By Brooke Holmes, Special to CNN
Editor’s note: Brooke Holmes teaches the history of medicine and Greek literature at Princeton University. She writes with The Op-Ed Project .
Earlier this month, high school students across the country made their final decisions about where to go to college. For the ones who plan to become doctors—as many as a third of the incoming class at my own university—the landscape this fall will look different in more ways than one: The class of 2016 will be the first cohort to navigate pre-med tracks geared to the new MCAT, the gateway test to medical school.
The revised exam, approved in February by the Association of American Medical Colleges, will still test aptitude in the physical sciences. But it’s engineered to gauge, too, how well aspiring doctors understand the social and behavioral side of medicine. And it tests for critical reasoning and reading skills.
The revamped MCAT confronts a problem that’s only getting worse. For all the strides we’ve made through technological innovation, medicine is failing at the very human art of treating patients. Doctors are ill-equipped to deal with factors like diet and poverty, which are now responsible for over half the cases of premature disease and death in theUnited States. Armed with state-of-the art drugs and machines, they don’t always consider whether using these resources will cause more harm than good. In many cases, it no longer makes much sense to call what physicians and patients have a “relationship” at all.
The AAMC hopes to reverse these trends by helping medical schools select for applicants capable of practicing, not just the science, but the art of medicine. There’s plenty of skepticism about whether a multiple-choice exam can screen for qualities less tangible than scientific competence. But there’s another question raised by the exam: how to prepare for it. Can we educate future doctors in a way that will make them more effective caregivers down the road? If so, how?
Let’s back up and ask an even more fundamental question: What do we want from our doctors? In a word: communication. By this I mean that we urgently need doctors who can talk to patients. But my understanding of communication is also broader. It’s the ability to navigate between two poles. There’s the body and the machines we’ve built to read its signs. Then there’s the person, together with his or her experience of pain and distress, cultural background, personal history, socioeconomic situation, and so on. We desperately need doctors who speak the language of the body and the language of the person.
One way of doing this is to have pre-med students take courses in anthropology, sociology, and psychology. Last year, the AAMC released a report showing how much medical students—and their future patients—stand to gain from training in the social sciences. Making these fields part of the pre-med curriculum can only help.
But the social sciences alone don’t cover all the skills crucial to quality care: the ability to observe people, to imagine what they’re thinking and feeling, to listen, to interpret complex situations, to navigate difficult ethical decisions together with patients, to practice with self-awareness. In fact, an overemphasis on the social sciences risks repeating the errors of a reductivist science of the body by promising a science of the person. That risk is even greater if students see the coursework as training for a multiple-choice exam.
The truth is that people are messy and complex. They aren’t always predictable, especially when they’re suffering and especially when they’re facing their mortality. Bodies, too, are complicated. Every clinical encounter, every clinical decision has something unique about it.
If we want future doctors to develop the arts of communication, the skills of interpretation, and the ethical sensitivities they’ll need when they finish medical school, we need to encourage them to train in the humanities as well. They should be taking courses in literature, philosophy, ethics, cultural analysis, the arts, and history, including the history of medicine itself. Indeed, given that the humanities are virtually invisible in medical school, it’s all the more important that they figure in the pre-med curriculum.
It’s easy to counter that pre-med students already have too much on their plates. The problem is that their diets are usually imbalanced. The students who should be the most well-rounded undergraduates often end up the least. And if pre-med advisers, stuck in the mindset that more science always means better results, start pushing a heavy load of social sciences, the humanities are at risk of being squeezed out.
Do we know that the humanities will help medical school hopefuls? Well, doing more humanities doesn’t seem to hurt anyone’s career prospects. Last year, humanities majors—a mere 5% of applicants—were accepted to medical school at a higher rate than majors in the biological sciences (52% versus 44%). What’s more, their MCAT scores were, on average, higher. The gap may well widen with the new exam.
But admissions statistics don’t mean much if the MCAT, let alone medical school, isn’t a reliable predictor of what really matters: Whether students become good doctors. What’s going on in the real world of medicine suggests it’s not. It’s precisely a crisis in care that pushed the AAMC to come up with an exam designed, at least in theory, to promote more humanistic thinking in clinical practice. It should also be pushing us to rethink undergraduate training.
Right now we inhabit a paradox. We tell pre-med students they need to focus on the sciences and then we complain that the doctors they become don’t treat us like people. If we want to improve the quality of health care, we need to be educating future physicians to think qualitatively and quantitatively, humanistically and scientifically. The new MCAT is nothing short of a wake-up call to develop a genuinely well-rounded pre-med curriculum.
The opinions expressed in this commentary are solely those of Brooke Holmes.
I have worked in teaching hospitals for the past 20+ years. Doctors have changed a lot over the years. I would argue that most are very good now at communicating with their patients, with a few exceptions. It's much different today than it was even 10 years ago.
A big problem arises, though, when docs get into practice. Their practices fill up quickly, and taking too much time with patients means they stay late, work overtime, and burn out. It is terribly expensive to have your own practice, and being in a group or clinic means you are pressured to see a certain number of patients. Insurance reimbursement is terrible, and so is Medicare, and the numbers of people you have to employ to process the claims is unreal.
Shouldn't you already be "human" if you have taken on a profession of caring for another person. Doctors last I heard have to be really intelligent. So being human, good communicators, listeners, empathetic and other synonyms should come naturally. But yeah teaching these social science courses probably would help. Is that what patients are complaining about?
As they celebrate their 65th birthdays at the rate of 10,000 a day, Baby Boomers are now approaching the stage of their lives when they will need more medical care. But they—along with everyone else—are going to have a hard time getting appointments.The doctor shortage was fostered in 1996 when Congress capped the number of new doctors Medicare would pay to train, a practice that continues to this day. Teaching hospitals, which now make up about 10% of hospitals nationwide, depend on those Medicare funds to pay about two-thirds of the cost of doctor-training. (Training costs include residents' salaries, malpractice insurance, equipment, the extra time that teaching procedures add to patient care, as well as the added costs associated with caring for the sickest patients.) Recently, the President's National Commission on Fiscal Responsibility and Reform proposed cutting Medicare funding to train doctors even further, by $60 billion through 2020. If this cut is enacted, the doctor shortage would get far worse. Meanwhile, Health-care reform will add an estimated 32 million people to the ranks of the insured, driving them to seek medical attention that in the past they may have avoided due to expense. The aging population will also create much greater demand. The number of seniors who need more medical care is expected to soar to 72 million by 2020—nearly double today's number. According to a 2010 report by the Association of American Medical Colleges, the increased demand means that our nation will need an additional 130,000 doctors, both general-practice physicians and specialists, 15 years from now. That's about 20% more doctors than we have currently. But doctors are aging, too. Almost a third of doctors in the country—about 250,000—are over the age of 55. By 2020 they plan on retiring. Right now we train roughly 16,000 doctors a year. To keep pace with demand, this nation will need to train an additional 6,000 to 8,000 each year for the next 20 years. If we increased the number of training slots today, it would take seven to 10 years for the new doctors to see patients (four years of medical school, plus three years of residency and additional specialty training). In many parts of the country, the shortage of doctors is already a reality. Statistics from the Health Resources and Services Administration say that 10% of the population lives in an area where there is an inadequate supply of health-care providers. These people may wait months to see a doctor. Sometimes no specialists exist where they live. While some responsibilities of doctors can be absorbed through other trained medical professionals, including nurses and physician assistants, they don't have the same unique expertise. If we don't make changes, long waits and limited access will become much more common for all patients. Please keep all of this in mind next time you decide to label physician's greed and inhumanity as the reason why they cannot spend more time socializing with you during their work time.
I am not even going to read the article because the headline tells me all I need to know. I have worked at a hospital for 6 years in the IT field and I can tell you the only Dr's who act human are the ones who don't come from privileged families who have had everything handed to them their whole life and thus treat anyone below their status like servants. You will always be able to tell the Dr that came from money and the one who didn't.
I took the MCAT in 1983 and was chided by my adviser as being "woefully underprepared." I was, by then, a political philosophy major, having dropped a chemistry and biology double major because I just could not see myself in a career in science if medicine didn't work out. I scored higher on the MCAT than every other premed at my school, and I ultimately didn't apply to medical schools because of the very inhumanity problem of which Ms. Brooke Holmes writes. The people with whom I associated in premed and exploring medical school options were so disconsolately uncaring and self-absorbed that I could not imagine spending the next 10 years of my life studying and working closely with them, nor could I envision a career with them as my colleagues. I ultimately chose a different field, earned 2 doctoral degrees, and had an awesome, successful career until my disability from MS. Now I see too much of the people I didn't want to hang out with when I was younger!
BWAHAHAHAHAHA! Doctors? Care? *continued laughter*
For those of you doubting Ms. Holmes' street cred for critiquing medical training, you only have to be a patient one time to feel the exasperation of the 7 minute office visit, especially if your provider–doctor or nurse or therapist–has his or her face in the computerized medical record for 6 of those minutes.
I am the Program Director for Stanford Medical School's Medicine and Horsemanship, an innovative equine-assisted learning course that employs horses to teach "bedside manner," team work, and leadership. Conceived by then-Chief of Neurosurgery, Allan Hamilton, at the U of AZ, Medicine and Horsemanship has been conducted nationwide for med students, physicians, nurses, and therapists, from the Mass General to the state of Washington.
Medicine and Horsemanship uses the sensitivity and nonverbal communication behaviors of horses in activities that simulate clinical scenarios such as critical care, the first 30 seconds of building rapport in the exam room or ER, and hospital rounds where 10 people in white coats descend upon a patient.
The course description is on the Stanford website at http://tinyurl.com/StanfordFAMMED-Courses and on my website at http://www.horsensei.com/#app=programs_medicine_horsemanship
Perhaps putting that money into a treatment center for underserved children would be more apropos to both using resources wisely and engendering compassion among training physicians.
Dr. Kane's program sounds really interesting and worthwhile. I'd encourage people to read about it, especially medical students who think it's wasted money that might be better used for clinics (where they will stick their face to a computer screen for 6 minutes of the 7 minute appointment).
