In this book, I hope to enlighten readers about the physician's life, and how the current medical climate has affected everything we do, every decision we make and our career satisfaction. The deterioration of the doctor-patient relationship has gotten worse and worse, fraught with mistrust from both ends of the stethoscope. If we are to turn the current situation around, we must understand the issues. My purpose in writing this book is to inform and educate people about the life of a doctor, the rigorous training involved, the daily routine of medical practice and the difficulties of reconciling the business of medicine with our ultimate goal of healing. My emphasis is on how the health care and malpractice crises affect physicians, and on how the doctor-patient relationship has suffered. Through a combination of personal reflections, surveys of physicians, statistical references and examples, I paint a picture of the physician that is more reality based than the TV shows, yet just as dramatic. This book attempts to portray physicians as people, not commodities and not technical robots, not the ultra rich and certainly not the heartless. I felt that I had something to contribute to the health care literature, especially in light of the changes coming as a result of the Patient Protection and Affordable Care Act of 2010. While there is promise of improving access to health care for patients, the burdens placed on physicians and their attitudes toward this legislation need to be expressed. We need to understand the issues from the physicians' perspective, from the other end of the stethoscope. My mission is to convey the importance for all people to pay attention to the medical profession, to understand their physicians' struggles and rewards, and to assist in salvaging the relationship that is suffering between doctor and patient. Suggestions for possible solutions to the ongoing problems facing doctors

The Other End of the Stethoscope

THE PHYSICIAN'S PERSPECTIVE ON THE HEALTH CARE CRISISBy Diana Reed

AuthorHouse

Copyright © 2012 Diana Reed
All right reserved.
ISBN: 978-1-4685-4412-1

Contents

Foreword..............................................................................ixIntroduction..........................................................................3Recruiting the Best and the Brightest.................................................11Indoctrination of Medical Students....................................................12Internship, Residency, and Fellowship.................................................21What Makes a Great Physician?.........................................................24Medicine vs. Family...................................................................25Oath for Doctors of Medicine..........................................................27A Lack of Practical Experience........................................................29The Three A's of a Good Physician.....................................................30A Typical Day in the Life of a Doctor.................................................32Thirty-Six-Hour Days, One-Hundred-Hour Weeks..........................................44Dealing with Insurance Companies and Managed Care.....................................46The Good, the Bad, and the Ugly—Patients and Physicians.........................48Remembering "The Good Old Days".......................................................55Chapter 3: The Business of Medicine Humble Beginnings.................................57The Costs of Private Practice.........................................................61Pharmaceutical Companies and Health Care Costs........................................62Insurance Companies' Costs and Control over Health Care...............................73Managed Care or Middleman.............................................................77Lawyers and Health Care Costs.........................................................89Rising Overhead Costs.................................................................89Decreasing Reimbursement Rates........................................................93Increasing Unpaid Time................................................................100Malpractice Claims Are on the Rise....................................................105Examples of Successful Malpractice Lawsuits...........................................108Consequences of Malpractice Litigation................................................114Defensive Medicine....................................................................124Doctors Make Poor Patients............................................................135A Little Knowledge Can be Dangerous...................................................135Doctors Have More Complications.......................................................137Being a Patient Makes a Better Doctor.................................................145Preserving Humanity in Medicine.......................................................149Art vs. Science in Medicine...........................................................150The Doctor-Patient Relationship—Adversaries or Allies?..........................151Getting Control over the Middlemen....................................................156Would a Single-Payer System Be So Bad?................................................157A National Malpractice/Complications Fund.............................................158Physicians and Patients: Heal Your Health Care System.................................162Afterword.............................................................................167Bibliography..........................................................................169Index.................................................................................177

Chapter One

A Career in Medicine

A career in medicine used to be viewed as one of the highest callings anyone could have—it was seen as a noble profession associated with respect, appreciation, and trust. Being a physician was regarded as one of the best things a person could do with his or her life. Medical schools were able to recruit the best and brightest students from college, and acceptance to medical school was extremely competitive. Aspiring physicians were some of the most intelligent and idealistic people, filled with enthusiasm about the opportunity to heal others and to learn everything they could about the human body, illness, and treatments. Is the medical field still a noble profession?

I grew up in the sixties and seventies, a rebellious era for most young people. My father died of lung cancer when I was sixteen, and his death shut me down emotionally for a long time. Because I was such a bad student and always in trouble, I dropped out of public high school and went to a free school called Skunk Hollow High School. Needless to say, I was not voted most likely to succeed, nor was I the class valedictorian or a cheerleader. In fact, no one would have pegged me as a future neurologist, yet from these nontraditional roots, I stumbled into this noble career. Skunk Hollow High School was a place filled with hippies, musicians, artists, and philosophers. There were no grades, no scheduled classes, and no attendance taken—basically no rules. At a time when I was rebelling against everything remotely authoritarian and struggling to define myself as a young teen, I finally found myself in a place where there was nothing to rebel against. I have many great memories associated with this school, but the greatest lesson I learned in this midst of true academic freedom was that unless you got up and did something with your life, nothing happened. If I wanted to learn something, I had to find the teacher or resource and make it happen. If I wanted to be good at something, I had to learn the discipline of practicing, studying, and hard work. This has been a cornerstone of my philosophy of life, and I admit I often have difficulty understanding those that wait their whole lives for something to happen or for someone else to make decisions for their futures. I became interested in herbs and nutrition, perhaps as a reaction to the failure of traditional medicine to heal my father's cancer. It was my first inkling of something that would consume my life. Perhaps it was a way to take control of an event over which I had no control.

