What are the main challenges you expect to face as a doctor?

[DropkickMurphy]

How exactly? Kickbacks from writing prescriptions? There are some ethical issues there you may want to consider first..

Hey, if they are going to feed me or give me free stuff to listen to their spiel, I'll hang my ethics on the coathook right next to where I check my emotions when I go to work.

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[ExKitty Doctor]

Nope....you hit the nail squarely on the head.

It was intended to be an expression that you don't let your emotions cloud your judgment and you don't let your patients' conditions or outcomes damage you as a person. Learning to shed the baggage that comes along with dealing with others' problems is a vital skill to learn.

Don't let your emotions cloud your judgement. Agreed.

Having no emotional response to treatment of patients? I don't believe this is something to strive for. So on this one, disagreed.

Learning to shed baggage, agreed.

2 out of 3 ain't bad.

 

[gujuDoc]

It isn't going to kill you if the patient dies. Do your best to prevent suffering and alleviate pain, but remember to check your emotions at the door.

Agreed. The thing is that yes the patients aren't automations. However, we will encounter so much death and suffering that we will eventually become immune to it. We can offer empathy and compassion but there is only so much a doctor can do. As you stated, I'd agree that most of medicine is about alleviating the symptoms. A very high percentage of the things won't have a cure per say but rather a source of symptom relief.

 

[gujuDoc]

Don't let your emotions cloud your judgement. Agreed.

Having no emotional response to treatment of patients? I don't believe this is something to strive for. So on this one, disagreed.

Learning to shed baggage, agreed.

2 out of 3 ain't bad.

I think you and DKM are agreeing more then you realize.

 

[DropkickMurphy]

I think you and DKM are agreeing more then you realize.

I think so too.....

However, we will encounter so much death and suffering that we will eventually become immune to it.

Yup. That "immunity" becomes very useful.

 

[gujuDoc]

Oh I fully agree with you. I think there should be a level of distance - to keep a clear head and make the best decisions possible. But completely checking one's emotions is not giving the best care to the patient either. Bedside manner is important. Its definetly not a black and white issue, there is grey area.

They aren't saying that bedside manner isn't important. They are just saying not to get emotional over it. you don't need to be overly emotional to have good bedside manner.

 

[ExKitty Doctor]

Hey, if they are going to feed me or give me free stuff to listen to their spiel, I'll hang my ethics on the coathook right next to where I check my emotions when I go to work.

While you're getting paid in free pens and food, the pharm reps are getting paid in dollars.

They are making 10 dollars for every 1 dollar they spend on you. Who's in the position of power here? They are using you, not the other way around.

 

[ExKitty Doctor]

They aren't saying that bedside manner isn't important. They are just saying not to get emotional over it. you don't need to be overly emotional to have good bedside manner.

Definetly.

 

[oldbearprofessor]

This is an important topic and doesn't deserve to become the usual pre-allo battle. Few would disagree that empathy with families facing a death or critical illness is important but that a physician must maintain some emotional distance from the situation.

A good guideline is to make sure that the caregiver is not behaving in a way that requires the FAMILY to comfort THEM. So, if you start crying in front of the family and they are telling you "it's okay" then it's time to step back.

In practical terms, almost everyone will shed a few tears the first few times a patient of theirs dies, even if they weren't that close to the situation. Those who haven't seen someone die can be severely affected by actually seeing someone die. Ultimately, with experience, it gets better. Those who really have a tough time with this probably ought to avoid critical care settings in their final practice. In my experience in dealing with interns and residents having their first close encounter with the death of a pediatric patient, a few days and a little time with loved ones does a lot and it's much better the second time around.

No matter how used to death one becomes, and in my business a baby dies in our NICU on at least a weekly basis, usually more often, there will be some that are tougher than others and this doesn't ever go away. Anyone who isn't affected by watching a 3 year old say "goodbye" to their newborn baby sibling isn't entirely human. But in all situations, it's possible to learn to show compassion without becoming so emotional that you aren't helping anyone.

One important value of learning to control your emotions at the time of death of a patient is that it will make you more able to stay around the family at that time. Many doctors feel very uncomfortable being physically present at the bedside when a patient actually dies. This may be due to a sense of guilt or failure, a feeling that the family doesn't want you there, or general discomfort. In reality, most families want the doctor there as well as the nurse and will tell you specifically if they don't.