Beverly could not be more on the money...I am currently in that very same situation. I am currently Doctor shopping but not in the way you might think I'm not looking for pain pills, I'm looking for a Dr who spends more than 5 minutes with you. I had one and he quit his practice because of what he said was to much "red tape from the insu companys, he was tired of all the paperwork and being told what he could order and not. Since loosing him 5 years
ago I have not found a Dr since who gives a damn. I know I'm sick there is something not right yet I can't get a Dr's attention I figure when I collapse maybe someone will care then. (probably not) I know why Dr's are the way they are, have you ever sat in the waiting room? Look around, you see a room full of people to see ONE Dr. You see tons of medical files each one representing a person. Bottom line, the more patients the Dr crams in a day the more money he makes. There is just no way any Dr can efficently see that many patients. Heck my mechanic cant even see that many people a day.. There needs to be a maximum on the number of patients to Doctors. There taking on so many patients and when it gets to much for them they simply farm you out to a specialist. "Oh the antibiotics didn't work" hummm you need to see an ENT guy....And your off to a new office with a new Dr and the same problem.. Based on my experance with the most recent Dr's I met I know I could pose as a Dr for a week, see patients in the same manner with no medical training and make people believe I am a real Dr.
You really make it seem so easy together with your presentation but I to find this topic to be actually one thing that I believe I'd never understand. It sort of feels too complex and very wide for me. I am looking ahead in your subsequent publish, I'll attempt to get the grasp of it!
Not possible with the US's current healthcare for profit model. They'd have to be healers first, and worry about their bankbooks second.
I don't think the issue is really the doctors in this scenario. It is the insurance industry driving the costs of health care into the crazy spiral that exists in the US now. Ask any doctor what their biggest expense is and they'll tell you it's insurance – their malpractice, followed by the costs of dealing with patients' carriers.
Does this author also consider CNN's own Dr. Sanjay Gupta to be a humanless drone because he decided to become a doctor instead of a liberal arts savant? Wonder what he would make of this article haha...
To both the author and all others posting here who have not gone through successfully enduring pre-med, scoring in the 80+ %ile on the MCAT after studying for years for one exam, simultaneously volunteering in the community on average 100s of more hours than any other type of major, all just to be considered for an interview and then competing for a seat in a medical school class of 150-200 students against 13,000 applicants+ per 150-200 spots, taking out $250,000 of loans out to spend 2 years during which it takes 16-20 hours a day of studying/7 days a week just to pass and then pass the United States Licensing Exams Step I at which point you spend another 2 years slaving from 5am-8pm at the hospital and then coming home at night to study for LCME shelf exams, then passing he United States Licensing Exams Step II, then entering a residency which will take a minimum of 4 years (for many up to 8 years) to complete on minimum 80 hour work weeks while being paid what amounts to below minimum wage per hour (try paying nurses or almost any other profession below minimum wage for their services and see what happens), while your original $250,000 of loans from medical school are now accruing interest at a rate at which your minimum monthly payment of the 25 year repayment plan is $1700 while your total monthly salary just over $3000, while passing LCME licensing exams and the United States Licensing Exams Step III all while simultaneously trying to serve the best needs of each patient most times of on the behalf of one's own personal needs or one's family members, while combating every single organization trying to discredit, complain about, and encroach upon physicians as a whole..please mind your own business and let us do our jobs of successfully learning the incredibly complex intricacies of the human body so that we can compassionately, yet adequately, save yours and your family member's lives when you come to us in your times of greatest need..oh yes I forgot all of this while trying not to get sued by you..thanks
Here here! It doesn't get better as you get older, get in a medical group, take more tests, get sued countless times, rinse and repeat... with aching joints
Very, very well said. I am currently a third year medical student on the east coast and totally agree with your assessment of the challeges that we as medical students and future physicians contend with. I understand that medicine is a calling but some of the obstacles that we face can be overwhelming and some of them are unnecessary. I am currently one of those medical students who is paying ~$50,000/year to work 10-12+ hours in the hospital all in the hopes of learning as much as I can so that one day I can really serve competentlyas an attending physician. However, I am very cognizant of factors involved in practice based medicine such as insurace companies, various health care laws, and the medical-legal aspect of medicine that will affect me as I progress. I think that it is EXTREMELY important for physicians to be aware of these issues and play an active role in affecting the decisions that are made in regards to them.
You've just demonstrated how insensitive doctors (or medical students, interns or residents hoping to become independently practicing doctors) are. All you appear to be worried about is everything you need to do and everything you need to pay for in order to become a doctor. And then, once you become a doctor, all you seem to be worried about is improving your own standard of living. The fact is: if you don't have the in-depth social skills, your bedside manner will be a poor experience for your patients–no matter how knowledgeable you are about medicine. And that is a disservice to your customers: your patients. Is it any wonder why people hate going to the doctor when they are ignored, their concerns minimized if the doctor even hears them, and frustrated by your rushed, impersonal examinations?
Your hatred of physicians and label on them as ruining healthcare due to their own greed is flawed. Maybe the issue could possibly be the fact that when the physician comes into the office in the morning they realize that they cannot spend 30+ minutes having in depth conversations with each patient as they have to see 30+ patients in 4 hours. It is a flawed system with no one to blame but Congress (however people tend to take their outrage and blame on the greedy, heartless physicians). As they celebrate their 65th birthdays at the rate of 10,000 a day, Baby Boomers are now approaching the stage of their lives when they will need more medical care. But they—along with everyone else—are going to have a hard time getting appointments.The doctor shortage was fostered in 1996 when Congress capped the number of new doctors Medicare would pay to train, a practice that continues to this day. Teaching hospitals, which now make up about 10% of hospitals nationwide, depend on those Medicare funds to pay about two-thirds of the cost of doctor-training. (Training costs include residents' salaries, malpractice insurance, equipment, the extra time that teaching procedures add to patient care, as well as the added costs associated with caring for the sickest patients.) Recently, the President's National Commission on Fiscal Responsibility and Reform proposed cutting Medicare funding to train doctors even further, by $60 billion through 2020. If this cut is enacted, the doctor shortage would get far worse. Meanwhile, Health-care reform will add an estimated 32 million people to the ranks of the insured, driving them to seek medical attention that in the past they may have avoided due to expense. The aging population will also create much greater demand. The number of seniors who need more medical care is expected to soar to 72 million by 2020—nearly double today's number. According to a 2010 report by the Association of American Medical Colleges, the increased demand means that our nation will need an additional 130,000 doctors, both general-practice physicians and specialists, 15 years from now. That's about 20% more doctors than we have currently. But doctors are aging, too. Almost a third of doctors in the country—about 250,000—are over the age of 55. By 2020 they plan on retiring. Right now we train roughly 16,000 doctors a year. To keep pace with demand, this nation will need to train an additional 6,000 to 8,000 each year for the next 20 years. If we increased the number of training slots today, it would take seven to 10 years for the new doctors to see patients (four years of medical school, plus three years of residency and additional specialty training). In many parts of the country, the shortage of doctors is already a reality. Statistics from the Health Resources and Services Administration say that 10% of the population lives in an area where there is an inadequate supply of health-care providers. These people may wait months to see a doctor. Sometimes no specialists exist where they live. While some responsibilities of doctors can be absorbed through other trained medical professionals, including nurses and physician assistants, they don't have the same unique expertise. If we don't make changes, long waits and limited access will become much more common for all patients. Please keep all of this in mind next time you decide to label physician's greed and inhumanity as the reason why they cannot spend more time socializing with you during their work time.
"Brooke Holmes teaches the history of medicine and Greek literature at Princeton University."
Wow, you have such impressive credentials to comment on medical training! You didn't even let the fact that Princeton doesn't have a medical school impede you from letting your opinion of medical training be known.
Seriously though, Dr. Holmes, this is silly. You clearly have no clue what medical training entails. Reading old history books about medicine doesn't make you an expert, or even knowledgeable, on this topic. Those of us who have already completed medical training or are currently in the midst of it (such as myself) can see how silly your opinion on this is. Why don't you go back to worrying about whether or not your humanities department will see another cut in funding again? Leave the overseeing of medical training to those of us who have actually lived through it and understand it far, far more intimately than a non-physician could ever possibly hope to understand it. Reading about it is one thing, living through it is another. We've had enough public and government interference in medical training already, to its detriment.
Ms. Holmes, you need to come to Honduras where I live. Believe me, you have nothing to complain about.
There are several points with which I disagree about the author's comments, however, a complete discussion would be beyond the scope of this response. Therefore, I will focus my discussion to one point; the sixth paragraph, first sentence.
"Pre-med " is a catch all phrase forany one who has already decided to go to medical school. Many students who go to medical school have a variety of under graduate degrees, almost all of which take about 4 years to complete. Since I can't speak for other types of students, I will use anecdotal reference.
Before I went to medical school, my under graduate degree was in electrical engineering. I have long since completed my engineering degree, medical school, internship, residency, fellowship and have been practicing 10 years. At this point, I am interested in all the courses she speaks of, namely anthropology, sociology, psychology, but only as a matter of personal interest. I cannot, however, advocate piling all these courses on top of the course loads that most of these undergraduates are required to so. I certainly couldn't imagine myself doing all these courses on top of the required course loads to obtain my degree.
The only effect of adding all these courses into a undergraduate requirement would be to extend the number of years required to finish an undergraduate degree. While this situation would be great for the board of trustees for a university or college as well the professors who derive their income from these universities, this situation certainly does not help the medicdal student by incurring greater debt over their lifetime.
On one point I do agree with the author. Communication ability is essential. However, more didactic lectures are not the answer. Inerpersonal communication isn't something one learns in a laboratory. This ablility should be taught in the field. Once the student is doing their clinical rotations in the third and fourth years, the student should be taught how to address patients and make observations.
Again adding more courses and requirements during medical school and residency does nothing more than add to the personal debt of the med student and increase the length of time required to complete residency. Extending the length of residency with more requirements may be great for the tax paying public (i.e. the more intelligent young hard working people you can get to work for sub mimimum wage salaries for a longer period of time, the less time this cohort has over their working lifetimes to collect those bigger medicare dollars), but looking at the direction medicine is going, I doubt we will continue to attract the same level of talent and dedication we have in the past.
I think the author acknowledged your argument in her 10th paragraph with her "imbalanced diet" metaphor. Don't you think it's possible that students destined for medical school could afford to take a little less of the physics and synthetic organic chemistry (unless their undergraduate degrees already include these, of course)? I think the physical sciences could very realistically be downsized without any detriment to patient care. Many other developed nations (with health outcomes better than in the United States) require much less science background than we do.
