but I know it goes on at other places. Again, that's why I said "unless your program doesn't follow the hour-restriction regulations."

So I suppose it's safe to assume that they aren't following the work hour restrictions.

 

[Nasrudin]

What kind of nit-picky nonsense is this. It's a passive aggressive point that goes exactly nowhere. Making the statement that nursing shifts are "typically 12 hours" = discreditation. How about we address the topic of the thread.

 

[acceptmeplease]

lol

First of all, the work hour restrictions after PGY-1 are 28 (used to be 30) continous hours anyway.

Second, it's absolutely not unusual for residents to go over work hours at least a few hours. It happened all the time on IM depending on how long rounding took and surgery is even worse about it. I do have to say I've seen the work hour restrictions for interns enforced pretty regularly though. I'm surprised you haven't seen this.

I also believe that the 5 x 8hr nursing shifts are becoming more common (although the 3 x 12hr shifts were pretty cushy). In our hospital at least, I've personally seen shifts change multiple times which makes me think they're 8hrs here (likely because medical students show up a few hours before the next 8hr shift starts and leave an hour or two after that shift ends).

I've never seen 8hr nursing shifts other than school nurses, outpatient clinic, and ambulatory surgery.

 

[Nasrudin]

Where I've worked it was a straight 8. For you guys 12. Great. 8, 9, 10, 12, whatever. This is medicine. If you want to quibble over the average shifts of your career as nurses in a thread entirely devoted to such inconsequential things to us go to allnurses.com or whatever it's called.