Finally, one of the most valuable experiences anyone can have in medical training is to participate in a post-death discussion with family members about autopsy findings or other type of follow-up with a family after the death. Not an easy experience for a med student to get, but very worthwhile.

And to recreate an old SDN debate, none of these skills can be learned in didactic empathy classes, only by actually being in the situation. Thus, folks with lots of medical experiences are a bit ahead of the curve here.

 

[DropkickMurphy]

While you're getting paid in free pens and food, the pharm reps are getting paid in dollars.

They are making 10 dollars for every 1 dollar they spend on you. Who's in the position of power here? They are using you, not the other way around.

That's if you prescribe their product(s)

 

[DropkickMurphy]

This is an important topic and doesn't deserve to become the usual pre-allo battle. Few would disagree that empathy with families facing a death or critical illness is important but that a physician must maintain some emotional distance from the situation.

A good guideline is to make sure that the caregiver is not behaving in a way that requires the FAMILY to comfort THEM. So, if you start crying in front of the family and they are telling you "it's okay" then it's time to step back.

In practical terms, almost everyone will shed a few tears the first few times a patient of theirs dies, even if they weren't that close to the situation. Those who haven't seen someone die can be severely affected by actually seeing someone die. Ultimately, with experience, it gets better. Those who really have a tough time with this probably ought to avoid critical care settings in their final practice. In my experience in dealing with interns and residents having their first close encounter with the death of a pediatric patient, a few days and a little time with loved ones does a lot and it's much better the second time around.

No matter how used to death one becomes, and in my business a baby dies in our NICU on at least a weekly basis, usually more often, there will be some that are tougher than others and this doesn't ever go away. Anyone who isn't affected by watching a 3 year old say "goodbye" to their newborn baby sibling isn't entirely human. But in all situations, it's possible to learn to show compassion without becoming so emotional that you aren't helping anyone.

One important value of learning to control your emotions at the time of death of a patient is that it will make you more able to stay around the family at that time. Many doctors feel very uncomfortable being physically present at the bedside when a patient actually dies. This may be due to a sense of guilt or failure, a feeling that the family doesn't want you there, or general discomfort. In reality, most families want the doctor there as well as the nurse and will tell you specifically if they don't.

Finally, one of the most valuable experiences anyone can have in medical training is to participate in a post-death discussion with family members about autopsy findings or other type of follow-up with a family after the death. Not an easy experience for a med student to get, but very worthwhile.

And to recreate an old SDN debate, none of these skills can be learned in didactic empathy classes, only by actually being in the situation. Thus, folks with lots of medical experiences are a bit ahead of the curve here.

Well said by one of the practitioners of the most emotionally stressful specialty in medicine (in my opinion).

 

[ExKitty Doctor]

That's if you prescribe their product(s)

If direct marketing to physicians didn't work, and physicians didnt increase their prescriptions of the drugs marketed to them, pharma wouldnt bother. But they do, because it works. They make an excellent rate of return. Better than TV ads and magazine ads combined.

Is it possible that you are one of the few who are immune? Sure. But overall, marketing to physicians works very well and puts lots of dollars in the pockets of big pharma and drug reps.

 

[DropkickMurphy]

If direct marketing to physicians didn't work, and physicians didnt increase their prescriptions of the drugs marketed to them, pharma wouldnt bother. But they do, because it works. They make an excellent rate of return. Better than TV ads and magazine ads combined.

Is it possible that you are one of the few who are immune? Sure. But overall, marketing to physicians works very well and puts lots of dollars in the pockets of big pharma and drug reps.

Yup.....but as you said, some of us are immune and willing to take advantage of the reps.

 

[ExKitty Doctor]

OldBear, thanks for posting.

 

[baylormed]

become a surgeon; that way you won't have time to go to cocktail parties.

You can also become a Pathologist or a Psychiatrist. Nobody will know what the heck it is you do and you will be free from annoying questions at family reunions.

Stranger: So, what do you do?
Me: I'm a pathologist.
Stranger: Oh. That's nice. **Pause** So as I was saying...

 

[ExKitty Doctor]

Yup.....but as you said, some of us are immune and willing to take advantage of the reps.

The practice itself is not ethically sound. Though you may be immune, most of your colleagues are not. Physicians as a group are being used by the pharm companies, their professional (and hard earned) judgement being bought with free stuff and lunches, while the reps and companies themselves are making big dollars on their investment. That angers me. Quite a bit.