I don't think many would argue that we should lengthen the path to a medical degree. It is not so unfeasible to think of adjusting the focus of our educations.
I'm happy to see this article here. No, it's not an earth-shattering new idea–but it is an important idea, because it is something we can do to improve the situation, even if only part of the way. I don't believe the author is implying that more education in humanities and social sciences is the only change we should consider. Clearly there are many other issues worth discussing–the rushed patient encounters, the pressure of lawsuits, patients as potential adversaries, etc. No one is denying the importance of these problems.
Don't condemn this idea because you don't believe it's the most important change we need. It is a given that there are many other serious changes to consider. And there are many articles out there that focus on those problems. I've not yet seen one discussing this topic so well.
I remember that handful of my classmates who, from the very start of medical school, seemed to have no trace of compassion or humanistic values. The admissions process had welcomed good actors into the profession. By encouraging more education in humanities and awareness of social problems, and by increasing the likelihood of admission for more humanities-oriented students, we may very well minimize this–even if only part of the way.
To the best and brightest young minds,
If you are even thinking of medicine as a carreer, take a few minutes and read through all of these posts. These will be your patients. Do yourself a big favor and become an accountant or an engineer or anything else. You will live a longer and happier life.
I'm not a doctor. I haven't been to medical school. But I am the mom to a 3 year old who was diagnosed with a Chiari Malformation (a brain abnormality where her cerebellum herniates down through the opening of her skull). When our pediatrician (who is USED to talking to kids and parents) informed us of Riley's diagnosis, it was over the phone and she said "Your daughter has a brain abnormality. You need to see a neurosurgeon, but don't worry because most people aren't diagnosed with this until their autopsy." I think she was trying to compensate for the fact that she didn't know much about Chiaris, but the way in which she informed us of Riley's diagnosis was unacceptable.
Riley has had 2 sedated MRI's, a sleep study, a 24 hour video EEG, and both neurology and neurosurgery consults. We've seen a trend that when we get the test results (after WE call for them), they are often given to us by a nurse who can't answer any questions about them. This results in frustration on our part because it results in yet another trip to the doctor's office for one simple question (the doctors' offices are an hour away). We become frustrated with the doctors and that impacts our perception of the care our daughter is receiving.
I know doctors are busy people and I wouldn't want to have their job, but a little compassion would go a long way. I wish I could sit down with medical students and talk to them about the effects of their interactions with patients...from a parent's stand point.
I'm a primary care doctor, I rarely order brain MRIs. However, when I do, I order it and inform the parent what I'm looking for and we talk about it before the MRI. Then, if she calls for the MRI and it's abnormal, I call. Not our nurse. Prior to the call, I will research about the diagnosis some more myself to increase my communication with the parent, however, I know my limits and communicate them compassionately. Now, a specialist may order 10 brain MRIs a day. Can you imagine how many abnormal one's the specialist receives a day? Between surgeries, hospital patients, clinic patients, and then to add phone calls in there! It's not realistic. I'm saying, this call would be a 15 minute call, as you would of course have questions, and there are of course answers that need explaining. It's best to have patient come in, appointment to explain, discuss and figure out a plan and be sure there is mutual understanding. Face-to-face is best, an hour drive or not. I agree there are problems in medicine. Just as you wouldn't want to have Riley diagnosed over-the-phone, physicians need to see patients to communicate best and coordinate care. Best wishes for Riley!
Thanks, Michele! And I agree...it's best to do an appointment to discuss tests results, but that being said...we're a 1 income, 1 car family and my husband is active duty service member who can't take leave that often add to that the fact that Riley's neurosurgeon is only in office two days/week and we're in a tight spot. I just wish they would take a little bit of that into consideration before getting upset with us when we ask to schedule tests/appointments on the same day.
Doctors need to see patients as a person not a number. They need to catch patients where they are in life. A disheveled looking mom who is obese, needs to hear, "I'm concerned that you look tired. Is there time you can create for you?" not: You're obese and you need to lose weight, then you'll feel better". Caring for patients is a process, an art of communication and empathy, and knowledge. It's not a cookbook. Caring for the person, planting seeds as you see them over time will help patient change habits. That takes time. As a physician myself, I've reduced my days in office to part-time to have good balance. Time with patients and personal time to rest, raise family. I make $85,000 a year working 3-4 days a week, including Saturdays and call. $80,000 education and weekly medical reading to stay current. I make less than my daughter's public school elementary school principal! I'm glad for what I do, and money isn't my focus.
I strongly doubt that any curriculum or exposure to Humanities can "teach" someone to care! That is a result of genetic makeup, and living life. It does not always have a positive result!
Well written, well said, Dr. Bendezu. I'm a northeast doctor and am now only working parttime ... about 50 hours a week ... so that I can have strong relationships with my patients. The extra effort is well worth it, and I stay out of trouble because my employers are getting 50 hours a week instead of the 30 hours they hired me for. That's the only way that I can beat the system. But, I go home at night feeling like I'm doing what's right for me and for my patients.
Hey, maybe they could teach that on the new MCATs ... how to outfox the system.
IIt's the system that creates uncaring doctors and the fact that many patients have unreasonable expectations. This article is written by someone who as far as i can tell has never worked in the health care field. The argumenents are very simplistic and have no data or reasoning to back up their claims. It's all opinion, no facts. Typical media... entertainment created to arouse emotions and draw readers so we will look at the advertisements.
I appreciate this article and its perspective, however I have to disagree. I think the problem in creating humane doctors lies not with pre-med selection (such as the MCAT) or education in the humanities. We select the right people regardless of their undergraduate major (physics versus philosophy). That is why the application and interviewing process for medical school is so rigorous, they test essentially every aspect of your background, preparation for a career in medicine and your commitment to serving your community and those most medically disadvantaged/underserved within the community.
I argue instead that the inhumane conditions in the practice of medicine itself for medical students, residents and attending physicians (36+ hours with no sleep, 80 hour work weeks, an increasingly complex medical system etc) forces physicians to care less about dealing with our patient's feelings, housing problems and other human factors and more on the medical priorities. The for-profit medical system is the problem here: it forces us to act like disease-treating machines rather than people who care about our patients and have our own human limitations.
Sounds like you've managed to fit right in.
totally agree with you that it's the hours and the working conditions that make physicians cold. We're just trying to survive the system, just like the patients and maybe get to see our spouse and kids at the end of the day. Training conditions don't improve all that much when you get out. Many people get into medical school and are now leaving sooner and sooner because of the working conditions. We need to start unionizing. It's not about the pay. It's about being human, for every one involved.
Having worked in a medical practice, most people do not stop and think what it actually costs to run a medical practice. The amount of medical mal practice insurance is completly outragous. Most physicians have to buy their own medical supplies, which are not cheap by any means and they need to provide the facility and pay their employees. Having said that they also need to get paid themselves. It is going to cost around 125,000-175,000 for their education how are they supposed to pay that back? Insurance companies are now dictating medicine and make the physician jump through 10 hoops before they will actually pay on a claim. If something is missing on a claim form forget it!! I do believe that doctors need to spend more time with their patients and treat them as a "whole" instead of treating only presenting symptoms. They are over worked and underslept. Especially if they are in the OB/GYN field of medicine. The problem now is not just that doctors need to be more "compassionate" there needs to be improvements in all aspects of the health care industry i.e government, insurance companies, patients themselves, and the physicians. Until that happens, nothing will ever change. However you do have physicans that scam the system and bill for things that are deemed unncessary or were never even performed that cost tax payers dollars!!
Having worked in an ER for ten years you need to be pretty bad to get sued.
Even of a mistake is made, adequate instructions, written not a form, will cover you.
Malpractice is rampant for a reason.
Re: Michael: " Having worked in an ER for ten years you need to be pretty bad to get sued.
Even of a mistake is made, adequate instructions, written not a form, will cover you.
Malpractice is rampant for a reason."
This gentleman says he works in an ER, but his assertions are incorrect.
As a Board Certified Emergency Physician who has also provided medico-legal consulting, I ask you think about the following:
1. You do not have to "be pretty bad to be sued." Lawsuits are initiated for frivolous reasons frequently. Bad Outcome does not equal Negligence. Sometimes patients get ill, and sometimes, patients even die. Doctors are not perfect, and they are certainly not Gods. And, medical outcome may not have anything to do with Legal Outcome: sometimes doctors and/or insurance carriers settle so everyone can move on with their lives. No, Sir, outstanding doctors with superb training, skills and good people skills get sued.
2. "Adequate instructions, written, not a form, will cover you." Again, this Gentleman is misinformed. It is true that clear and specific instructions is part of quality care AND is medico-legally recommended, but it will not by itself protect a physician from legal action. I have reviewed cases where despite good instructions, the physician is still sued.
3. On one point we can agree: Malpractice is rampant. But the Gentleman's reason for the rampant malpractice is wrong. Americans have a system that expects doctors to never make errors; we allow patients to abuse their own bodies but then demand doctors to 'fix' them–or else; and most of all, we have a hodgepodge of tort-lottery-systems in each State which allows frivolous malpractice suits to go forward.
Think this doesn't affect you, personally? Ask if doctors over prescribe medications, over-order tests, over-hospitalize patients, and do things to prevent being sued by their patients, rather than spending time listen to, and working with their patients. Ask if defensive medicine improves or impedes your relationship with your doctor.
Mr. Michael, you may mean well, but I suggest you spend some time and effort to gain a more in-depth understanding of how malpractice works, and what it means for patients, doctors, nurses and our health care system.
When the motivation for what to be is money this is what we get.
Ten years ago all these 'doctors' would have been MBAs.
Admission standards to Med school are a joke.
I don't disagree with the need to have doctors be more empathetic, to slow down, "to care", as everyone seems to imply that many don't. I have been a physician for 20 years. I can tell you I remember very well the reason I went into medicine as well as the reasons many of my friends did. No one chose this profession because they didn't care. Many of us had events in our lives that made us want to help others, the loss of a loved one to disease, for example. However we find ourselves with so many doctors who, after a few years after residency, have become quite jaded, hurried, aloof, etc. So what happened??
May I suggest that one issue that is being overlooked is that the system we have created is fostering this behavior. I used to practice in the Northeast and routinely saw 30-35 patients a day. This didn't allow for long visits or the kind of interaction, the human connection, we all want from our physicians. From an economic standpoint, it wasn't possible. We have a system that rewards high volume, over zealous test ordering (for fear of litigation), quick service, etc. The days when your doctor could routinely spend time just catching up with you and your life are gone from most practices. Where one does still see this is in concierge practices, offices where no insurance is taken, practices that limit the types of insurances they accept if they accept them at all.
