Friday, March 16, 2007

Physicians, Image of -Where Have All the Flowers Gone?

In Defense of Doctors, the Department of Defense, The U.S. Army Medical Corps, and The Veterans Administration

Where have all the flowers gone? Long time passing.
Where have all the flowers gone? Long time ago.
Where have all the flowers gone?
Young girls picked the , every one.
Oh, when will they ever learn?
Oh, when will they ever learn?

Where Have the Flowers Gone?
Words and Lyrics by Pete Seeger, 1961

Flowers come in all sizes, many colors, in varying seasons, and with unique, changing, and complex characteristics. There are glorious and anemic ones, bold and shy ones, adventuresome and retiring ones. All differ. Roses may be red, and violets may be blue, but dandelions get around more than the others do.

Whatever their characteristics, flowers symbolize hope, optimism, renewal, beauty, and life. On the wall of my office hangs a plaque. The plaque proclaims,” Don’t worry, don’t hurry, and don’t forget to smell the flowers.” I don’t forget, for flowers are what it’s all about.

We reward deeds well done with flowers. What do you give a diva to show how much you appreciate her aria? How do you tell people you care for them? With flowers, of course. I recall a sage old Connecticut family practitioners. When asked why he and his wife of fifty years had hit it off so well, he confessed, ”I send her flowers every Saturday to celebrate another week.”

Where have all the flowers gone in our society? Why don’t we send flowers anymore?

This is an anti-hero age. We no longer send bouquets or offer praise or optimism, beauty, life, or achievements.

Instead we doubt, dissect, disparage, analyze, impugn, question, and investigate.

Boy, do we investigate. We investigate Presidents, Vice-Presidents, Attorney Generals, Politicians, Army Generals, Priests, Physicians, and Establishment Institutions. The prevailing attitude is: if they or it have succeeded in our society, something must be wrong. Our most prominent heroes, even Mohammad Ali, have feet of Clay. So we send no flowers, only regrets that things are not perfect.

“Investigative” reporters “reveal” to us what we know already – that our leaders and the organizations they lead suffer from human frailties. The reporters “astonish” us each morning with mundane disclosures: Presidents dislike their political enemies. Partisan politics exists. Our enemies are bent on killing us – and it’s our own fault because we do not talk to them. Congressmen appease, and even try to please, their constituents. Supreme Court Justices, heaven forbid, argue among themselves over controversial issues. The Justices even maneuver in their cloakrooms to win over their brethren to their point of view. Goodness, learned lawyers act like they are made of flesh and blood. No flowers are bestowed upon them for lifetimes of hard work and solid accomplishments.

And physicians?

Well, they are the worst. Imagine. They err like other mortals. They occasionally misinterpret signs, symptoms, and results. They cannot guarantee perfect results under all circumstances. They cannot even repeal the Laws of Nature, or the inevitable Limits of Longevity. Physicians are not even omnipotent, omniscient, or omnipresent.

Take those Army doctors at Walter Reed or VA physicians everywhere. Can you believe it? They didn’t inspect all those moldy dormitories housing wounded veterans, and they did not respond immediately to all those complaints filtering up through the military medical bureaucracy, the largest medical-hospital complex in the world.

Sure, these military and VA doctors are saving more soldiers on the frontlines than in any other previous war. Sure, they have installed a universal electronic health record system linking all their hospital and physicians – a system that allows them to outperform the civilian sector for most quality indicators and is looked upon with wonderment by medical managers and medical executives. Sure, veterans are flocking to VA hospitals and clinics, for those $7 prescriptions Sure, the VA has launched a construction project called CARES. Sure, most military hospitals are fifty years old, compared to 12 year old in the civilian sector. Sure, heads had to roll, even heads that have devoted all of their lives to there military careers and their country.

And those civilian doctors? Reporters are stripping their petals one by one, complaining they are “too conservative,” or they don’t spend enough time with patients, or make too much money. They are too highly paid, the argument goes. Forget that average $100,000 medical education debt. Why should should complain? Sure, their incomes have not kept pace with inflation for a decade. Sure, the amount doctors are paid has dropped for the third year in a row and represents only 6% of all the money spent on health care in 2006. Sure, physicians are expected to receive significant cuts under Medicare’s pay formula for the next decade. Sure, managed care and Medicare forces doctors to spend only 15 minutes with patients in order to meet their bottom lines. Sure, the doctor shortage and economic squeeze leaves little time to answer patients’ questions. Sure, they are producing all medical innovations, new drugs, and new treatments that are lengthening longevity and making us functional into old ages. But medicine costs too much, and somebody has to sacrifice.

Maybe we should praise our doctors and their institutions, considered many to be “the best in the world.” That may be why the U.S. introduces 80% of the world medical innovations and wins 80% of the world’s Nobel Laureates in Medicine even though we only have 5% of the world’s doctors. Maybe we should give our doctors flowers, instead of defoliating them. Maybe they should be our heroes, rather than our villains. American doctors are not miracle workers, but given limited resources and Nature’s limitations, they are damn good.

Be fair. Put physician performance in perspective.

Smell the flowers. Show flower power. Plant a flower. Grant your favorite gastroenterologist a GI Bill of Right. Give Decorations to those who treat patients.

And remember. Those who throw dirt lose ground.

Criticism has its place. But so do flowers.

(In the interest of full disclosure, I am not a veteran. I do not have children or relatives in the Armed Forces. I do not receive pay from the VA. I did do part of my training at a VA hospital, as do more than half of American physicians.)


1. Brianigan, William, Dole, Shalala Pledge Full Investigation into Military Care, Washington Post, March 8, 2007.
2. Shanker, Thom, and Stout David, Chief Army Medical Officer is Ousted, New York Times, March 13, 2007.
3. 2008 Dems Vow to Reform Veteran Care, Associated Press, March 15, 2007.
4. Glendinning, Glen, Medicare Ripple Effect Linked to Dip in Spending Growth on Doctor Services, American Medical News, March 12, 2007.
5. Adams, Damon, Tight Schedules at Odds with Patient Demands, American Medical News, March 12, 2007.

1 comment:

Dr. Val said...

Couldn't have said it better! Bravo, Dr. Reece... I've posted a little something about this wonderful concept: