Why Doctors Are Sick of Their Profession

All too often these days, I find myself fidgeting by the doorway to my exam room, trying to conclude an office visit with one of my patients. When I look at my career at midlife, I realize that in many ways I have become the kind of doctor I never thought I'd be: impatient, occasionally indifferent, at times dismissive or paternalistic. Many of my colleagues are similarly struggling with the loss of their professional ideals.

It could be just a midlife crisis, but it occurs to me that my profession is in a sort of midlife crisis of its own. In the past four decades, American doctors have lost the status they used to enjoy. In the mid-20th century, physicians were the pillars of any community. If you were smart and sincere and ambitious, at the top of your class, there was nothing nobler or more rewarding that you could aspire to become.

Today medicine is just another profession, and doctors have become like everybody else: insecure, discontented and anxious about the future. In surveys, a majority of doctors express diminished enthusiasm for medicine and say they would discourage a friend or family member from entering the profession. In a 2008 survey of 12,000 physicians, only 6% described their morale as positive. Eighty-four percent said that their incomes were constant or decreasing. Most said they didn't have enough time to spend with patients because of paperwork, and nearly half said they planned to reduce the number of patients they would see in the next three years or stop practicing altogether.

American doctors are suffering from a collective malaise. We strove, made sacrifices—and for what? For many of us, the job has become only that—a job.

“I’ve noticed the growing incompetence. Idiots almost killed a family member 3 different times due to lazy, stupid mistakes."

First, I don't know if it's growing, or has just become more obvious, but there is definitely a significant amount of ‘bad medicine’ being practiced. Honestly, whether you do well or not when you present for care is very much a function of who you wind up seeing. Further, it doesn't matter if the person you see is on some list of ‘top doctors’ etc. Read the book “Brain on Fire: My Month of Madness”, for a true story exemplifying this.

Why is this the case? IMHO, many reasons. I'll give one here.

The emphasis in medical school currently is on algorithm-driven approaches to diagnosis and treatment (if A, do B etc.). This is being driven by bean counters, bureaucrats, and by a relatively new branch of academic medicine - ‘outcomes analysis’. Obamacare was based, in part, on the belief that an ‘outcomes analysis’ approach to medicine would eliminate unnecessary procedures/treatments, and thus reduce costs and lead to overall better care. It didn't, doesn't, and won't. The reasons for this are many, and I'd be happy to discuss them - but it is not a short answer.

Essentially, ‘outcomes analysis’ is based on statistical analysis of large databases of patient information (e.g. medicare databases) and on review of clinical trial data. The idea is that you can figure out what works, and what doesn't, based on this type of statistical analysis. This approach has become very popular with politicians, insurers, and some healthcare administrators because 1) it provides them with a basis for denying payment for specific treatments, 2) it diminishes the importance of the knowledge and cognitive contributions of individual physicians - thus making it easier to replace more expensive physician input with the input of lesser-trained and lesser expensive ‘care providers’.

The problem is that patients are individuals, and their medical problems don't always present themselves in some ‘classic’ way that makes diagnosis straightforward. For the same reason, ‘one size fits all’ types of treatment approaches are not going to be the best choice for every patient.

The bottom line is that good medical care requires thinking. We aren't teaching medical students, residents, fellows etc. how to think anymore. They aren't learning to ‘think outside the box’. They are, instead, learning to ‘check off boxes’ - like following instructions for how to assemble something from IKEA.

Anyway, there are many, many additional problems, but this is a big one.

To LongWayHome:

All I can say to YOU is get used to the crappy service AND LIKE IT. As they said in the old Soviet Union, you pretend to pay and we pretend to work. IT IS about 0bama; he and your party passed 0-care if you didn’t notice. THIS IS about government hyper-regulation which has been fouling up health care since WW2. The health care system pre-0bama had some serious flaws but now it is going to go right down the craphole, thanks to your POS buddy.
But, to to my friends in liberty, stay healthy and be more careful than ever when using the health care system.

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