Many doctors practice "defensive" medicine. They live in fear of making ANY mistakes. This creates a situation where the patient is no longer someone you care about, but a possible adversary. If you wish to be treated as a human being, may I suggest that you treat your physician the same way? They are not gods. They will make mistakes. I am not suggesting that negligence should be tolerated. It never should. And if a physician is negligent they should not be practicing medicine ANYWHERE. However if he or she is doing everything that is recommended, following guidelines, etc, etc, and something unfortunate happens, it should not mean that they will forever be black listed. Sometimes bad things happen and no one can prevent that. That is the nature of life.
I moved to North Carolina a few years ago in order to leave the rat race of the North and find a way to practice medicine the way I always wanted to practice. I see fewer patients, have time to chat, to get to know them and let them get to know me. Being able to slow down and do this let's me be a better physician, definitely a happier one, and that's good for my patients.
You can't teach empathy. I don't think you can "screen" for it in medical school applicants. Honestly I don't think you have to. Most young doctors want to do the right thing, be the good doctor. Maybe it's time we let them and not foster a system that beats that out of them.
An ER visit two years ago.....no exam.
My 'primary' care doc.....never done an adequate exam.
You CAN teach that.
I am a primary care Internist. I practice high quality, evidence based medicine. I meet or exceed all national guidelines for care in multiple areas for prevention and chronic conditions such as diabetes. I spend the appropriate amount of time with my patients and listen to their concerns. Other physicians that I work with provide slipshod and substandard care and either over test or under test with no logical plan of action. I work for a small hospital system in New Jersey. In thanks to my dedication and high quality of medicine that I provide to my paitients, I am getting laid off because I am not making enough money for " the system" even though the system is a burocratic nightmare and poorly organized and poorly run. The next time you hear an advertisement for a hospital about how good they are and how much they care about you as a patient, don't believe it. Patients are just dollar signs to hospitals and the quality of care varies widely depending on which hospital and which Doctor you go to. I am seriously thinking about quitting the practice of medicine due to the lack of respect that I have received from employers and insurance companies as well as government red tape and a broken system of reimbursement. The primary care physican shortage is here and it is getting worse. The above reasons are examples of why.
You Practice Medicine......the problem comes in when you say care.......most doctors simply don't care! When they don't take their patients seriously,when the bill is in the mail before the patient is out of the office,when you set up appointments for you patient then charge them for missing said appointment when it was never something their schedule could handle! I'd rather stay sick then see a doctor that only practices money gathering. I wouldn't take my care to a shop that practiced the way a doctors office does.Why would i take my self someplace I wouldn't take my car>?
BTW why does adolescent medicine get thrown in with pediatrics >? know how hard it is to get a teenage boy into a pastel colored room>?I simply believe they need their own doctors
Your associates who provide "slipshod care" may work more quickly and efficiently than you do, possibly with equal or superior outcomes. Your assumption that extra time taken necessarily means better quality is tenuous.
You may do better in a very low overhead solo or concierge practice.
Then the patients spending their own time and money can decide whether you are as good as you think.
It is unclear whether arthor of this article is writing more from her own interest for promoting the humanities in universities or for truly more humane doctors for society. The current process of selecting for physicians are not limited by simply MCAT or completion of scientifically oriented course work. In fact, humanities majors have had the edge in the application process in medschools because of the diverse experience and knowledge they bring from their backgrounds. Not all who are interested in science are heartless or narrow-minded individuals. By the same token, not all humanities bent graduates are adept at the art of empathy. Look at all the law school and business school applicants, what percent of them come from a humanities background? What becomes of them? You don't prepare empathetic, caring doctors with a curriculum. You train them through work and real-life experiences. That is why med school admission offices pay extraodinary attention to their applicants extracurricular experiences. The author clearly does not know who are the folks that ultimately thrive in medschool, or ultimately as doctors that win respect in the community. They are folks who devoted their life to the higher call of medicine that is beyond a single-minded pursuit of a mere science.
Reading with interest all the pro-doctor, anti-doctor, anti-establishment opinions here. As a doctor, I was holding my emotions in check until I read that comment about doctors by hypatia, "You could gut most of them in search of a heart and never find one."
What a cruel statement. I wanted to cry when I read it. Well, okay, I did cry a bit. I was thinking about the 50-year-old farmer, I saved in the ER, and when he got better, he brought me a mason jar of honey from his farm. Yeah, I cried then, too. How heartless of me.
Maybe hypatia needs to train for the more empathic MCATs.
The way medicine is practiced now is all based on patient numbers, throughput, office flow etc. Hard to find a doc who really takes time with patients. Their training does not help either as it's more about focusing on the task and less on the patient. Maybe they should try to take certain elements of how docs used to be taught...and incorporate those into present day training. Years ago when you asked a colleague about their work, the discussion would center around interesting cases, problem diagnoses etc. Now, the answer is likely to be more about the good lifestyle that their "business" affords them.
I am not a doctor...but wish you were my doctor, well said and we on the patient side feel it.
B.S. I'm not gonna sit here and listen to "how much better it used to be". The old way of doing things is what bankrupted the system. If you talk to a new doc, the converstaion is focused on patient populations and capitated medicare plans not how much money they are making. When adjusted for inflation, physicians make less income now then they did 10 years ago, and this will conintue to decline with medicare cut backs.
good luck.. mine moves at a 100 mph.. she is in and out in no time.
I cannot even get past the first problem, before she is already scripted me and out the door.
talk about in a hurry.. She doesn't like to listen either. She jumps on the first thing you say and is gone before you can go any further.
Try a good FNP for many basic problems. They are capable of managing many chronic diseases as well as many of the most common complaints and they generally are alotted more time to see patients. A good FNP knows when you need a referral to a higher level of care, but common diseases occur commonly and FNP's can handle these.
Cleveland, this is why you make a list with your most important symptoms in the top 5 spots before you go to the doctor's office. Hand her the list first thing. All your items will get discussed.
The author is saying doctors can't communicate with their patients because she is not educating pre-meds well and that the new MCAT will do the job for her.
Did you not read the end? "The new MCAT is nothing short of a wake-up call to develop a genuinely well-rounded pre-med curriculum." She isn't at all saying the MCAT will solve the problem, she's saying it should be a wake up call that there is a problem that needs to be fixed.
Unfortunately ethics, morals, and compassion cannot be taught. Are doctors without these traits? Probably as much as society in general.
This is yet another pointless article. Did Professor Holmes really think that this was a novel article worth writing? Physicians go into their respective specialities because they are interested in addressing different aspects of a patient's life. Adding more history and classics into a pre-med education changes nothing.
Don't forget to make more money also.
There are doctors who should care more but if its that big of an issue they problem went into medicine for the wrong reasons. I think it would be a bigger help to have doctors who are more knowledgable about and more willing to consider things like chiropractic care and other alternatives. I go to the dr for a back probloem and the first reaction is you need pills then i need an xray or mri then i need physical therapy then i need surgery. All of this when 3 inexpensive trips to the chiropractor takes care of it
Another person from the ivory towers who pretends to know it all, and more comments from Joe Public about how little their physician knew or cared.
I'd like to invite each and every one of you to walk a mile in our shoes.
Totally agree with you. Author needs to spend some time in the ER, caring for dozens of patients, swinging different shifts, on the fly decision making. Nothing except your sense of helping others can fully compensate you for that. Few understand how much we do care.
Changing the test will only result in teaching to the test; it will not change the group of students interested in pursing a medical career.
You don't even need to change the teaching. All such questions from the MCAT would be leaked out by exam taking students, and MCAT training centers like KAPLAN – like it happens at all levels of exams in medicine and probably in other fields as well.
If you can end the patient visit within 15 minutes or less and fill out the government and insurance forms what else is there? When I began practicing I spent about half a day a months fiddling with forms, when I retired I was spending over 1/2 day a week doing this silly work. As an intern I helped treat a lady who had deliberately cut her wrist tendons in a suicide attempt. The highly trained surgeons re-attached all those tendons. She had a gall bladder attack and a couple of other problems of some magnitude during her hospital stay. Doctors did a cholecystectomy, psychiatrists saw her; and after a month we sent her home smiling, and apparently as good as new. That week she killed herself.
why is everyone so angry?
The following is based on 26 years in primary care before I moved into aesthetics.
This is a beyond isolated, ivory tower, oblivious to reality piece of complete drivel. Basically people want to stuff themselves with garbage, smoke, drink, snort or inject whatever. Then some fat cat insurer expects me to fix it all for 40 cents on the dollar.
So, which question on the MCAT do I have to answer to fix all that?
I think this is a good example of part of the problem. People do things that are bad for their health: they smoke and drink and eat completely improperly. But there are specific, psychological reasons for why each individual struggles with these things. It's not as if people just want to make themselves feel like crud; perhaps you might benefit from a more holistic understanding of human health. As far as insurance companies go we certainly have some problems, but that is a different issue.
Still fighting the good fight in primary care. The NUMBER ONE problem is the RUC committee in the AMA which ridiculously overpays and incentivizes tech happy proceduralists. Drop the CPT rates for niche -ologists and watch health care improve.
So true. So true. And if I don't fix it they sue, they sue.
The one that asks ...... "is your primary interest in becoming a physician to treat and comfort sick people or trying to figure out how to exact another 60 cents from insurers, medicare and medicaid????
In reading all these replies, one recurrent theme I have noted is that when physicians miss a diagnosis or get it wrong, they are abrupt, arrogant, rude, idiots, jerks–you pick your derogatory term of choice. No one says "he fixed my coronary disease with a successful surgery and I'm alive today, golfing, vacationing and watching my grandkids grow up, but what a jerk and I hate him, the money-grubbing, God-complex buffoon." Half the "medical horror stories" out there are about doctors running too many studies, and the other half are about doctors who didn't run any tests and missed something. The fact is, not every patient gets the right diagnosis on the first visit 100% of the times (and sometimes if you do, it's purely by luck, not because your doc was brilliant!). Doctors aren't seers, and tests are sometimes necessary and yes–sometimes they aren't revealing and are negative. Many diseases are a "diagnosis of exclusion." It doesn't mean the doctor is an idiot and was running tests knowing they were going to be negative. Most doctors don't get paid by the test, either. We get paid the same whether your test is positive or negative. We know you are frustrated, and believe it or not we are too, even if we aren't the one hurting. We don't know what is wrong with you when you hit the door, and we are trying to figure it out to make you better. This is a hard job, and there is a reason why it takes 10+ years to learn to do this on our own. There is no other profession that requires this much training. We don't work this hard or train this long because we are sadists, we do this because medicine is difficult!
