Category: Physician Stakeholders

This is Really Pathetic!!!

Check this out. What you will find is an article reporting that female physicians, on average, make $2 Million less than their male counterparts do over the course of their careers. Sure, their work/life balance might favor the home front somewhat more than the guys, but $2 Million worth??? And this study is adjusted for hours worked!!!

And, just to round out the pathos, recall the studies I have posted here previously, that found that women actually tend to be better doctors then men. More compassionate, greater attention to detail.  My last two concierge internists have been females, and I wouldn’t have had it any other way.

Bottom Line. Beyond the inherent injustice of pay inequity, the author goes on to point out that all of this sends a very troubling message to women considering a career in medicine. And this, my friends, is the last thing we need in an era where good doctors, in fact, any doctors, are hard to come by!!!

Things You Might, or Might Not, Guess About Medical Malpractice in 2021

Check this out. What you will see are the findings of Medscape’s surveying more than 4300 physicians in nine specialties concerning their experiences with, and attitudes toward, medical malpractice. Why do I think we should care about this? Simple! Over the course of my career, I have had the opportunity to speak with many physicians about their experiences with medical malpractice. What I have heard from these doctors, our customers, is that being sued is an experience that has a profound effect on the physician defendant, often for a protracted period of time and not infrequently forever. Trust me. When a doctor is in the throes of a malpractice suit, we are going to have a real challenge in gaining her time and attention for our “important” drug promotion communications.

Every one of the pages contained in this report is of interest, but some really stood out for me. For example, on page 2 we see that slightly over half of the doctors surveyed had been named in a malpractice suit at some point in their careers, typically in concert with other defendants. Scrolling forward to page 3 reveals (you probably would have guessed this one!) that lawsuits are significantly more likely for specialists than they are for PCPs. Page 5 also deals with common sense, in that it points out that surgeons are the most likely targets of litigation. Brief and impersonal interactions with patients, complicated procedures and high expectations (especially for plastic surgeons!) combine to lead to this outcome. Page 13 is really scary and at least to me, somewhat surprising. There we learn that two-thirds of malpractice cases take longer than a year to resolve. In some cases, much longer! Doctors left in suspense for way too long!

And, surprise! Although many pundits, including me, predicted that the COVID pandemic would lead to a raft of malpractice cases, e.g. “failure to diagnose,” NONE of the doctors surveyed reported having a suit filed for a “COVID related allegation,” and 87% of doctors reported no concerns about such legal action.

Bottom Line. Just as they always do, this Medscape study provides important backstory insights as to what is going on in the minds of our physician customers. Read the whole thing. It will only take you a few minutes. Then contemplate what these findings might mean to the mental health of our physician customers.

That might take a little longer!

You’re a Doctor When You’re Not Giving Anesthesia???

I had to read the title of this post several times to figure out what it meant. Maybe you did too. Check this out. What you will see is a conversation between an anesthesiologist and a confused patient and his wife. Quite simply, these people were confused because they believed that only CRNA’s/nurse anesthetists gave anesthesia. The idea of a “doctor” giving anesthesia was apparently totally new to them.

So what caused this confusion? The posting physician wonders if sex bias was the cause. Or maybe both the anesthesiologists and the anesthetists who had cared for the patient previously had introduced themselves by their first names, muddying the waters. Based on a recent personal experience, I think that the answer is more fundamental.

So here I was, a week or so ago, at the Surgicenter on Hilton Head Island. Like the patient described here, I was in for an outpatient endoscopy. In pre-op, the anesthesiologist stopped by my cubicle, asked me the usual trick questions like “What did I have for breakfast that morning?” (I gave the correct answer… Nothing!), etc. He introduced me to a young lady who, he said, would be “My anesthetist.” All good.

As my gurney got pushed into the endoscopy suite, both the anesthesiologist and the CRNA were in the room. A quick discussion between my gastroenterologist and the anesthesiologist came to the bottom line of the latter saying “I’m going to do this one.” The MD rather than the CRNA.  He then told me he was going to administer the propofol, and off I went to lala land with no opportunity to inquire as to why he had stepped in for the CRNA in my case. 

Bottom Line. Given the verbal exchanges described above, it is little wonder that the average patient could be confused about the roles of the anesthesiologist and the CRNA. Who does what? When? Why?

Interestingly, the piece concludes with the perspective that it is really important for anesthesiologists to “promote their brand” as effectively as CRNA’s do. Make sure to introduce themselves as “doctor.”  Explain that they will be “supervising” the CRNA.

The benefit of this communication? Letting the patient know that he has not one but two people involved in administering his anesthesia and in monitoring other vital functions. Such clarity, I would argue, would be far preferable to the situation in which I found myself last week, with my last waking thought being “Why the last-minute crew change?”

In brief, while the author seems to believe that this discussion is about respect, I believe it is more fundamentally about patient confidence.

“Hazardous” Yes and No Questions

Check this out. What you will see is a great riff by a psychiatrist on how hazardous yes and no questions can be to a relationship. Or even to a conversation.  So many times when you get a curt yes/no response, what the responder actually means is “Yes (or no), but…..”

The plot thickens. Ask a person a series of yes/no questions, and the thought process behind the answers becomes more and more stilted. And more and more information gets left on the table.

AND. It is fairly easy to see that repeatedly being subjected to that kind of prosecutorial questioning can have a negative effect on interpersonal relationships. 

