Category: Physician Mindset

Industrialized Medicine

Check this out. What you will see is a psychiatrist, who specializes in helping physicians and their organizations deal with “complex personal challenges,” asking his colleagues a question. Are they “healers” or are they “widgets.” According to Dr. Adelman, the trend over the last 50 years toward “industrialized medicine,” where doctors’ workflows are controlled by corporations rather than by their own wills, has caused there to be so much “coming at them” that they are like Ethel and Lucy in the chocolate factory. They just can’t keep up. They become unable to do “their best work.”

A powerful quote from Adelman’s post:

Malaise sets in when you realize that you have become an almost inanimate object.  This is ‘physician burnout,’ which has been conceptualized by some as a form of moral injury visited upon us by industrialized medicine.

Bottom Line. The move away from being a healer and toward being a widget seems inexorable. This is not likely to get better in coming years.

My question? Then what will “worse” look like in years to come???

Fewer Physician Visits By PSRs Post-Pandemic?

As you will see in these survey results from FirstWord, that is the desired scenario for about half of the 100 doctors they polled. Throughout the six months of reporting on the results of my On Doctors’ MindsSM conversations, that about lines up with what I have been finding. As we predicted back in November of 2020, many doctors are looking forward hopefully for a return of the “old normal.” BUT. About half of all physicians we have talked to, and especially many specialists, have learned over the course of the pandemic to “do without” PSRs, readily getting  the answers and information they need in their practices from other sources. 

While you are looking at these results, check out the data concerning virtual details. Here, 57% of doctors reported that they find them to be equally or more “effective” than personal PSR visits. BUT. In my conversations with physicians, the majority of doctors are avoiding these virtual visits like the plague (Sorry!) due to difficulties in scheduling and the extra time required. Translated, perhaps the virtual details that are happening are “effective,” but most of my discussants, and I believe most physicians more generally, are not letting them happen.

Bottom Line. Throughout our study of the effects of the pandemic on office-based physicians, we have been telling our pharmaceutical clients that they had best be prepared to increase their physician micromarketing sophistication as the pandemic winds down. Doctors are differing widely in their preferred mode of communicating with pharmaceutical companies. One size definitely doesn’t fit all here, and we need to be ready to respond to these differing physician preferences. 

It Is Wrong For Doctors To Retire “Early?”

The gentleman pictured above is Dr. Jimmy Turner, the self-proclaimed “Physician Philosopher”. In this post, he sets out to debunk the title shown above. In doing so, he argues that a physician’s early retirement does not render the slot he occupied in medical school a waste. How many years should a doctor be required to practice in order to make his education worthwhile? 10? 20? Until he dies? Good question!

He also defuses the concept of early retirement contributing to the physician shortage. Here, he argues that too few doctors entering the field, rather than too many doctors leaving medicine, is the actual cause of the doctor shortage. He’s probably right again!

Of course, Dr. Turner has an axe to grind here. He coaches physicians on the principles of FIRE, Financial Independence and Retiring Early. 

As I pondered this piece, I thought of the work I do as a Board member at Volunteers In Medicine on Hilton Head Island, SC. We have 10,000 patients who would otherwise be medically underserved. And what lets us care for all of these patients with only a minimal budget? Volunteers. RETIRED volunteer physicians, nurses, dentists, pharmacists, etc., all anxious to continue to put their clinical skills to good use, especially now that they don’t have to worry about running a practice as a business. Many in their 70’s, retired for years, but still going strong.  

Bottom Line. So, is it really wrong for a doctor not to work full time practicing medicine until she dies, worried the whole time about finances and burning out? 

I am going with a big “No” on that one! How about you???

The Rise And Fall Of Doctor Google

The Rise And Fall Of Doctor Google

Check this out. What you will see is a complicated interplay of public perceptions of physicians and the doctors’ own self perceptions. Said what?

Here’s the deal. Prior to the pandemic, Americans were increasingly likely to trust medical advice found on Google and in the social media, and decreasingly likely to trust physicians. Scroll forward. COVID has brought a return of the perception that “the Doctor knows best.” Only problem is, now that they have been placed back on their pedestals, doctors are more than well aware of their limitations in preventing mortality and morbidity caused by the coronavirus. AND. They still have to deal with the administrative claptrap that was burning them out prior to the pandemic. AND. They are wrestling with new factors like telemedicine which were thrust upon them by the pandemic.

Bottom Line. It’s not an easy time to be a physician. Was it ever?

The “Difficult” Patient

A simple thought for the day. Check this out. What you will see is a brief but fascinating little piece. The point? With 15-60% of patients being considered by their physicians to be “difficult,” the underlying problem just might not be one of psychiatric pathology in the patient. Maybe the problem needs to be reconceived as resulting from a damaged interaction between the patient and the “health care delivery” she has encountered.

Bottom Line. It always amazes me how often “reconceiving” a problem can be a powerful first step towards its resolution.  