There was a time when doctors actually spent time with a patient ...... talking with them ... examining them ... in today's world the patient first encounters the screening receptionist (the one that biopsies your wallet), then the nurse, then the PA and rarely gets a minute with the doctor.
so instead of the med sch (which charges $$$$) teaching future doctors how to care for, listen to and communicate with patients, and giving them the opportunity to them learn through the experience of 4 years of med school, how many more years of residency and fellowship. you want to "weed them out" with a test when they are in their senior year of college? on their communication skills? med schools, you are over-priced lazy bums!
I'd love to spend a day with you, alongside your shoes. I think compassion and tenderness and all of those high levels of caring are not the issue; I think simple courtesy is. At least, that is all I want by way of non-medical treatment from a physician. Just elemental good manners. I do not believe courses are necessary in this.
I would sooner see students whose future work will be dealing with countless people-poor, stupid, arrogant, know-all, suffering, terrified, irresponsible, every difficult kind-reading literature. Start with "A Country Doctor's Notebook," by Bulgakov. Just reading that book should be a graduation requirement-no exam, no report, no nothing. Just read it. Please.
What are physicians most afraid of ? lawsuits. They are afraid of making statements that will be misunderstood. They are afraid to tell the real truth to their patients about life and death. They consider death as defeat instead of a natural progression. They need more classes about accepting death instead of sustaining people in vegetative states who will never recover as their families end up in the poor house. Wake up people ! speak your mind and do not be afraid. We all die and we expect quality of life....anything less than quality is not acceptable, therefore, let's make some changes !
Focusing on quality of life is a great concept, but I find that many families (rarely the patients) want everything done, even if we explain what that means. Modern technnology has made the public have unrealistic expectations of what medicine can do. Education needs to start with the public. We cannot give you new lungs or magically make you lose 200 lbs. We need more of an "upstream" type of thinking and to quit expecting medicine to fix things that are currently not fixable.
Adding social sciences to the MCAT does not make better doctors nor does it select out would be bad doctors. All it does is increase the prerequisites to get in, adding a year of carefully crafted courses designed so that premed students ace the test.
You take an egghead, force them to work more than 40 hrs. straight for little pay, prevent them from living any kind of life or develop extracurricular interests, let them think that they are god and then they feel resentful when they are not worshipped, and you wonder why they can't communicate with sick people? Or develop relationships with anyone, really. They never developed themselves! First the system needs to choose well developed people to enter med school, and then the profession has to lose the awful arrogance of martyrdom that they have to memorize everything. Train them to fish, not to eat fish; it is easy to look up facts nowadays so teach them to use the technology. Then let them live normal lives, leave at 5 PM, go home to families, engage in their communities, and return refreshed in the morning. Everyone has figured out how to live within that discipline except doctors, thinking they can't hand off patients to the next shift. The profession would become more attractive, more people would enter it, more doctors would be available to cover the 24 hours, and doctors would become real people who could interact with real people. And best of all, patients wouldn't have to go to 10 doctors to get a diagnosis! That alone would increase physician efficiency by a factor of 10. Doctors would be happier and patients would be properly taken care of. Maybe we are getting close to this dream because the current system has failed sooooo many people. The profession is past self-policing; the public is forcing the profession to change or go broke. When will the profession and their training schools wake up?
you are cute
The problem with all of the comments and the article is the lack of personal responsibility. Corpulent and non phatty American want health care now, free, and the latest and greatest. You all cant's have all three.
Most americans would not need health care if they stopped eating like pigs. I remember one fat patient with back and knee pain who wanted a quick fix. I started to talk about diet and a walking program. He mentioned he didnt eat much. Salad during the daytime and oatmeal, but for dinner he had some chicken. When I asked ho big of a portion, he said the WHOLE CHICKEN. LOL No wonder he was overweight, obese, and finally morbidly obese.
Apparently semi-literacy didn't hold you back in med school "doctor".
Maybe if the ambulance chasers weren't ruining this society then the doctors could care more and do more, but until they get the lawsuits and crooked lawyers out of their lives, then all they can do is practice as they are doing. Having 3 doctors in my family, not one of them will see a patient, if they have been involved in a car accident, because of the lawyers and the court time that takes them away from their practice. It's just like the school teachers can't discipline because of the lawyers threatening to sue every time you say something to little Johnnie.
People spend more time researching a new car than investigating about their doctors, I look where they went to college, residence , what hospital allow him /her to work at, if there are any lawsuits.
If he/she has Board Certification.
I would not see a Korean Dr , we lived there, and we were medivac in order not to see one, same goes foe any other doctor that is gratuated from a University that is not well known, how long it took to finish.
Also I would not see a doctor graduated from the "medical schools"private in the Caribean that American students that failed to be accepted here , attend.
I had cancer and no thanks to the doctors I am alive, I was so disapoited with the care of some, that I went back to university to study a medical profession.
go to bed carla. you are tired
You need to go back to your meds for your mental condition, or change doctors ,mental illness is serious.
I have worked in the # 1 cancer center and have never met as didicated staff as them. I have also work with residents, and I see the problem is with doctors that study in their country that are not western, they grow with believes that humans are born with a destiny and one should not rebel against what destiny has for a person, while Western believes are that we make our destiny , that we decide and have free will.
I have had Social Workers from India, doctors that do not like to touch patients, that patients should accept the "will of destiny",
Many do not respect female patients and refer to male family members. I had a Chinese doctor that could belive the patient that was 65 had hearth surgery and now 4 years later needed chemo, "Her comment She is too old".
The US has to limit the hundreds of foregin medical residents, that are intereted only in economic benefits and do not owe a cent , college in their countries is free.
We need to help economically to students in this country to get free if posible , to study medicine.
Cuba took several low income students from the US to study in Cuba, lest invest in doctors, nurses, social workers that understand and respect our values. Not bring people that want to impose theirs. I am am talking about the ones that come as medical residents .
I dont agree with you at all. Do you wokr at Cancer center of America?
Many of the best cutting edge doctors came from outside of the US. I will mention only one. Dr. Michael Debakey. He was not born here. He was from Lebanon. He has trained many of the great heart surgeons in the country.
I could write a book about bad doctors! That's all I have dealt with since I was a child. I was taken to all kinds of specialists for severe stomach issues, and it would always be the same story: more tests, the tests don't show anything, sorry, thank you for your money. I was actually growing up in a dysfunctional family and the problems were related to extreme stress and anxiety, but not one doctor thought that one up.
Then a few years ago, I tell my doctor I am feeling very tired and exhausted and walked out of the office for a prescription for... antidepressants??? When I started getting severe back problems from RSI, my doctor's answer was to take over the counter pain killers (what I actually needed was several months of physical therapy).
Yes doctors are human. Yes doctors need to make a living too. But frankly in my life there haven't been too many cases in which going to the doctor was any better than not going at all. Thank goodness for the Internet, now we can find our own answers.
You sound prone to having mystery medical problems, probably better if you stay home and find some flaky solution to your own troubles
The irony of your story is when my wife was told by a doctor that the best thing for her medical problems was to "stress less," it was a 2 lb abdominal tumor. I would call that doctor bad, not the one performing tests designed to figure out what is wrong. Your social situation would be much harder to align with medical symptoms, so maybe you should give them a break. They do not want to strip you of your money. That is not why they go into medicine. The people who profit most from your healthcare dollar are insurance companies. That, or you must know a doctor who can make $40 million in a year like the CEO of the big insurance companies.
Come spend a day in my shoes with me at work – then let's talk empathy.
turn that frown upside down.
Good doctors should get paid more and the bad ones, well should get nothing. The schools that most doctors go to teach them to treat their patients with drugs, instead of troubleshooting their problems. The schools have to change.
your a moron
This guy obviously knows nothing about current medical education
A multiple choice exam to get at my subjective humanity? As a physician I'm just thrilled at the prospect of my humanity being reduced to A, B, C, D, or E. Then again, everything else in medicine is a niggly checklist thanks to lawyers, insurance companies, and ethics boards (the new addition – probably thanks to the likes of this author needing to justify her university salary). So I'm not surprised – in fact the most surprising part of this article is that I actually took the time to express my disdain for the concept it promotes!
It's the insurance companies...no it's the doctors...no it's the lawyers...no it's the patients...no it's the government...no it's the educators...no it's becasue the world is not owned and run by Disney.
When I visit a primary care doctor's office, I am not looking for a buddy or friend. I want a competent professional who will repair my wounds, tell me they are beyond his expertise or tell me they are not repairable at all. Then, if I decide to see a specialist, I expect the same advice from them. My feeling is, except in rare cases, knowing a doctor professionally on a first name basis is bad for one's health.
it's not necessarily about being on a first name basis, but more about their ability to listen and care about the patient such that they actually might hear bits of information that might get the proper diagnosis as well as care about the patient such that if the notice the patient is having bad side effects and they know of an alternative, the patient will get the alternative. Like for example, one lady I know was told that the symptoms she had were nothing (the doctor didn't really ask many questions and didn't really listen). the patient went to a different doctor and found she had a life threatening condition that needed immediate care. In my own case, the doctor scoffed that I might have type II diabetes because I didn't fit the profile. However, I came armed with blood glucose numbers obtained on my own with a tester I bought. Had I not done this, I would likely have been patted on the head and sent home and continued to worsen and have complications. A doctor has to be able to listen and communicate well. Being super book smart doesn't guarantee these attributes exist.
If I thought like that, I would be dead. My doctor that wasn't interested in me sent me on my way with a warning not to use the vicadin the er has given me, all I needed was motrin. Five days later my husband brow beat me into going to urgent care where I got a human being of a doctor who took one look at me and said he would know and be able to treat me or admit me to the hospital before he was done. He took xrays, and a urine test. Turned out I had an asymtomatic kidney infection, meaning I was in no pain but with 105 temp and dehydrated severely (had the temp at the dr. office but not the er, pain was in upper left chest at er). The er was treating me for the upper left chest pain which turned out to be a herniated diaphram which the urgent care dr. diagnosed when my temp went down and that pain returned by running an upper gi. My professional uncaring dr. sent me home with the comment, sorry you don't need a chest xray, you don't have pneumonia, now go home – in the hall way word for word in front of other patients.