 

[DropkickMurphy]

The practice itself is not ethically sound. Though you may be immune, most of your colleagues are not. Physicians as a group are being used by the pharm companies, their professional (and hard earned) judgement being bought with free stuff and lunches, while the reps and companies themselves are making big dollars on their investment. That angers me. Quite a bit.

Welcome to healthcare in the US under our present system....there are lots of borderline unethical practices (if you're the type of person who is prone to finding basic business practices unethical). I hope we never go to any other system of healthcare because the results of that would be far worse than anything produced under our present methods of operation.

 

[gujuDoc]

Well said by one of the practitioners of the most emotionally stressful specialty in medicine (in my opinion).

Yup I agree with you that oldbear's post was very well stated. In fact, I'd go so far to say that what he said so eloquently is exactly what we all were trying to get at. I was never meaning to imply that at least at some point we won't feel emotion for what a patient is going through just that we all need to know and will learn how not to let it get to us.

 

[ExKitty Doctor]

Welcome to healthcare in the US under our present system....there are lots of borderline unethical practices (if you're the type of person who is prone to finding basic business practices unethical). I hope we never go to any other system of healthcare because the results of that would be far worse than anything produced under our present methods of operation.

I agree that there are def. unethical practices in our current system. Issues related to medicine as a business are complex, deeply ingrained, and difficult to address/solve. The issue of drug reps however is one of the less difficult issues to address. Some hospitals and many doctors/practices simply don't see drug reps anymore. I think that is a positive thing.

 

[DropkickMurphy]

I agree that there are def. unethical practices in our current system. Issues related to medicine as a business are complex, deeply ingrained, and difficult to address/solve. The issue of drug reps however is one of the less difficult issues to address. Some hospitals and many doctors/practices simply don't see drug reps anymore. I think that is a positive thing.

I, for one, will be one of the docs who will continue to do so. I don't turn down free food.

 

[DropkickMurphy]

Yup I agree with you that oldbear's post was very well stated. In fact, I'd go so far to say that what he said so eloquently is exactly what we all were trying to get at. I was never meaning to imply that at least at some point we won't feel emotion for what a patient is going through just that we all need to know and will learn how not to let it get to us.

I've had to leave the room on several occasions to keep from crying because of patients, or have had to recuse myself from a case because of emotional issues on my part. However, I do try to leave "work at work" whenever possible.

 

[oldbearprofessor]

Yup I agree with you that oldbear's post was very well stated. In fact, I'd go so far to say that what he said so eloquently is exactly what we all were trying to get at. I was never meaning to imply that at least at some point we won't feel emotion for what a patient is going through just that we all need to know and will learn how not to let it get to us.

Thanks for the nice responses. Might encourage me to try posting in the war-zone known as pre-allo more often.

By the way, my personal solution to the ethical dilemma of pharm (or in my case formula company) reps is to take equally from competing companies. In particular at national meetings, I take a pen and a 5 minute talk from one company and walk over to the competing booth, take their pen and ask them about what the other company said. Repeat in multiple directions times 3 and you have an entertaining hour and a variety of pens. You can even learn a bit about competing products!

PS - Check out the pedi forum sticky about a neonatology private group. Some of you might be interested.

 

[georgia_md]

I was just curious what specific challenges you guys expect to face as a practicing physician.

My three main priorities will be :

1) Golf
2) Women
3) Money

Not necessarily in that order.

By the way, I am just joking

 

[DropkickMurphy]

My three main priorities will be :

1) Golf
2) Women
3) Money

Not necessarily in that order

So where would patient care be on that list?

 

[gujuDoc]

I agree that there are def. unethical practices in our current system. Issues related to medicine as a business are complex, deeply ingrained, and difficult to address/solve. The issue of drug reps however is one of the less difficult issues to address. Some hospitals and many doctors/practices simply don't see drug reps anymore. I think that is a positive thing.

Maybe I'm missing something or truly don't understand the whole debate surrounding drug rep companies, but how is a pharmaceutical rep coming to a doctor's office such an unethical thing? its not like they are putting a gun up to a doc's head and saying buy from me? Besides many of the free samples they give docs often help patients out if they are in dire need of the medication before they get their prescription filled.

I guess I don't see what the issue is, but maybe I'm missing something.

 

[baylormed]

So where would patient care be on that list?

Well, if he chooses to be an Ob/Gyn, it would fall under #2.