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Tuesday, July 8, 2014

"Doctors have become a profession of whiners"?

A news feed headline I just saw.
Doctors have become a profession of whiners. Meetings, dinners, doctor’s lounge and blogosphere are flooded with physician complaint, tirade and anger. The volume of pained voices suggests that health Armageddon is only a few moments away.

It was not always so. Medicine is a career where idealism runs rampant. In medical school interviews young students really do answer that they want to help their fellow man.  Nonetheless, in recent years that has changed.

Instead of espousing the latest breakthroughs, preaching preventative care or carrying on collegial disagreement about research direction, doctors harangue about insurance company dominance, the intrusion of dehumanizing electronic records, ridged evidence-based-venn-diagram treatment regulations, lost autonomy, malpractice assault and of course plummeting reimbursement. Why has the mantra of the doctor moved from; I am here to help, to I am here to be harassed?

Pundits blame doctors for much that it wrong and therefore justify broad attacks on the profession. Doctor’s [sic] over-diagnose, over-treat, and over-charge, all resulting in massive cost overruns. They fail to use objective analysis and best standards, depend too much on pharma sales data, and rush lemming-like toward the next glittering breakthrough. Physicians are accused of making income their primary drive, with overblown salaries and even fraudulent billing. The power of the doctor’s order drives chaos.

Are physician complaints simply the response of a failed profession as it is bludgeoned with reality?  Should we hear their frantic words as bombastic, hubristic self-preservation, or is it a warning?  Whom are they trying to protect?  What are they trying to achieve?...
A prominent physician wrote that. My comment:
I will be citing this on my blog. Been thinking, reading, and writing a lot lately about what I call “psychosocial toxicity” in the healthcare workforce culture. At its worst, it poses patient safety issues. Beyond that, it’s enervating and counterproductive for everyone involved.

While there may be a (negative) “publication bias” (only the angry and frustrated docs get attention; happy ones don’t blog or comment as much), the problems are significant, and need remediation.
I recently challenged another physician's blog post definition of healthcare's "toxic workplace" as perhaps too narrow (given that it was simply a petulant litany of all the ways physicians are burdened by organizational and regulatory things they dislike). His response?
"Go to hell."
Yeah, that's real constructive. I replied that maybe he ought consider retiring. Medicine is not the only field with maddening requirements and professional frustrations.

Been giving a lot of thought to all of this lately. As I wrote in a prior post,
My recent posts have ruminated on what I see as the underappreciated necessity for focusing on the "psychosocial health" of the healthcare workforce as much as focusing on policy reform (e.g., P4P, ACOs, PCMH), and process QI tactics (e.g., Lean/PDSA, 6 Sigma, Agile), including the clinical QI Health IT-borne "predictive analytics" fruits of ""Evidence Based Medicine" (EBM) and "Comparative Effectiveness Research" (CER). Evidence of psychosocially dysfunctional healthcare organizational cultures is not difficult to find (a bit of a sad irony, actually). From the patient safety-inimical "Bully Culture" down to the "merely" enervating emotionally toxic, I place it squarely within Dr. Toussaint's "8th Waste" (misused talent).
My study continues.

More to come...

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