Maybe this approach will work, but I have my doubts, along with rapidly eroding respect for any profession in the so-called "health industry." There was a time when physicians treated the whole human body, as a system. Now, if there isn't an expensive test for it, or the symptom doesn't occur in the 4-square centimeters that a doctor specializes in, they seem incapable of diagnosing or treating, well, anything.
sound like you need to find a new doctor. we doctors are human and get tired and frustrated like everyone else. insurance companies, state regulations, and circling vultures (i.e. lawyers) make practicing medicine ever more difficult. most doctors would now not recommend the practice of medicine to their own families. personally i find rural medicine extremely rewarding and would highly recommend it to any one that truly wants a rewarding relationship with their patients. you will never get rich, but you will be loved, respected and rewarded daily. and, heck, the money isn't that bad.
mdbill: I am just finishing my first year of medical school and am interested in during rural primary care after residency. Can you give me any advice concerning the "in's and out's" of working in a rural practice compared to an urban practice from your perspective?
The insurance companies won't let doctors spend enough time with their patients to get to know them. Personally, I am on the side of the person who compared them to auto mechanics. I too want a doctor who is top notch at fixing my body. I don't need them to be my friend. But let them give me as many medical tests as they want. I think reducing the number of tests allowed is being penny wise and pound foolish.
I was lucky to have a wonderful Developmental Pediatrician for my son's first 5 years of life. My son has special needs, and this doctor was like a grandfather. He genuinely seemed interested in helping his patients and their anxious parents. He gave us all the time we needed when we saw him and he even made his own phone calls to refer us to other specialists. Yes, he was often running behind, but because he was so amazing, everyone who saw him was willing to wait because they knew he wouldn't rush them out the door. He was a gem and I was so sorry that he retired.
Your observation assumes the problem is at school and not at the working place, which is wrong. The system discourages doctors to see their patients at all means, and when doctors actually see the patient it is for the less possible period of time. Also, doctors are made to fully rely on lab analyses, so they can support their prescriptions to avoid being sued. It is ridiculous trying to “fix” something in a classroom when the whole system to provide medical services is all wrong.
The answer to the question is NO. Obama care cancels the idea of Doctors caring for patients. Obama care will turn the office visit into a cattle call.
So before "Obamacare", doctors were more human?
As a student I don't think the educational process is flawed and I don't think most doctors truly don't care. But the reality is earning a living as a physician is tough money. Our reimbursement is being decreased yearly. Also the average doc graduates with over well 100k in loans (personally I'll have over 200k). From the students I know, you either have parents that can pay and you finish with next to nothing or you're like me 200k in the red.
Complaints that we don't care are bull. I really hope to care for my patients and fill their needs (medical and emotional) but at the end of the day I'm a person too. I also want a comfortable life for my family and want to be there for the important parts of their lives. If you go to a restaurant and you aren't full at the end of your meal then buy more food. Similarly if you want more time with your doctor you have to be willing to pay for it. I would never go somewhere, take something, and then leave only paying a fraction of the cost, thats called stealing.
Good luck. The work is noble but noble work in an unreasonable society is a tough row to hoe. Be sure you get paid well, have time away from work for yourself and family. If you have these two things that most everyone expects and takes for granted, it may be easier to put up with us and treat us nicely when we are not treating you nicely. Good luck and thank you.
Couldn't agree more. I'm in medical school now and we all take a patient centered medicine course weekly. I think that this is pretty standard across the board in domestic medical schools. So much of doctoring is patient interaction and the AAMC is right to focus on it as an important characteristic of an aspiring physician, I just don't think that putting an empathy section on the MCATs will really vet properly. Can a written exam really judge this properly? I think that the MCAT should stay content based while the schools should be responsible for figuring out who will be a good fit. Isn't that what the interview is really for? Many schools have geared their interviewing process towards finding those empathetic people, assuming that by that stage in the application process, the student is qualified in terms of grades and scores.
I want the guy working on my car to care about nothing else but me car. I want him to be a lunatic for making any machine run better and as efficient as it can for as long as it can. Someone else can worry about the guy driving it. The same with my doctor- I want a cold blooded mechanic that does his all for the machine and let the social workers worry about the driver.
To a great extent the uncaring nature of doctors is something that society, the insurance companies, and the government have created. The extreme and rather outrageous nature of malpractice litigation has created a huge wall between doctors and patients in the form of high malpractice premiums and robotic adherence to whatever the latest guidelines are. Doctors have far less incentive than they used to to try to actually think about what's best for the patient simply because trying too hard can actually trigger more lawsuits. The ridiculous machinations that insurance companies and Medicare put providers through and the lack of oversight in controlling payouts to specialists has meant that doctors overall are far less interested in true primary care and far more interested in running extra tests and finding lucrative specialties.
Improving education can help a little but it is not fundamentally going to change the problem. We need to stop removing the reasons doctors have for caring about their patients and give them a reason to care:
1) Stop awarding punitive damages to plaintiffs and give only a tiny portion of punitive damages to the attorneys. If punitive damages are warranted, most of them should be donated to charities.
2) Limit the amount of punitive damages based on the income of the accused and limit the allowed scope of liability.
3) Limit the amount of punitive damages that can be payed by malpractice insurance. The fact that malpractice insurance pays all of these damages currently makes it a lucrative business to do these lawsuits. And it makes the process somewhat pointless since the accused pays the same no matter what the outcome of the court case is.
4) Expand the current statutes in the Health Care Act to require that every simple payment by Medicare must be formally reviewed. The corruption in this process is staggering and simply holding hospitals and doctors accountable can dramatically reduce costs.
5) Establish a national standard for record-keeping and billing for primary care and streamline to the point that family doctors can again manage their offices with minimal staff.
6) Establish merit-based payout system for Medicare. The percentage of coverage for procedures must be tied to objective measures of expected quality-of-life improvement. The current system makes most of its payments for people at the end of their life, frequently in situations where quality of life is minimal and not expected to improve. I do not believe it is the government's role to dictate how aggressively a patient should fight to prolong his/her life; but the government should neither spend taxpayer's money to play God. If a patient (or their family) wants a procedure that is not going to meaningfully improve the patient's life, such a procedure should be treated as being more elective than necessary. Procedures to extend someone's life should only be viewed as medically necessary by Medicare if there is an expectation of a meaningful quality of life after the procedure.
My only issue with your suggestions is with who gets to decide what a meaningful improvement of quality of life would be for each person. If, let's say, someone has a chronic disease, do we deny a procedure that will relieve pain but not extend life? What if they're only going to live another year? It can be a slippery slope.
ah yes...it can't be your fault...you are a physician after all.
The author is correct but misses other factors like the pressure for electronic records which can affect doctor/patient time,, the medical school emphasis on passing and teaching for the Boards, the intervention of insurance carriers, and cook book medicine described as evidence based medicine. Many of my retired colleagues practiced good medicine because that's what they did "practice the art of medicine".
You always have two sides to the story, you have folks who abuse doctors with arrogant or combative behavior. You have folks who show up to ERs looking for Drugs and will say just about anything to get high. Like someone said before you have apthetic or careless patients who refuse to take care of themselves or think of a Physician as someone who can magically fix their issues without their participation.
On the other side you do have condesending docs who don't listen to patients or think that every patient should know better.
Medicine has become an assembly line, where they try to hurry the patient along so that the next patient can come in, and the next, and the next.
We have given doctors technology as a way to keep better track of our heath, so when I go to my doctor and start talking about my problems, all she's doing is looking at her computer and/or typing on it. Hey doc, I am over here!
And what happened to doctor having developed some kind of attention deficit issue so that in each visit you can discuss one, and only one, issue you are having? If I have both knee pain and a skin rash apparently I have to choose which is bothering me the most and mention only that, because if I mention both there's a good chance the doctor will ignore them both.
And what happened to follow up calls, doctors discussing test results with you, etc? Did that go out of fashion too? Then we hear so many people die of preventable diseases... if only than had seen the doctor in time!!! Well, how about making going to the doctor a positive experience and then maybe people will see the doctor more often.
Need to spend time with a patient to be considered compassionate. spending 1/2-1 hours is not reasonable other than possibly on initial visit. IN the ICU setting, the time is with family. Probably need compassion counsellors–not very well paid techs with some additional training to affordably help patients to speak with someone. Else, you will have to pay $40for 15 mins time. Get lawyers to stop putting crazy requirements into insurance, certification, etc
Some people are just not able be "more human." I truly believe that taking some course, or some test for that matter, will NOT cause people to change their personalities. Lets face it, some people are just jerks. As someone who went through a medical school that tried to teach the "humanism in medicine," relating to patients, cultural sensitivity, etc...I can say for certain that its simply does not click with some people. It's extremely difficult to undue 20+ years of learned behaviour in taught courses. However, there is one major caveat to all of this; uncompassionate doctor does not equal bad doctor. I have worked with some people who are the biggest social misfits you've ever come across in your life, however when patients take a turn for the worst, most (if not all) of them are extremely competant clinicians. If you ask me, I will take a socially awkward, competent doctor over a friendly, borderline competent one anyday. The goal of going to any healthcare provider is to figure out whats going on and to fix/treat/manage it appropriately in accordance with the established standards of care, not to have a warm conversation.
Every story has two sides. My daughter is a surgical resident who is consistently working 14 to 16 hours a day. She even has work to do after going home for the night. Sleeping 3 to 4 hours a night is normal. Most people do not see the side of extreme long working hours and touch years of training to become a doctor. In my daughter's case, she loves to communicate and spend more time with patients. But the truth is, for most of her working days, she can't even eat lunch.
I have spent 17 years training to be a surgeon (4 yrs undergrad + 2 yrs grad + 4 yrs medical school + 7 years residency/fellowship). I am going to be older than 40 when I get my first "real" job, as residents and fellows get paid living wages. I will have to pay back almost $900,000 in student loans before I retire with the interest I have incurred, as I simply can not afford to pay my loans while in training. More than $2000 a month of my earnings go directly to paying my loans, and will be that way for 30 years. That makes me 70 years old when I pay off my student loans. If I had to push all that back to do a five year "public service" of primary care as some here have suggested I am morally and socially obligated to do as a physician, I would very possibly die before I am out of the red.