After high school graduation, I moved out to California in my little white VW van, piano in the back, boyfriend in the front, and all the world ahead of me, undiscovered. I played the French horn to the cows at rest stops along the way. I enrolled in the local college to take a few courses that interested me while I worked days as a file clerk in a court reporting office. Anatomy and physiology, psychology, microbiology, and Edible Wild Plants comprised my first year's schedule. By the end of the year, I was hooked on learning about the human body. I became more and more aware of how little I really knew. I then took a course in deep tissue massage that incorporated principles of healing, movement, and energy analysis—alternatives to traditional medicine—which were highly controversial. I experienced the joy of touching others, experiencing their energy, and making a difference in how they felt. I was learning to develop my perception of others, looking for blockages in their energy fields or auras, and to channel my own energy to heal others.

As my knowledge of health and illness grew, I came to realize that there are basically two kinds of patients. There are those with mild ailments that are not life-threatening, often associated with physical or emotional stress, musculoskeletal aches and pains, or depression. Many of these people can get tremendous benefit from healing massage, acupuncture, or chiropractic treatment. In addition, nutrition and herbal remedies often help minor ailments and generally improve health. There is, however, another group of people who have much more serious illnesses that are frequently life-threatening, who are in need of "real" doctors. I found myself wanting to be the real doctor, to have the knowledge and ability to deal with the serious illnesses that affect peoples' lives. For better or for worse, I decided that I wanted to know more, to do more and to help more sick people, and so I became a premed student. I completed my bachelor's degree in chemistry. I took the MCAT exams. My mother, who was a singer and assistant professor of music, was surprised that I would give up my budding career as a french horn player to pursue medicine. I remember telling her that I just couldn't see myself tooting in the back of the orchestra for the rest of my life. Although I was never voted most likely to succeed, I became determined to reach for the top with a career in medicine.

Recruiting the Best and the Brightest

Getting into medical school used to be extremely competitive, and only those with the highest GPAs, MCAT scores, and demonstrable interpersonal skills were accepted from thousands of applicants each year. Applicants had to show that they had some experience in a health-related field, or excellent accomplishments, in addition to grades and test scores, that made them a better person. For example, an applicant had to have good communication skills, especially the ability to listen. He or she should have a track record of service to others. Demonstrated leadership ability was a plus. And most important, did the individual's behavior show a consistent pattern of compassion, honesty, and altruism —character traits that are consistent with the highest standards of professionalism?

It took me two tries to get accepted into medical school. The first rejection was a big blow, and I realized how poorly prepared I was, as well as how little I knew about the medical field. I took the MCAT exam a second time, improving my scores, and spent a year as a research technician in a lab run by a hematologist/oncologist who was working on a cure for melanoma, a particularly deadly form of cancer. After the first rejection, it was very tough to get the courage and confidence to try again for a medical career, but fortunately the people around me did not let me give up. I knew so very little about what being a doctor was really like. Working with a physician in his lab helped open my eyes to the difficulties of treating diseases like cancer that had no cure, with limited treatments available. Before this, I guess I had an idealistic notion that I would spend the majority of my day making brilliant diagnoses and being showered with love and gratitude from adoring patients. I certainly didn't believe I would end up like my uncle, who was a general practitioner in the New York City projects, treating underprivileged and frequently ungrateful patients most of the day in a small, dingy, office that smelled of antiseptic and old age. I didn't think much of his situation when I decided to go into medicine, but now, as I look back, he was perhaps one of the most honorable professionals I ever knew.

While acceptance into medical school is still competitive, many of the best and brightest students are choosing other careers after learning about the difficulties that doctors face today. Medical school applications are down in numbers (FACTS: Applicants), and many of the brightest students are opting for careers with greater financial rewards and lower demands. Who in their right minds would want to deal with training that consumes half of one's life, followed by the actual job that is incredibly demanding and time-consuming, all for a shrinking income and rising overhead? I recently met a young man in high school who told me he was planning to become a neurologist, like me. It was all I could do to encourage him in his efforts. I had to hold my tongue when I thought of all the challenges he would face in pursuing a career in medicine. I knew that he had no idea what demands, disappointments, and sacrifices his choice would entail on a daily basis.

Most premed students have very little idea of what is involved in the practice of medicine. Getting into medical school is just the first of many hurdles to overcome.

Indoctrination of Medical Students

Medical school entails four years of intense study after completion of a bachelor's degree. After completion of medical school, a residency is required that may involve another three to seven years, depending on the specialty one chooses. By the end of medical school, students are now called "Doctor," but they are still woefully unprepared for the practice of medicine. Residency turns them into seasoned, well-trained professionals, but many choose to stay in training for another one to two years for a fellowship, in order to concentrate on a subspecialty. Sometime in their late twenties or thirties, physicians can finally embark on their careers. Most are excited about going out and tackling what is considered by many to be the most challenging occupation that exists. Little do they know how challenging this career will be and the types of obstacles they will encounter while trying to provide the best quality care for their patients.

