REFLECTIONS OF A RETIRED PHYSICIAN
“Academic excellence is not a strong predictor of career excellence.”
After my retirement from 40 years of medical practice, I could not help but often think about and reflect upon the medical profession, doctors and the practice of medicine. My thoughts focused around the following important questions:
1. Why were there so many doctors, with different understandings, characters and personality traits?
2. Why for some doctors is the practice of medicine nothing more than a money making profession, while for the others, caring and attempting to help the sick is more important than making money?
3. Why were there so many choices, contradictory views, clash of values, difficult conversations in medicine? Why weren’t we taught anything about them during our training?
4. Why were the character traits and behaviors of “good doctors” different than “not so good doctors”?
5. Why is medical care allowed to turn into corporate care for more profit?
6. Why has EMR (electronic medical records) instead of reducing paper work, increased reduced personal contact with the patients?
I vividly remember, during my gastroenterology training, my teacher and mentor Prof. Dr. Eddy Palmer saying, ”There are two types of doctors. When they see a patient, one thinks how can I help this patient, while the other thinks, how much money can I make out of this patient? The first doctor is undoubtedly a good doctor; the second one is a business-man doctor who has chosen a wrong profession. You should always try think, become and act like a good doctor”.
I think, we doctors learn more medicine from our own practice, our own mistakes and experiences. For me, the most difficult and stressful situation was when I faced with, what psychologists call, ”cognitive dissonance” in which having two strong and contradictory beliefs in how to handle a medical problem. Over time I learned that the “First Do No Harm dictum“ is not always possible. Even a simple medication can have serious side effects. I taught myself how to ignore the existence of less important possibilities and to go with your gut feeling. Nothing in life is 100 percent correct.
I strongly believe that a person’s character and personality are not the same thing. Character is acquired hereditarily, and it remains the same during the entire life. A strong character is associated with a strong sense of morality, ethical principles and intellectual honesty. On the other hand, personality trends are learned; they can easily be changed, modified and controlled by self-interest, bribes, fears or threats.
I have worked with many doctors, including those who were graduates of top medical schools in the USA. Some of them have had weak character and personality traits, such as lying, doing unnecessary procedures for profit, changing their notes and medical records, stealing narcotic medications, exhibiting sexual harassments toward nurses, and/or often using abusive language. There were many examples of sexual misconduct by the doctors who were deficient in character and in moral and ethical values. Among them, two of the most publicized examples in the press were The University of Southern California (USC) campus gynecologist Dr. George Tyndall who prayed sexually on 700 college girls for many years. The other well publicized sexual abuse of teenage girls was committed by Dr. Nasser of Michigan State University physician who abused members of American Olympic Gymnastics Team, over the years, under the guise of physical examinations.
To me, the most important aspect becoming a good doctor is to have a strong character that thrives under pressure and remains as steady as a rock under any difficulties, with a burst of physical and mental energy. A good doctor, under no circumstances loses his cool, shouts or uses demeaning language. A good doctor never says, “I don’t know. I can’t help you”. A good doctor always express hope and gives encouragement with his/her words and body language, to his/her patients.
So, as I see it, something is wrong with the selection process of candidates for medical schools. To me, the above mentioned character deficiency examples show that only candidates with strong characters, more than just academic achievements, should be chosen, educated and trained to become good doctors.
Medicine is indeed very difficult, mentally and physically demanding, stressful and ever changing with new knowledge in science and technology. It requires a strong willpower and mental energy to continuously learn, and to keep up with ever changing medical knowledge.
Additionally, the business aspects and administration of medicine is fast changing and taking the joy out of the practice of medicine. Doctors are no longer in charge as to how to practice medicine or how to run a hospital. Profit oriented business people have taken over medical care and turned it into corporate medical care, where CEOs and administrators become much more important than doctors and nurses. Big corporations have acquired many independent hospitals to create major hospital chains so that they can prevent competitions, by buying doctor’s private practices, employing salaried physicians and telling them what to do, for more work and less pay, to increase their profit margins. It is interesting to note that from 1975 to present, the number of health care administrators increased by 3,200 percent.
Digital technology, EMR, algorithms, A.I. Technology, computer assisted diagnosis; in reality increasing doctor’s work schedules, have taken away the joy of thinking and practicing medicine. A doctors basic tenant which is to be with the sick and enjoying comradery of doctor–patient relationships have been taken away from them forever. Doctors now spend more time on the computer screen, instead of seeing, examining, touching and comforting their patients.
This is why burnout, depression, substance abuse, alcoholism, quitting the profession and suicide are seen most frequently, among doctors.
As I see it, health care and medical practice in the USA and in the world is heading in the wrong direction.