The fact is, there is very little undergrad courses are going to do to improve an MD's communication skill. Much of it is innate–you have it or you don't. Even if you do, it takes some practice. And it s a two way street–some patients you jive with and some you don't. For every amazing physician that wins all the humanitarian awards out there, there is a small group of his/her patients who think s/he's rude, terrible and a poor communicator.
What these articles and PhD's seem to overlook is that the person who graduates from medical school is often not the person who graduates from residency and starts practice as an attending. Those years in between are grueling and can be soul-sucking. Physicians are humans too–all the things patients' want we want too. I want to have time to sit and talk with you. Sometimes I just can't. I want to be a good doctor, a good surgeon. I want you to get better. When I go home and things don't go well, I am upset, and lash out at my friends and family, and I cry too. And on a selfish level, yes I want to be respected. I have not spent a single holiday in 7 years with my family, I spent them working. I have missed weddings and funerals. I haven't taken a vacation in years because I can't afford it. I live in a tiny apartment, and drive a 12 year old car with tape on the bumper. So when I am immediately confronted by a family or patient that I don't care, or read these articles that say I only did this to get rich I, over time, get more and more dismayed and disgruntled. Why the #$%^ did I do this to my life if all my patients think is I'm a money-hungry dirtbag? I took anthropology in undergrad, and it doesn't help me deal with these frustrations any better.
But I do it because I like it. Because it's challenging. And because I want to help people–when things go right, there is no better job in the world (and that has NOTHING to do with my salary). I like that I have job security, even though reimbursement has dropped 20%, which means at least a 20% pay cut when I finish training. If I wanted to be rich, I'd have gone to business school. (I know, those are the college friends who pay for our dinner when we go out).
Could not have put it any better.....
Bravo Dr BMD. As a retired RN I can say I agree with you 100%. After 40 years of nursing, I've never met a Dr who didn't care. I've worked with some who had no personality when working with others but they were exceptional in their fields. I've worked with many who were exhausted, over worked and yes, underpaid for the horrific hours you work while in training. Medicine is a calling, not for someone who wants of "big fat bank account". That doesn't occur any longer. The costs of running a medical practive and insurance is astronomical. One has to be dedicated to be willing to work and pay financially and emotionally for the costs. As an RN I've seen far more patients who have been verbally and physically abusive towards any health care worker that "walks in the room". The problem is the system that can't begin to meet the needs of everyone. Don't blame those working in the system. Blame those who have made it what it is. Thank you to all health care workers who try their best to make the broken system work.
Thank you! Well said! –Michele, MD. (primary care physician).
arose4yu: You said the magic words: Spend time with patients. This needs to happen EARLY in medical training...from year 1 of medical school. I agree that you can't teach empathy and compassion...but you can learn to cultivate those things and build communication skills by working with people from day one.
Never a bad idea to train doctors to be more human. Some environments under which we work with sadly doesn't allow us to talk to our patients as much as we would like. We care, but the thing that matters is giving the impression and communicating that we care. I have walked into rooms to introduce myself to patients, and have been greeted in return with curse words, threats, and rudeness because they didn't understand why they had to wait while we see all the people with chest pains and strokes, and gun shot wounds, drug overdoses, septic shock, cardiac arrest, before we can see their "flu" symptoms. It gets worst in the super rich populations who think because they have more money, their discomfort is worth more than the lives the "poor" people. On a positive note, 7 months ago I had a patient whom I apologized for the wait, he told me he understood. I almost got on my knees and bowed down to him.
I have alot of experience with doctors over the past twelve years with parents who had critical illnesses. My sister and I have had to fight with them, to question them, to remind them about the people they are..not the scientists they have become –cold and callous. Out of all the doctors we have encountered only two have been the best doctors we have ever had-compassionate, understanding.... Classes aren't going to teach you to be empathetic that comes within and that also comes with more exposure to your patients. Med students should have some time spent with nursing students...keyword: spend time with patients.
Most med schools do have you spend time with a nurse, but the fact is the two jobs are so very different. You make it seem that the nurses spend time with you because they care more, and that is such an incorrect and oversimplified notion.
DrB - precisely. I'm a nurse, and I consider part of my job to spot the things the doctor needs to know. That's why nurses write notes in the chart!
Docs who spend too much time with any one patient consistently wind up with hours and hours of overtime and burn out. The best patients are the ones who write things down in a concise list so that the doctor can approach the problems quickly,.
You don't know what you're talking about. I dare you to study nursing and medicine and you will see the result. Blame the system and the owner of the hospital. We deal with life and death. Many times that we don't enjoy eating our lunch break. We're always in a hurry.
May–Ironically, as one of the few who did nursing before I went to medical school. I daresay I am one of the few who DO know what I am talking about. I have all the respect in the world for the nursing profession, but the jobs ARE different. All I said is that the nurse who doesn't leave the floor or unit should not be classified as caring more than the doctors who have patients all over the hospital and clinics to run just because they are more visible. No one said you don't work hard, or miss lunch, or care less. But the fact is, the job of a nurse is different from the job of the doctor.
It's almost like you're reading my thoughts...
My doctor is another warm and fuzzy one – Hello, Jennifer, what do you think you have this time? What did you read on the internet? Honestly, why do these people become doctors if they care so little to resort to sarcasm as the first words out of their mouth?
Jennifer–why are you still seeing that doctor??
my money is on fibromyalgia
Let's teach medical students how to be more compassionate towards their patients by having them answer multiple choice questions on a computer screen in front of them...yeah, that's compounding the problem, not fixing it.
You dont need more education for doctors to Care .....you need doctors to care..that doesnt take money nor training....
The best way a person can help themselves is know what is wrong before they walk into the office and understand the side effects of any therapy. I am glad I have a Ph.D, in Biochemistry so that I can do that. Thus, I am one of the lucky ones and can sit back and reallize how bad it could be.
How sad that in the US people needs a PH degree to know their bodies. In other "underdeveloped" countries most MOST of the population, knows exactly how to treat their bodies, with appropriate diet; vegetables, fruits,etc.etc. And the first question Doctors ask to their patinets is: What is your diet? What are you eating? And then they provide the appropriate changes...just saying...
The degree doesn't always help. Even going in with info, I have issues. I had one doctor where I asked for the test values and she first told me they don't give her the test values, just the conclusion which was that more testing was needed. When I said that I was disappointed to hear that because the specalist always gave me the values and I liked having them so I could look up what they meant, which in this case was that they were so close to normal really I didn't see why anyone was making a big deal about this, she then gave me the values. I don't know if she thought I was some paranoid person so she didn't want to give me values, or if she was afraid I would ask her to interpret them and she didn't understand them (which she admited that she just took the specalists conclusions), but it seemed odd that after I started talking about a journal article I was reading from 2009 that indicated that my levels were just on the low end of normal and not an indication of an issue in most (I think the article said something like 90-95%; it had exact numbers) people suddenly she had the values. Yet even after discussions like this, she still won't talk science with me and dumbs everything down (I stay with her though because my last few drs were even worse and I don't want to take a chance; my last one REFUSED to explain anything stating that "it was the same as in any office." what does that even mean? and the one before that told me patients weren't capable of remembering what happened in a dr office correctly anyway. When I tried to say that I was a chemist and I really liked to hear the science, I just got sighs and one basically indicated he didn't know the science because that isn't how they are trained.)
I'm a pathologist and even I have trouble getting the actual lab values on my tests. My doctors finally realized that I'm trying to take responsibility for my health and trying to enter into a true patient-doctor relationship where we each have certain responsibilities. It's the nurses and clerks who continue to give me a hard time (mabe they're wanting to pull a power-play). So, I just deal with the doctors now.
Everything in the USA is about money, profit and politics. Medicine in the USA will always be about profit and politics which is why it lags behind many other developed countries when it comes healtcare.
I agree with your concern. The health and health care field continue to make the same mistake. It should be person-centered rather than patient-centered if we are really going to improve health and we want a partnership with the person whose health we are trying to improve.
If our vision is to truly improve health, then we need to start out with the right framework. The right framework is "person-centered" health rather than the more limiting "patient-centered" term. "Person-centered"
incorporates the person's whole life (rather than just when they are "sick"), brings in prevention, taps into the full health community (rather than just formal health care providers), addresses human behavior, and understands that improving health requires dealing with a broad set of factors (e.g. income, education, housing, food).
At the core of health maintenance and improvement is a collaborative partnership between the person and the key health providers/supporters (broadly termed).
Gary Christopherson, http://www.HealthePeople.com
They don't have a choice, at this point, hypatia. The AMA long ago sold their souls for pennies on the dollar. "We will guarantee you patients if you just take a little less money per patient". That savings never got passed on to the patients, of course, and doctors thought that they could make up the difference by just seeing a little higher volume. Not most of them would go out of business if they didn't take the insurances (which is what your suggestion would require).
I recently heard of a university study that concluded that students who are well-off financially have no compassion or empathy for those who are needy! People become doctors these days to get rich, not because of any deep seated need to help anybody (and very often it's the children of doctors in med school; your average student can't afford those aspirations)! So, between the rich doctors and corrupt insurance companies, medicine is a joke in the U.S.A. and it's no surprise to me that these people don't appear to care. They DON'T CARE (unless you've got some $$)!!
No one complains about how much a doctor makes when THEY are the ones who are in the operating room or the ICU. I have yet to meet a family member who said to me "thank you for saving my husbands life, oh, and you make too much money." The simple truth is that the average person has no idea the amount of time, money and dedication it takes to not only get INTO medical school but get THROUGH medical school...and I'm not even talking about residency training after that. Your WORST day professionally in your job is still better than what some physicians deal with on a daily basis. Doctors are UNDERpaid. Simple truth.
I don't agree with this....there are plenty of ways to get rich quicker than to become a doctor. Not all doctors are rich either unless you're talking about radiologists or surgeons.. Sacrificing a decade of your life after undergrad school? and then paying back all those loans, insuring yourself with malpractice insurance...I'm not a doctor but I'm friends with a couple and it's not all roses. If you want to get rich, build a top selling app for Apple or Android.
