Wednesday, December 3, 2008

Physician culture -Doctors are Human

Be thou as chaste as ice, as pure as snow, thou shall not escape calumny.


Surprise! Surprise! Doctors are not as pure as the fresh driven snow, as chaste as vestal virgins, as invincible as knights in shining armor, as saintly as Marcus Welby, as susceptible to the lure of money as ordinary mortals, as immune to fatigue as Lance Armstrong, or as happy as clams.

• Pure and chaste we are not. Their overall divorce rates are 10% to 20% higher than the general public, and 37% higher among female doctors, partly, I suspect, because of infidelity.

• Invincible we are not. Physician suicide rates over the last 49 years are 28 to 20 per 100,000, well above the general public rate of 12 per 100,000.

• Saintly we are not. A few are even arrogant, abusive, and disruptive (“Arrogant, Abusive, and Disruptive – and a Doctor,” New York Times, December 1, 2008).

• As susceptible to the lure of money we are not. After all, 4 of 5 graduating medical students choose specialties, where the pay is 2 to 3 times that of primary care doctors. And many receive money from health-related companies as consultants and lecturers and advisors (“Cleveland Clinic Discloses Doctors’ Industry Ties, New York Times, and December 2, 2008).

• As immune to fatigue as Lance Armstrong, we are not. The Institute of Medicine has just released a report saying to avoid mistakes from fatigue, medical residents should work no more Thant 16 hours without a taking a 5-hour sleep break, should have one day offer a week, and should have at least 2 back-back-days off each a month ((“Medical Residents should sleep after 16 hours, experts say, Washington Post, December 3, 2008).

• As happy as clams we are not. According to a national survey of primary care doctors conducted by the Physicians’ Foundation released on November 18 to all the major media, 78% of physicians say medicine is either ‘not longer rewarding’ or ‘less rewarding,’ while 76% say they are at full capacity or overextended. Only 6% describe the more colleagues as ‘positive,’ and 42% describe the morale of colleagues as either ‘poor’ of ‘very low.’ “

Why Newsworthy?

Why is all of this newsworthy? Two reasons: 1) we have overstated our case as a noble profession, somehow free of ordinary mortals’ faults; 2) we are victims of our success, leading to overblown expectations of the miracles of medical science.

Corrective Measures

Are there corrective measures we can take to re-establish our humanity? Yes, of course.

• We can admit and apologize for our mistakes immediately.

• We can be open about our financial arrangements and ties.

• We can treat nurses and other care team members respectfully.

• We can follow these rules in a hospital setting: 1) Ask permission to enter the room: wait for an answer; 2) introduce ourselves- show ID badge; 3) shake hands; 4) sit down and smile if appropriate; 4) explain our role as a member of the health care team; 5) Ask how the patient feels about being in the hospital.(“The Six Habits of Highly Respectful Physicians, New York Times, December 2, 2008).

• We can anticipate those moments of human truth when seeing patients in the office; calling the office, making an appointment, receiving directions, meeting the receptionist, waiting in reception, waiting in exam room, meeting the clinicians, giving a history, having an examination, having an invasive procedure, giving a lab specimen receiving discharge instructions, leaving the organization, obtaining test results, receiving a bill.

• We can manage expectations for surgery and procedures by giving patients to a free interactive online expectation of exactly what to expect during and after the procedure (see

• We can acknowledge the importance of ten simple rules for meeting patient expectations as set forth by the Institute of Medicine: 1) Care should be continuous; 2) care should be customized for the patient; 3) patients should be source of control; 4) knowledge should be shared and information should flow freely; 5) decisions should be based on evidence; 6) safety should be a given; ; 6) transparency is necessary; 7) patients need should be understood and anticipated; 9) waste and duplications should be continuously reduced; 1)) cooperation among clinicians is a priority.

• We can be warm human beings.

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