View Full Version : Some comments - dealing with doctors

01-22-2007, 04:32 PM
I read the article "Dealing with Doctors" on the main web page with a lot of interest. I think Saysusie was the author (?), and as always, she touched on issues that are very important to most of us. But I did want to offer a little bit of perspective - maybe the flip side of the coin. Although I don't handle cases anymore, a lot of my work still deals with medical malpractice - I review claims files for malpractice insurers; interview health care providers; and work with hospitals and individual doctors on malpractice prevention. I'm also a patient with a lot of doctors, so I see all the problems Saysusie describes. But I don't think it's so much that doctors are uncaring, most of them are at the mercy of a rapidly changing medical system, just as the patients are.

Health care in America is in a crisis, whether the politicans and business wizards recognize it or not. Many areas of the country are critically underserved by primary care doctors, because more and more doctors are choosing to go into the lucrative specialties and sub-specialties. There is a desperate shortage of primary care doctors in many rural and inner-city areas, so the doctors who are there are seeing high daily patient loads, sometimes upward of 60 patients per day.

When the average family practice doctor graduates from medical school these days, he is immediately faced with repaying student loans that can easily top $200,000 - more for "name" schools. In addition, malpractice insurance premiums in some states range from $50,000 to $100,000 per year or higher. A doctor who wants to set up his own practice or buy into an existing one has to come up with the money for those expenses too, usually through loans. So many doctors start their careers drowning in debt. Specialists and subspecialists can spend anywhere from five to ten years beyond medical school in a residency or fellowship just to qualify for their particular specialty, so they are often just starting their practice at the point when other people are well-settled in their careers. And, unfortunately, most of their medical school and residency will be devoted to learning about diseases, medicines, tests and procedures - not about "patients". If they are lucky, they get a few classes in doctor-patient interaction - many of them don't. Many of them have to learn to turn off their emotions just to survive residency and medical school - many never learn how to turn it back on. Divorce, marital problems, suicide and substance abuse - you don't think about those as affecting doctors, but they do - in very high numbers. Most American doctors will be sued for malpractice at least once in their professional lifetime - in some "high-risk" specialities like OB and neurosurgery, it's almost a given. So when doctors meet a new patient with a complex or challenging medical problem, they are not always thinking about how best to help the patient - they are wondering, is this the patient who's going to sue me?

On top of all this, medical care these days is increasingly being dictated by insurers and managed care companies, not by doctors. Many insurers, especially in capitated HMO or PPO situations, actually penalize doctors financially for specialist referrals or hospitalizations. Doctors who spend too much time with patients, don't see enough patients per hour, or refer too many patients to specialists risk being "red-lined", meaning they lose their participating provider status with a particular network or insurance plan. So instead of really talking to patients and discussing preventive care, emotional health, and other important issues, doctors have to squueze it all into a 7-8 minute office visit. Is is really surprising that doctors spend more time writing and talking than they do listening, or that they rely more and more on prescriptions? In addition to spending 8 to 8.5 hours per day in the office, most doctors also make daily "rounds" for all patients who are hospitalized (sometimes as early as 4:00 or 5:00 a.m.), dictate or write notes on every patient seen, and often get phone calls in the evening or on weekends. They may also be asked to "cover call" for other doctors, often with patients they've never seen.

We all want doctors who will listen to us as people, not just patients, care about our whole health, and remember who we are from visit to visit. Most doctors, to their credit, do try. But the medical system here doesn't lend itself to holistic care, and as more and more insurers get involved in dictating medical care, the situation may get worse instead of better. If things are going to change, patients have to get involved at all levels, not just with our own doctors, but with the people who dictate health care policy in our country.

01-23-2007, 04:31 PM
I AGREE 10000% -

Thanks for sharing - amen and amen

Much love,

01-23-2007, 04:32 PM
Could you tell, that I'd jump up and hug you if I could? :D :D :D
So consider yourself hugged right now !!