Uninsured - some computer specialists make more money with far less school. So do some school superintendents, lawyers, and MBAs. Doctors may be doing well, and at the upper end of middle class for the vast majority, but they are hardly "rich".
The opinion expressed by the author seems a little "liberal artsy." Besides the many other replies from other respondents with which I agree, the real world economics of medicine doesn't permit spending an hour with each patient getting to know their thoughts and feelings without being financially self-destructive. Deep communication won't happen in a 12 minute visit. What do patients really want from their physicians? They want their physician to fix all of their ailments for cheap (or better yet, free). What do insurance companies want from the physicians? They want their physicians to fix all of their patients' ailments for cheap (or better yet, free).
I was the onlly student in my med school class who had ever been a hospital inpatient prior to admission to med school. That experience provided me with a wealth of empathy for patients, from the fear of the unknown and the loneliness of lying in a bed all day with nothing meaningful to do to the pain of having to endure questionable procedures.
Here's my suggestion. What would be wrong with the medical profession requiring all physicians to serve a period of time (5 to 10 years) in a general practice before being allowed to train in a specialty? No one wants a general practice because that's not where the money is. Unfortunately, we need more GPs and fewer specialists.
Here's why: 4 years of college + 4 years of medical school = $250,000 in student loans. By the time you finish specialty training you are pushing 35 years old without ever making a salary that can adequately support a family, let alone even think about paying back your loans. My monthly student loan payment is more than my mortgage. I have put off a family, children and any sense of an enjoyable life in order to pursue my dream of becoming a physician. Now to say I should push that back for another "5 or 10 years"? Absurd.
Well, if my suggestion is absurd, then what do YOU suggest that addresses the needs of the patients rather than just your own self-centered perception of the problem, as you so ably described it? After all, no one put a gun to your head and forced you to choose medicine for a career.
"General practice" is actually quite specialized. Both Family Practice and Internal Medicine require residencies. Do you really want people practicing in a specialty they know nothing about? Or are you suggesting that everyone train for 3-4 years in primary care before any other specialty training (increasing the time and costs of training)? It is a myth that a surgeon or radiologist can easily switch to primary care – the knowledge and skills sets are quite different.
One of the issues is really preventative health. Doctors are great at treating illness and are really mostly incompetent at preventing illness. Take Type II Diabetes. A doctor does not deal with it until a glucose tolerance test says "Yup, You're diabetic, let's get you on meds." Truthfully, preventative medicine doesn't pay, but with Type II Diabetes on the rise, Doctors are going to get rich treating it. What we need is for the health industry (starting in our schools) to teach how to live healthy before we need surgery (heart bypass for one) and meds (blood sugar control for one). Of course all the food companies wanting us to eat Twinkys, frozen dinners and pop are going to oppose that, but that's greed for you.
I agree with the need for prevention. This burden should not fall solely on physicians however. For example, when we are looking at the alarming increase in childhood type II diabetes, I think the issue is with personal choices and parenting. This issue starts in the home as much as (more than?) it does in the clinic.
It is not the doctor's job to teach you a healthy diet. There are plenty of sources for you to learn that. Frankly, if you have a family history of diabetes, then you had damn well better take responsibility for your diet/exercise. If the doc sees a problem (like a higher than normal Hgb A1C), then s/he should certainly let you know that you are at risk, and should make some suggestions (such as a diet low on the glycemic index), but there are plenty of resources out there for you even if your doctor doesn't tell you precisely what to do.
Other developed countries provide far better medical services to the general public (not necessarily the uber-rich 0.01%) – for far less money – than the USA. The only difference is that here in the USA, we live under the delusion that nothing will work properly unless there is a wealthy investor sucking huge profits from it. The self-contradictory nature of this proposition is amazingly absent from most public discourse.
There are many interesting points made in the article, but the author completely seems to skip the politics of medicine today. Doctors are increasingly forced to spend less time interacting with patients due to the costs involved, heavier patient loads, and overregulation by the government. Being more humanistic in today's hospital translates into malpractice lawsuits and it is only going to get worse once the main areas of the healthcare mandate go into effect in 2014.
We have Bean Counters here in St. Joseph, Missouri too.....
Part of the problem is that the profession has become controlled by "bean counters." I know a number of physicians who are caring and compassionate and take the time to communicate with their patients, but I have also met some that have made it clear that they are "on the clock" and under control of the bean counters. I had a family member in ER and the doctor told me directly that he could not admit my mother because she was not "sick enough" to be approved by his superiors - i.e., the bean counters who worry about what Medicare would actually approve.... He wanted to admit her but his hands were tied... It had nothing to do with Obama's health care plan - this occurred during the Bush administration.
Most doctors are fine human beings who treat their patients like fellow humans. The problem is that the industry is being run by profiteers who treat their fellow humans like an expendable resource to be disposed of after wringing the maximum amount of profit out of them.
Not possible. You could gut most of them in search of a heart and never find one.
hypatia, you are a bad person. just though you should know.
Interesting. The cardiologist that I worked for many years retired and was then hired by the uniiversity in Seol S. Korea to teach a course at the medical school called "Compassionate Medicine". He also regularly participated in Doctors Without Borders in Tibet.
Primary care physicians need social and language skills to listen and understand people's needs and coach them through
Procedural specialists and surgeons need to be aware of the appropriate indications for each procedure and to be technically excellent in the performance of their repertoire.
The "craft" world of primary care and the "industrial" world of "interventional medicine are pretty different.
I'm not sure the best selection process for one relates well to the other.
I don't know where other people go to school, but as a Biochem major at Southern Miss, my degree required 2 histories, 1 commuication, 1 social science, 1 art, 2 composition and 1 literature. I'm also probably forgetting something. The fact is NO class teaches people how to care about others. Quite simply the only option is for Med school to teach significantly these medical conditions that result from "diet and poverty". And even then what are doctors supposed to do? We sign them out to a social worker and move on because we can't force someone to eat, we wave a wand and find them a job. What does this author want doctors to do? Scare the patents into caring about themselves?
Scaring negligent and undisciplined patients into caring about themselves is a good thing! The other half of the solution is to stop punishing children for having low-quality parents. Many, many American kids are malnourished and lack access to clean water and other basic needs simply because we as a nation place a higher priority on helping corporations and wealthy investors than on helping the poor and ignorant.
It always amazes me how much pontification I read/hear from people like this Princeton Prof that have NO CLUE what we do or how we feel. The reason the profession has become so difficult for us is just this type of intellectual emesis...first Hillary Clinton tried to overhaul medicine in our country, then we end up with ObamaCare! Those of us in the "trenches" are too tired and too busy taking care of the patients (that we don't care about!) to put up a fight. John Q Public will be the losers in this; they just don't care or understand until it slaps them in the face.
Tell this clown to come into the trenches. See how compassionate he/she can be after being elbows deep in human blood, no food, rest, or bathroom break for 12 hours in a hectic ER. I have seen this environment break people.
This article doesn't address the economics of why doctors always seem so hurried and don't communicate. Before entering the "real world" of private practice medicine, I held this idealized notion that doctors should take the time to get to know their patients, build relationships, and educate patients about their disease processes. That's what I was taught in school. Here's reality: it doesn't pay. If I spent as much time as everyone wants me to spend in education and building relationships, my practice will go under and cease to exist. And I'm in one of the highest paid specialities in medicine. When Medicare reimburses me $50 per visit, I can't afford to spend an hour with the patient. $50 an hour will not keep the lights on or pay my staff.
That $50 is assuming they show up to the appointment. If they don't insurance will pay you nothing for that 30-60minute period of time. Of course your staff, med. malpractice, rent etc.. will still want their money on time. As a consequence of a moderate amount of people failing to show up for their appt. (despite often times being confirmed the day before)docs overbook. This leads to rushing visits when people do come, but what is the answer? If people would have the common decency to call 2-3days before to cancel much of this situation could be avoided.
or or you could do what most places who have studied this problem do and call your patients the day before to make sure they know the time and are still coming. This isn't some uncommon practice.
Consider discontinuing Medicare. I did, and now I have more time to spend with patients. Don't enable Medicare. Just say NO. The main disadvantage to not taking Medicare is that the Medicare patients are the most appreciative group around. I do miss them, but to continue with their insurance reimbursement would be...well, I would have to go out of business.
You can't TEACH compassion. It is something you either have or you don't. Robots could probably do a better job of caring.
Let's just say I'm glad I never have to think about the MCAT again!
Maybe the answer to how can doctos be more human lies in revamping medical school education. The first two years you are stuck in anatomy lab/library/preceptorships/study areas almost 24/7. at orientation you are told to plan your social events a month ahead....and aside from a couple free hours a week, you really only have about one to two days per month when you can take a break. then come the clinical years, where you do 27 hour shifts, 12 hour shfits and are yelled at by attendings, patients, nurses for things you were never taught to do...and on top of that you are still expected to study for shelf exams....then comes internship where you easily work 80+ hours and residency...more of the same. you can take the most compassionate person in the world with the best communication skills, and after 4 years of med school and then residency, they are guaranteed to lose some of that, simply because the medical education environment does not foster communication skills or compassion.
how are you supposed to practice communicating when youn have two weeks to learn all of immunology and do several patient write ups and are therefore stuck in books instead of actively interacting with people?...oh and how are you supposed to practice communicating with patients when you are constantly being yelled at to go do discharge summaries on this patient and another one, to get lab work for another patient, all the while being yelled at by nurses, residents and attendings...and on top of that, there isn't really much of an example in communicating between colleagues, because as a medicl student your interaction with other doctors consists of you getting pimped (asked random facts on the spot) or....getting yelled at some more. it doesn't matter how competent you are or how much you know, the stressful environment just brings this out.
before medical school, i really used to care. and now i struggle with showing even the slightest of emotion. from the gruelling studies to constantly being over-worked, sleep deprived and verbally abused, you get to the point where you just don't care. a lot of other medical students feel the same way. the focus needs to be placed on how do we change medical education and environment to prevent student doctors from losing the compassion they had when they first decided to pursue medicine.
Well, I am glad I will be a first year this fall............maybe. lol
*sqeak squeak* world's smallest violin until doctors stop allowing themselves to be controlled and/or shill for insurance profiteers.
Then the doctors who open boutique and cash-only practices are chastised for catering to the "rich." I would LOVE not to have to worry about insurance companies. Their pathetic 40% reimbursement shows up 6 months after services are rendered, and thats assuming the office billed the insurance company correctly.
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