Doctors Don’t “Communicate” About Medications

Check this out. What you will see is a simple but important thought. Our old friend, The Country Doctor, suggesting that while businesses spend a disproportionately large percentage of their time and effort focused on how to sell something rather than on how to produce it, physicians take the opposite approach. Especially given the increasingly tight limitations on their time, doctors simply cut to the chase, tersely telling patients what medications they need to take and how, and failing to “sell” the drugs and their benefits with anywhere near the same level of intensity that the drugs had been sold to them.  

Bottom Line. So what? So plenty! Consider the impact of all of this on patient adherence. And, perforce, on the doctor-patient relationship.  

Maybe we, as an industry, need to help doctors to become better salespeople. I am thinking that this could result in a triple win. For the doctor, for the patient, and for us!

Hospital CEO “Cut!” After Participating In Surgery

Yes, you read that title correctly! And no, the CEO was not an MD!!! Check this out.  What you will see is one of the more bizarre stories you will encounter this week. Guaranteed!

Here’s the deal. For some inexplicable reason, the CEO of a hospital in Bristol, TN entered an operating room to “observe” a surgical procedure. What he expected to learn from this observation process remains unclear. What is clear is that, for some other inexplicable reason, the surgeon in charge of the case asked the CEO if he would like to make the first incision on the anesthetized patient. He did!  

As tends to happen in 2020, word of this “got out.” First to the hospital’s compliance program, and then through the press. What happened next?  Exactly what you would think. The CEO and the surgeon are no longer employed at that institution.  

Is that all? Perhaps not. This blog post contains mention of possible criminal actions against the CEO, and the possibility of civil lawsuits as well!

Bottom Line. But wait. Maybe there is more going on here than meets the eye. I’m thinking that this is really a story about an “In the heat of the moment” fantasy.

Ask 5,000 surgeons on Twitter if they would let their hospital CEO’s make an incision in their patients. The answer? A resounding “Hell, NO!” Good rational thinking in response to a survey question.  

BUT. What MBA hospital administrator has not fantasized about being a doctor, you know, one of the guys who really make the hospital work? And what surgeon has not wanted to show his CEO who is really boss by letting him play with his toys, unfortunately in this case a patient’s body? 

In a world where habits, heuristics and emotions account for the vast majority of human behavior, consider this just one more reminder of how imperfectly survey responses predict actual behavior! The kind that occurs “In the heat of the moment.” 

Frankly, I Don’t Care What Your Cardiologist Says!!!

Check this out.  What you will see is a riff by a Cardiothoracic Anesthesiologist on “stuff” he doesn’t want to hear from a patient prior to surgery. For example, this doctor believes that he is more than capable of evaluating a patient’s operative and postoperative “risk.”  He doesn’t need a warning, or a clearance, from your Cardiologist. Similarly, he doesn’t want your Pulmonologist’s opinion thrown into the hopper either. And God forbid you would request a specific anesthetic!!!  

As an aside, he includes a great quote about one of the key aspects of being an Anesthesiologist. Time is usually of the essence for this specialty, since they must “diagnose and treat at the same time.” 

Bottom Line. What do we learn from this riff? In the decades that I have used my Ph.D. in psychology to study physicians, I’ve noticed three important and related trends. First, physicians have become increasingly specialized, one could even say hyperspecialized, during this time period. AND. These specialized physicians have become increasingly sensitive about other specialists treading on their turf. Finally, armed with “information” drawn down from the Internet, patients attempts to direct their own medical care are increasingly fraught with risk as they attempt to enter into the specialized world described above.  

Yup, that all makes sense!

What A Female Physician Has Learned About Being A Female Physician

Check this out. What you will see is a list of 10 key lessons this doctor has learned about how to survive as a female attending physician. Probably the most significant of these is “Lesson 4. Female resentment is real.” So how does she deal with that? By remembering to “Pick your battles” and realizing that “You must develop coping mechanisms.” 

Bottom Line. And the other key lesson here? Remembering that “Change is slow.” Female physicians are not the statistical oddity that they once were, but that does NOT mean that they have been fully accepted into the profession.

Transformation-Take Two

Yesterday, we discussed the fact that one of the states a hospitalist reported going through as he deals with treating COVID patients is “transformation.” Over the course of the last two months, he has come to understand that the “scrubs” have let the “suits” take over and ruin medicine. He is now vowing to stand up and be counted in the fight for good healthcare and for better physician quality of life.  

Here’s another one.  A self-proclaimed one minute read that implores doctors to “wake up” and start living the lives that they want to be living, rather than continue to be abused into living someone else’s.

Bottom Line. “Wake up.” I am betting that as we come out of the pandemic, you are going to hear expressions of that theme a lot. Doctors and Nurses have doubtless been jerked around enough, with 15 hour shifts, lack of PPE, etc., that they are indeed likely to want to seek out a better lot in life. AND. Being used as political footballs and being yelled at by gun toting demonstrators demanding to be “liberated” so that they can crowd the ICU’s will likely fan the flame.  

There’s only one question. Will medical professionals be able to get organized enough to get changes made? Banding together has never been their strong suit, which is how they find themselves in their current situation. 

We shall see!