Secret Doctor Conferences...

Squid,

For many specialties, the nature of the work itself is just tough. Anyone who is on call for a night can just get whatever comes in -- you have to care for each person in turn, in order of acuity. Often you can call for help, but the nature of the profession (and the people drawn to it) is such that sometimes we just won't ask for help when we should.

In training, we work long hours for a lot of reasons -- residency is still a rite of passage, but also, you just have to see enough cases to learn what you need. OBs and FPs have to do as many deliveries as they possibly can, because from most deliveries you learn absolutely nothing technical (once you have the basics down) -- it's the really horrid, bad situations that teach you, and those don't happen often... so statistically, you have to do lots and lots of cases. Same with surgery and various procedures -- you just have to do as many as you can. For FPs, residency is three years. Sure, I could have worked not as hard in residency -- but then did I want to be a resident for four years? Five? For an OB/GYN it's four years -- make it five? Six?

Another note, related to Evan's 100% spot-on post, is this: many patients have done some reading up on the net, and come in with their diagnosis in hand. That isn't necessarily a bad thing, but sometimes it does make your job harder. Do you have any idea how difficult the anxious and hypochondriac patients are in this, the Information Age, when they can just type "chest pain" into Google and then come into your ER DEMANDING their CT angio, because they *know* it's a pulmonary embolus because it said so on the Web?

One other (and even less related) note: patients usually sue when there was poor communication. Not always, but often. Many patients will reasonably forgive us for being human, as long as they understood that we care about them and that they were heard. In primary care, we get a lot of opportunity to develop long-term relationships with patients, and that helps when things go badly (by natural course or by error, or both). It's harder for specialists, who might see the patient only a few times, and who can see a selected and even more challenging patient population.

Blah blah blah. Sorry. It's nice to hear other docs commiserating sometimes. I love what I do, and I'm privileged to be able to do it. We should start an OT thread on the things that go right sometime...

 

It is a matter of pride and tradition. As Residents we are resident in the hospital. That was literally true for my father. Hospital provided him clothing and washed it, food and a room to sleep in a a bit of spending money. He was there in the hospital 24-7. That was how it was until he was a Chief Resident. When I was in medical school we started taking call in our 3 year including Christmas etc. One is 6, very easy. In residency we were one in 3 or 4. Easy compared to when we were Chief residents when it was one in 2. You would get up make rounds before the professor got there say 5:30 and get everything ready. Surgery at 7 rounds and clinics after and then the admissions for tomorrow. Call at night (you get up a bit less as Chief the juniors are doing the gut work and you get up to do the procedures and make decisions) do it again and go home at 6pm and sleep. That was how it was. It was about experience. You had to see it touch it and do it to learn and the more you did the better you got. We had a joke "The only bad thing about every other night call is you miss half the good patients". Sad but true. So we keep up these behaviors.
It is a bit better now they have limits on hours but that means less experience.
Clearly it is harder for many of us Boomers to keep going for those long hours. In my specialty there are too many training programs going unfilled. As I look around at our clinic and hospital more the half the doctors will retire with in a year or two of each other. No one to replace us. Tough to recruit.

 

Exacty...my whole practical knowledge of abdominal pregnancy is based on one case in 4 years of residency. 95% of the deliveries I do, I could teach a brand new med student all they need to know in one day. It's those rare cases that come along once every 4 months that I think back to my days of residency and 110 hour work weeks.

 

Unfortunately, I don't think you can have the best of both worlds. My wife's friend lives in Sweden, she just got a call from her friend there that their daughter had abnormal blood tests and she has some sort of metabolic problem. They were just told that the earliest they can talk by phone to a doctor...and yes, you heard that right...is 3 weeks. During that phone call they'll decide how quickly she needs to be seen.

At this moment my wife is talking to her sister, a doctor in Finland, trying to see is by flying to Helsinki, they can be seen earlier, otherwise, they'll be flying to the U.S.

Cost is not an issue in Scandinavia. Cradle to grave, the goverment will take care of you. You never have to consider cost...but, things like that happen.

 

Well, I can tell you infant mortality rates are better in Scandinavia. I'd be interested in other measures of Primary care. Cholesterol levels, hypertension, diabetes.