Over the course of my 50-year career collecting information from physicians for my pharmaceutical company clients, I have increasingly moved from “interviews” to “conversations” for exactly the reasons talked about in this article. Only by using phrases like Dr. Adelman is recommending (“Talk to me about….” “Catch me up on…” “I’m all ears”) can we understand the whole story that the discussant wants to share with us. Only by using these phrases can we understand the salience of individual themes to the discussant. What comes up first? What gets talked about the longest? And by listening carefully to the story being told, we can also understand its overall emotionality, as well as the emotions engendered by various parts of the story. 

Bottom Line. If you really want to understand what someone is thinking, don’t ask them questions. Let them talk!

A Time for Doctors to Shine???

Check this out. What you will see is a physician author describing physicians as going through Kubler-Ross’s five stages of grief in terms of their professional autonomy and compensation. Over the last couple of decades, doctors have increasingly been forced to cede their power, and much of their incomes, to stronger forces. Insurance companies, medical systems, etc. Early on, we saw doctors in the first stage of grief. Denial. Doctors denied that their lives were being tampered with, and they stayed silent. Mentions of physician “unions” were rebuffed. 

Over subsequent years, the doctors predictably marched through the other stages of grief. So now they are where they are. Interestingly, as COVID-19 looked like it was passing off into history, doctors believed that this would be an ideal time for them to recapture their pre-grief former lives. Not so fast! Many of our citizens are facing difficult financial times as a result of the pandemic. Small businesses are struggling to stay open. AND. Many Americans are mindful that among developed countries, the US has the least cost-effective healthcare system on earth. Not a great time for doctors to be asking for more money and more autonomy.

Bottom Line. SO. Dr. Pearl is suggesting that American physicians move on to the last stage of grief. Acceptance.  No, not acceptance of the fact that our healthcare, and doctors’ lives, will continue to get worse and that there is nothing to be done about that.  Nope. Acceptance of the realization of what is broken, e.g., an uncoordinated fee for service system. And making the commitment to fix the problems. 

Then, and only then, will physicians and patients be able to stop grieving!

Gut Girl, M.D.

Check this out. What you will see is a video by Dr. Dawn Sears. She’s known as “Gut Girl” because she is a Gastroenterologist, but for another reason as well. Besides her successful practice, she’s had the guts to establish a consulting business that, among other things, helps medical institutions achieve more engagement from their female physicians by setting up programs that avoid burnout, clean up toxic environments, reduce sexual harassment, etc.  

Bottom Line. It’s interesting. Most of the physicians with consulting “side gigs” like this that I have sent you to have been female. When male physicians do side gigs, they focus more on successful financial planning for doctors.  

Gender stereotyping strikes again?

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???

Should Doctors Give Patients Their Cell Phone Numbers???

Check this out. What you will see is a well-reasoned discussion of the above thought question. The result? The recommendation that doctors’ cell phone numbers should not be distributed under most circumstances. Why? Optimal medical care cannot be delivered spontaneously. You call the doc after he has had two glasses of wine. What happens then? You call a doctor who has 2,500 patients of which you are one, and you have not seen her in over a year. Not surprisingly, her first thought is “Who the heck are you?” Etc.  

Bottom Line. In the age of social media, we have learned to expect instant two way communications. Likely, a doctor’s cell phone should not be a part of this networking. OR. Maybe we need to rethink the overall premise that spontaneous communication is good communication!

The Pandemic And Medical Malpractice

Want to know what one of the longest-term side effects of the COVID-19 pandemic will be? Easy one! Growing numbers of malpractice cases against physicians and hospitals.  

Check this out. What you will see is a primer on the changing face of healthcare litigation resulting from the coronavirus. Example. Oncologists in my On Doctors’ MindsSM study are telling me that they are seeing “stage shifting,” i.e., patients presenting with later and less treatable forms of cancer due to delayed/missed colonoscopies, mammograms, etc. What if these delays were caused by a hospital shutting down “non-emergency procedures?” Liability???

AND. If a case is filed, what impact on outcomes results from the trial being conducted via Zoom???  

Bottom Line. Explore any of the topics included in this article’s pull downs. And remember. The healthcare institutions and practitioners being discussed here are our customers. What impact do we think this all will have on them…and on your business???

New Causes Of Malpractice Concerns For Physicians

I just got off the phone with a Family Physician discussant who was participating in one of my On Doctors’ MindsSM conversations. He had a lot of interesting things to say, but one really stood out in my mind. More specifically, he told me in no uncertain terms that he had NO interest in participating in medical care delivered via telemedicine. None! He feels that he cannot deliver proper care without “putting a stethoscope on the patient,” and that the malpractice concerns attendant to telemedicine are consequential. 

Then I read this. An actual case study involving a “wearable,” i.e., a medical device that permits remote monitoring of patients. In this case, a device that was supposed to keep track of a patient’s heart function. Only thing is, the patient didn’t put the darn thing on for several weeks after receiving it, and never got it to function. Punchline? The patient’s doctor got a report from the wearable’s manufacturer, that he shared with the patient, that the gadget had determined that the heart function was “normal” during this time frame. Whoops!!!

Bottom Line. New technologies are opening up new “roads to risk” for physicians relying on them. Medicus Emptor (Let the doctor beware)!!!