The process one goes through in medical school is a very complex combination of intense study and test taking, introduction to patient care, and learning to interact with patients in a nurturing way. By developing the ability to question and examine patients, formulate differential diagnoses, order the appropriate tests and confirm our final diagnoses, medical students become medical detectives. Once a diagnosis is confirmed, we can then choose a treatment that is most likely to be effective, which may involve medication, surgery, or the many other options available today to treat disease. This involves a great deal of science, as well as intuition. There are many individual patient factors involved in choosing the appropriate treatment for a given illness, such as coexisting illnesses, drug interactions and insurance plans. There are also many psychological factors involved in the art of medicine that require a physician to interact with their patients in a supportive and educational role.

I spent the first two years of medical school in classrooms, reading thousand-page books, taking tests, and dissecting the dearly departed who had the courage to donate their bodies to medical science. I remember my first day in the anatomy lab. It seemed like yesterday that I was having some difficulty dissecting frogs without gagging, and suddenly I was surrounded by dead human beings. Most of us were praying that we wouldn't throw up or pass out. We uncovered these stark, naked, aged bodies that had been preserved in formaldehyde, wrinkled and frightening—just shells of former souls that once walked the earth. At the same time, we had a tremendous sense of appreciation for these men and women who had donated their bodies so medical students could learn. We honed our skills in dissection and surgery on these cadavers as we prepared ourselves to work on the living. After a month, we became desensitized to the sights and smells of the anatomy lab. A driving curiosity and motivation took over as we cut and dissected limbs, chests, brains, faces, and eyes. Our exams consisted of pins stuck in various muscles, nerves, arteries or veins with questions about the pinned structure. This was just the beginning of our transformation into physicians. We were also studying physiology, biochemistry, pathology, and pharmacology, just for starters. These basic sciences were the foundation for the many aspects of human health and disease we would be learning over the next several years.

Medical school was an incredibly rigorous and demanding training that required hours of study both in and out of the classroom. The goal was perfection, to know it all, which could never be achieved. This didn't stop us from striving for it. There were many long nights spent cramming for exams, and many times I felt that I could not cram another fact into my head. I wondered often during those first few years whether I would ever be worthy of being called "Doctor." When one of my fellow second-year medical students committed suicide, the rest of us began to realize the degree of stress with which we were all struggling, and that this was only the beginning of our careers. She was one of the best students in our class, usually getting the top scores on exams. Underneath that incredible genius, however, was an emotionally fragile young woman, and none of us recognized her anguish. Evidently, she was not able to deal with the inner demons we all had lurking under the surface. We began to realize then that perfection was impossible, that knowing it all was impossible, and that mistakes would be made, some of which would affect human lives. We had to accept our imperfections and do the best we could. There have been recent articles focusing on the problem of medical student depression and suicidal ideation, which is a far more common problem than ever previously recognized (Dyrbye et al., 2008). Fortunately, shedding light on such an issue helps all of us cope with those feelings and realize we are not alone in the tremendous emotional upheaval we are experiencing. It also may help friends to recognize when a fellow student is in trouble and needs our help. The transformation from Joe the college grad to Dr. Joe, the surgeon, is not a simple one.

The second half of medical school is the clinical portion. We were finally allowed to enter the hospital with our starched, short, white coats (the long coats were only allowed for the real doctors). At first it was a challenge just to find our way around the hospital, the lab, X-ray, and then to find our "team." The team was made up of attending physicians (the teachers that ultimately supervised the patient's care), the residents (physicians in training for their specialty), and the medical students (the bottom rung of the ladder). It seemed that everyone in the hospital knew more than we did about the practical aspects of patient care, including the nurses.

We were assigned a few patients about whom we were to learn everything. We quickly found out how little we knew, despite the past two years of intense study. We were useful to the team mainly in obtaining results of tests, keeping track of our patients' vital signs, and attempting to present those results on daily rounds. Scut monkey is the endearing term for medical students on a team and playing that role was an initiation rite that we all went through. If you did your job without griping, went home and studied the diseases of your patients and the meanings of those test results, you were rewarded with pearls of knowledge the residents would share, when time allowed.

We followed our residents around like loyal puppy dogs, trying to emulate their behaviors with patients without showing our ignorance. We could not write orders, we could not make any medical decisions regarding our patients, and we weren't much help on the team except for that scut work that saved our residents some time. We were apprentices, learning the art of taking histories and doing physicals, learning diagnosis and differential diagnosis, the appropriate tests to order, and treatment options for disease. We learned about death and dying, a true lesson in humility for a future healer. We learned about birth, and in the process we were reborn ourselves.

(Continues...)

Excerpted from The Other End of the Stethoscopeby Diana Reed Copyright © 2012 by Diana Reed. Excerpted by permission of AuthorHouse. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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