It all depends on what measure of healthcare is more important. My wife's father was told he needed a quintuple bypass in August, he was scheduled for surgery in December. A patient saw me on a Friday because of a problem, I had her scheduled for surgery on Monday.

 

I don't disagree about the hubris I was just explaining the history. Can't know where you are going till you understand where you have been. I don't disagree with the tired Doc issue either when the Armed Forces took away many of our general surgeons in town I worried about the remaining Doc, patients and myself and family. The boards are not responsible they just give exams and certify training and competence. Most of the Medical schools in the country are financed by states or use public hospitals for training. States cut back on the money and the classes are smaller. Choice of speciality is influenced by societal factors including the Medical Malpractice problems. My specielty does not fill programs for three reasons, first is the malpractice in our field. The constant pressure to be perfect and the consequences for any bad outcome is tough and students see that and ask why do that. Second is most males don't even consider it unless they plan to go into academics or a subspecialty from the get go. Thats fine but it cuts the number of applicants in half. Not many male general Ob/Gyns coming out of training. Finally for everyone the hours and the call is a problem.

I don't have solutions, nor do I disagree with your position. The medical system is sadly broken on a number of levels. We could increase staff but if we start tomorrow it will take 7-10 years to see any differences in numbers of staff.

 

Squid its beautiful to see your point of view! Because its truly the norm of the american people to expect that medical personnel be perfect "after all thier messing with peoples lives?" and that they exhaust all medical resources for every possibility regardless of the cost because all have the right to be treated the same..... right?

Its not reality!...... Insurance is what pays.... and they won't pay for exhaustive test for minor chance issues unless overwhelmingly indicated!.. Its a game of odds based on symptoms and history and age. Then when they do have the money... and the test are ordered, its viewed as excessive unnecessary tests that were ordered if the test come back inconclusive!

Gut instincts are very valueable and are derived from years of experience... nevertheless they too are not perfect!

when you bring your car in to the shop, they start at the cheapest and most likely cause that promises the most likely reward of finding the cause and fixing? If they tore the transmission apart everytime your car hickupped, it would cost thousands?
there is a chance that the problem is the transmission but after testing.. its only a bad spark plug wire!

People are similiar!... its tough to diagnose unless the problem is presenting itself upon arrival. Even then you can miss it!

The fact is... the possibilities are so broad and wide, that there is much to be missed.

You can take 20 doctors and present them with a scenario and you will get about 5 inconsistencies in diagnosis and once agreed on the diagnosis, you will get about 10 - 15 different ways to go about treating it!

Rarely is anything textbook, but has to be weighed in the balances of chance, probability, and whats most likely to be the issue based on culture "yes culture.. many cultures present heavy with certain issues more than others", events, history, age, gender etc etc etc......

People need to get out of their head medicine is an exact science!

Then as Even mentioned.. then you get into the psychopathic part of things where people gender problems based on phobias, drug seeking, insecurities etc....
Humans are very complex.... its tough when they come in and they don't even know whats wrong with them and you don't know them from Adam and you are supposed to "tell them all things" and fix it without any errors!

 

I certainly hope it's true. If it isn't I would strongly encourage doctors to do so.

I do embedded programming for industrial applications (Petrochemicals, chemicals, machine control, pharmaceuticals, etc) and am subject to *very* strict oversight due to the government safety and performance requirements: auditing, random drug testing, cGMP, FDA CFR 21 requirements, etc.

Yes, I have made mistakes, so far I haven't directly or as a result of programming errors actually killed anybody. If somebody did die as a result of my incompetence, I'd probably take it very hard and maybe leave the career altogether.

Peers of mine who have made serious - fatal - errors usually leave the career. A couple committed suicide.

 

And this is the whole reason Doctors do sit around and discuss cases and patients... to get a collective opinion about the best treatment etc to avoid pitfalls from the limitations on one persons experience and knowledge.

Its a good thing!... they are far to busy to do it for fun or mischeif!

 

You've managed to display a remarkable lack of understanding on subjects before, but in this case you’ve really outdone yourself. Congratulations!

What, may I ask, do you do for a living? Perhaps broom pusher, where there really are no consequences to inaction or error on your part?