01-25-2007, 05:24 AM
I have always been a big advocate for patients to be proactive in their care. Especially us Lupus patients. I truly believe that it is absolutely necessary that we learn as much as we can about Lupus, its symptoms, treatments and medications and that we begin to learn our own bodies and how we react to our medications, our environment and our treatments. In order to get to a point where we can manage our Lupus, we have to work as a team and the members of that team includes our family, our health care team, our emotional support system and (most importantly) ourselves. We will not be able to manage our illness on our own and in order for us to be an asset to this team, we must educate ourselves about our illness.
I truly understand the stresses that doctors face and the fact that much of their autonomy is being stripped away by outside forces. As a Probation Officer - Pre-Sentence Investigator, I know what it is like to have to handle four times the amount of work that regualtions stated we should have and having our hands tied by State mandates, County regulations and Penal Code restrictions. As a County Employee, we were grossly underpaid for the work that we were required to do and we were expected to do the work of five people with the County constantly telling us that we were not going to get any help!
In this profession, we held the lives of not only our probationers, but their families, in our hands (based upon the decisions that we made about their sentencing). The sentence that they received affected them, their parents, their spouses, their children, their employers and more.
I have seen many Probation Officers develop an "uncaring" attitude wherein they refused to look at the offender as a whole person who has been influenced by family, environment, living conditions, illness, emotional crisis etc. - All of these factors are what makes a person who he or she is. Not just the crime that was before us at that moment. Sentencing recommendations HAD to be made based upon all of those factors and it was our job to present the entire picture to the court and to make our recommendations based upon the entire person...not just the crime! I conducted many trainings with our overworked Probation Officers, to always instill in them that, no matter how hard our job was and no matter how much these other influences wreaked havoc on our ability to do our jobs, we must never, ever forget that this is a human being who is sitting in front of us, and that human being deserves our full attention when we are with them, and that human being deserves to be looked at from each perspective that has made him/her what and who they are and has brought him/her to where they are today. We cannot dismiss anyone based upon the fact that we are overworked, overburdened or hampered by outside forces. None of these things changes the fact that we are dealing with a human being, a compete human being. Therefore, we need to care about this human being who is in front of us - we need to care about why he/she is here, what forces have led him/her to where they are and what will it take to help him/her to turn their life around (and sometimes that meant sending him/her to prison, sometimes to jail with probation, sometimes to therapy etc. etc. etc.).
So, I say that there is always time to "care". Whenever you are dealing with a human being (who is a complex being) and their life, it is imperative that you care, particularly if you are in a profession that is supposed to be helping them. I would venture to say that most of us have found that our treatment was much more successful and our outlook much more positive when we finally found a doctor who listened and who "CARED". For many of us, having a caring doctor has been a Godsend and has had a calming effect, and has made the difference that we needed to get control of this disease. Caring is possible and in the medical profession (just like in my profession), I think that it is absolutely necessary.

Peace and Blessings

01-25-2007, 09:19 AM
I absolutely agree with you that they should - unfortunately too many of them don't have someone like you to teach them about the importance of caring and compassion. I think the curriculum of many medical schools would be much improved if they had patients teaching a few classes in doctor-patient interaction. But, sadly, I fear the situation is going to get worse instead of better - as medicine becomes more and more specialized and dependent on technology, it also becomes less and less about the human beings involved. I guess that's why my frustration tends to be more with the whole medical system rather than individual doctors - every month, I see at least one case file where a patient who should have been helped wasn't because an insurer overrode a doctor's best judgement - and other cases where a diagnosis was missed because the doctor or the hospital relied on a computer's interpretation of a automated blood test, and the sample was never checked by a live human being. That's why I think we have to get involved not only in our own health care, but voicing our opinions about the whole system, and trying to change it, and by challenging our doctors, our hospitals, and our communities to get involved too. Part of what we can do with our individual doctors is start thinking like smart consumers as well as smart patients. We don't work for the doctors - they work for us. If you wouldn't accept long waits and callous or indifferent service from your bank, or a retail store, or your dentist - why accept it from your doctor just because he (or she) is a doctor? Sometimes just writing a letter to your doctor when you're dissatisfied with the quality of care can be a wake-up call for them, and makes you feel more in control.

01-25-2007, 09:56 AM
oh yes..I have personal experience with the "letting the computer determine results of blood tests and then not acting on those results!" syndrome :lol: It was just such a syndrome that caused a serious flare which led to a lengthy hospital stay to hear a doctor say "I never got those results, if I had, I would have done something different".
And I absolutely agree with the maddening affect of insurance companies overriding a doctor's recommendations, based solely upon money. I can feel your frustration in your words and I am with you 150%!! I have had to, on several occassions, go to member services at my HMO to register disatisfaction with either my doctor or my daughter's doctor. Fortunately, when this happens at my HMO, we get IMMEDIATE results and the issue is readily taken care of in one way or another. Like you said, it is unfortunate that this does not happen with all health care providers because insurance companies dictated how they should provide health care!!
You are right, they work for us..we are not their employees. So, once again, I advocate (like you) that we get involved in our care, that we become proactive in how our health is handled and that we be aggressive about our needs. Doctor's need to hear from us and probably want to hear from us. They probably also appreciate those times when we point out to them that they must slow down and listen to us!!
I also agree that this system is headed for a breakdown because it is already in a full blown crisis! I do not know how to change the system except by starting with me :lol: . For my part, I urge everyone to please become educated about your health care provider, your illness, your options, etc. and be aggressive about your care!!! Do not be afraid to stand up for yourself, to fight for your rights and to demand that you be heard!!
Marycain, I think that you and I are standing on the same soap box wishing that we could shout it out to the entire nation and frustated about the daunting task of making a change!! But, change can start..one person at a time!!
Peace and Blessings

01-25-2007, 12:20 PM
Amen!!! I'm right there with you - just wish there was some way to turn our soapbox into health care policy! I do get the chance to educate some doctors about why better communication between patient and doctor benefits them as much as their patients - I just wish I could get the message across to the doctors I see as an patient as well as I can to the doctors I see as clients. It's funny how they pay a lot more attention when they are paying for MY time than they do when I am paying for theirs.