I’ve had high school friends who went on to become MD’s, and that is one career I would never consider. The bulls*** they had to endure, especially the CYA garbage from insurance co’s and Medicare, is in no way made up by salary. Even if every doctor started out at $1 million a year, it wouldn’t be enough.

I think any individual who chooses to become a medical doctor is following a calling of some sort. At the very least, they have care and compassion for their fellow human beings. As a mean introverted Type A workaholic, I honestly couldn’t understand the motivation for a human being wanting to become a medical doctor

Despite all the modern technology, medicine is still very much an “art.†I doubt you could pick a randomized sample of the population and train them to all be doctors, no more than you could “train†them to be an artist or a classical violinist.

And if you want that personal one-on-one care without all the “costs†associated with it, I’m really not sure how you would accomplish that. Sounds like some sort of Socialist Utopia, and last time I checked you were some right-winger who doesn’t believe in that.

If you want that level of care, pay a visit to The Mayo Clinic in Rochester, MN. The doctors there will sit with you as long as necessary – and bill you accordingly.

 

On this point I'll have to disagree...somewhat.

The reason I'm a doctor is that I had planned on being an officer in the military. However, the year I was commissioned, 1990, was the year of the "Peace dividend" following the fall of the Berlin Wall. So, hardly any of us were commissioned into active duty.

So, four years of planning in college down the drain. We were in a bit of a recession then, so I decided for the sake of job security, and nothing else, to try my hand at getting into medical school. People were having a tough time getting jobs in business and I was a Business major. Long story short, 15 years later, I'm happily practicing.

The group of people I hung out with in medical school were mainly of the laid back type. No one was going to bust their nice person learning about protein folding of gamma receptors when we all knew we would never, ever need to know that in practice. I could honestly say none of them had a "calling". No one ever said, "I'm doing this because I care." We spent our weekends getting drunk at the college bars, playing Sega Genesis, trying to pick up girls and racking up student loans to go skiing in Colorado.

Lastly, remember that depending on the med school, only about 60 to 70% of people go into fields that deal with patient care. A lot go into research, pathology, anesthesia, radiology. Not that they're not caring people, but if you quiz some of them, a lot will probably say, I just don't want to deal with patients, or I'm not interested in continuity of care. I think anyone who has been to medical school can tell you they knew a bunch of people with no interpersonal skills, and no sense of compassion. Remember, a lot of kids are driven into the profession from their parent's desire to make them succeed.

I bring these "myth shattering" comments up just because you see it all the time, oh, he's in medicine, he must have had a calling. He wants to help people. She's sacrificed so much. Have any of you met any cardiac surgeons? Not to be throwing out generalizations, but they're the biggest bunch of arrogant people who are barely interested in meeting patients. "Ok, your cardiologist says you need a bypass, I'll have my nurse schedule it for next week...nice meeting you."

Now I'm not saying that any of these docs, myself included, are bad doctors. :lol: I really believe my patients enjoy seeing me and I have a great rapport with them. But in the end, I don't feel like I sacrifised a lot to get where I am. I only work about 50 hours a week, I get 6 weeks of vacation and I get paid $220,000/year, and we're low paid compared to other parts of the country. If I had gone into Cardiology in this part of the country, it would be $540,000...and these guys work less than I do! See how many docs would still do what they do if you promised to wipe out all their med school debt, but pay them $44,000/year(median US income).

So, in closing, I would say that it would be a very big misconception to believe that medicine is made up of altruists whose only goal in life was the betterment of mankind. We are essentially, the wealthiest group of professionals, in the wealthiest country on Earth...hearing it that way, I don't think it takes a brain surgeon to figure out the real reason people do it.

 

Yes, I remember during our first week of orientation in medical school, a student getting into a verbal fight with a nurse because he was upset there wasn't a doctor there to supervise our vaccinations. He was demanding information about side effects and ingredients. It was actually pretty embarassing to witness. And this was the nicest nurse in the world. All this for one of those booster shots you get before high school. He was told to make an appointment separately to see a doctor and then wanted to make sure he didn't have to pay for it.

I mean he was a putz and guys like him were about 10 to 15% of our class. They treated nurses as inferiors and they were still med students!

As for myself...I married a nurse, no better way to get in good with the hospital staff! :lol: