<p>First, I would like to expound on a few inferences I had made so far based on my own observations of doctors.
Doctors are portrayed _ and should be_ as people persons yet all the doctors I have seen seems to distanciate themselves from their patient. In fact, they were either patronizing (perhaps, even condescending), self-centered (doesn't seem to care about their patient's suffering), immoral (cares more about the money brought to their office), antisocial (avoids contacts with their patients by seeking refuge in their office and leaving all the "social" work to be done by their secretaries though they had nothing to do at that moment) or arrogant (makes the patient wait for NO reasons to possibly make the entry into the patient room more "spectacular").
All those observations (done both as a patient and by shadowing) seem to contradict virulently to my ideals of how a doctor should behave. Even if this is NOT their intention to make the patient feel neglected, inferior or unimportant, their behavior seems to be inappropriate for their function as lifesavers. </p>
<p>I am very struck by such misbehavior (maybe not done on purpose, but this is not the issue), since the tremendous screening of premeds should at least guarantee that the doctors to be have decent social and people skills. This makes me wonder if their CRAZY medical education or memorization crippled their altruism or conscience. Perhaps, the long and painstaking intership caused this. I just wanted to have comments or insights about this because I am very concerned if I have always misunderstood the way a doctor should behave. </p>
<p>Any clarifications are more than welcome! Thanks and I apologize for the long post.</p>
<p>Disclaimer: I do not indict doctors of immoral behavior because I cannot and will not ascertain that such behavior is made on purpose. Also, this is a subjective judgement, yet even though it is subjective, the doctors should not arouse such feelings in a patient (me), even unconsciously.</p>
<p>the system causes the immorality.</p>
<p>for example:</p>
<p>before you would pay the doctor upfront and then bill your insurance, now you go and the doctor has to bill the insurance.</p>
<p>I wonder how many doctors you are referring to? I can imagine in shadowing you may see a side of some doctrs that most patinets do not, but I suspect some of what you see is a bit of defense mechanism. I'm also not sure what the "immoral" part is. I will look up the definition of "moral".</p>
<p>Here it is;</p>
<p>Definitions of moral on the Web:</p>
<p>relating to principles of right and wrong; i.e. to morals or ethics; "moral philosophy"
concerned with principles of right and wrong or conforming to standards of behavior and character based on those principles; "moral sense"; "a moral scrutiny"; "a moral lesson"; "a moral quandary"; "moral convictions"; "a moral life"
ethical: adhering to ethical and moral principles; "it seems ethical and right"; "followed the only honorable course of action"; "had the moral courage to stand alone"
arising from the sense of right and wrong; "a moral obligation"
the significance of a story or event; "the moral of the story is to love thy neighbor"
psychological rather than physical or tangible in effect; "a moral victory"; "moral support"</p>
<p>Okay, I see. So maybe it's not "right" to be patronizong, uncaring, business people who seek refuge. It certainly isn't like Dr. Welby. I can tell you when I'm not here I am lurking in physician forums where you will get an earful about how disrepected physicans often feel by their patients, not to mention managed care companies.</p>
<p>Moral in the sense that it conforms to the ethics of a doctor, and what is "right". Usually, people with good conscience will behave morally.
Yet, the pecuniary attention of doctors was very striking when I was a patient (trying to make the procedure as expensive as possible, trying to lure me into his personal clinic instead of the hospital even though the hospital was better equiped...) I might understand they suffered a lot of loans but it does not justify their behaviors. Besides, some of them were just damn rich (not all of them). Another example is purposefully (or seemingly purposefully) making the patient wait for nothing. Arrogant behavior and offhand behavior was also seen.</p>
<p>I have seen this behavior in every the vast majority of doctors I have known (8 out of 10). Most of the time, I met them on a long term basis since I often accompanied my parents and sister to the hospital (yeah, they had many chronic problems). I experienced this on 2 different doctors as a patient.</p>
<p>"the pecuniary attention of doctors was very striking when I was a patient (trying to make the procedure as expensive as possible, trying to lure me into his personal clinic instead of the hospital even though the hospital was better equiped...) "
Was this one experience or several?</p>
<p>Several (not always as a patient). I would say 3-4 experiences (on the 2 doctors mentioned above). I also witnessed it with my parents as patients. On other experiences, it was with dentists.</p>
<p>The example you give sounds like "fee for service" rather than managed care FWIW. Fee for service usually leads to very ggod behavior around here. I wonder if cultural differences could play a role. I'm not saying that doctors don't misbehave but most I know are concientious to a fault.</p>
<p>Maybe, but this does not explain their patronizing behaviors. Some of them are just tactless in their treatment of patients. Come on! If they want money, they better treat well their patients, or they will be deserted. That's just common sense. Also, I bet most of them had to be moral or altruistic in their behaviors before med school to go through the interview process_or at least, they should have been good at lying, which is quite improbable. That's why I supposed their excruciating education could have engendered this sad result.</p>
<p>If they want money, they better treat well their patients, or they will be deserted. That's just common sense</p>
<p>Not in managed care. Patients are assigned to you and neither of you have much to say about it. Working harder and being "nice" does not mean more money ( well, there are the dreaded "patient satisfaction" surveys) . If you are pre-med, you may know better than I what it currently takes, but in my day ( mid 80's) it was energy and enthusiasm. I'm not sure about "altruism". I don't think the education process makes bad doctors, nor did I think it was "excrutiating". It may have been the most rewarding time of my life. It is much more likely that the daily wear and tear of having to be "on" and feeling unappreciated has engendered the results your seeing. Still, I'm curious about why you have such a high number of bad experiences. I don't think most people feel that way about their doctors.</p>
<p>Well, I guess I have to assume that we are too sensible in our family. Yet, my parents felt the same way as patients, and it is quite obvious sometimes (not always) that the doctor is condescendent. I think there should be some kind of "self awareness" course in medical school. Perhaps an additional "patient doctor relationship" course would be necessary.<br>
Your portrayal of medical school makes me SO motivated, but BDM has severely debunked this.</p>
<p>What is "BDM"? What do you mean by "too sensible"? BTW, there are all sorts of what I call "Be nice classes". I must admit I have been referred to one....That was during my time working for an HMA, when working harder was rewarded with working harder. I don't thinnk I was ever mean or condescending. In fact I think I gave my patients plenty of power and along with it responsebility. I did not promise to fix things that patients needed to fix themselves. I don't believe I shamed or criticised; I just siad "I can't fix that". Even in private practice I don't offer to sell things I dont feel right about. ( I don't hawk "magic pills"). Most of the time I will work as hard as, but not harder than the patient.I could make a LOT more money if I did. I feel THAT would be a moral dillema for me, but I wonder if it comes off as uncaring sometimes</p>
<p>BTW, I am a Child Psychiatrist.</p>
<p>BDM is BlueDevilMike, who is supposed to be in medical school. He posts a lot, so you could see many of his previous posts on this forum. What I mean is that doctors make me and my parents feel as if we were begging so that they cure us. They make us feel as if it was not their duty or job, but rather their superhuman nature, that will make them examin our illnesses (it was not even a complicated case). They tend to make us wait by always arriving 30 minutes late to work. Then, they parade in front of the patient and take their time (sometimes relax an extra 10 minutes) even though they are damn late.
Do you listen to the radio sometimes? All those doctors who are actually SELLING or Promoting "magic pills" (known to us for a long time) publicize frequently.</p>
<p>BDM is BlueDevilMike</p>
<p>...I just figured that out. I traced a few of your threads. It occured to me that doctors that let you "shadow" may be a little....different. They must have more time and showmanship, and less concerns about confidentiality than many. Well, it was a long time ago, and maybe I'm not remembering school the way it was, but I still think of being a student as the last time somebody was doing something for me. No responsebility, just absorb knowledge! Sometimes when I think about why I became a doctor I wonder if it was because I loved going to school, and I was good at it...Anyway, there is no denying that internship and residency was a bit of a bear, but I've heard that's much better now. They say interns and residents have unions and "rights" now"! Maybe THATS where the change is.</p>
<p>That really motivates me. My concern was that I don't want to go to med school and become an obnoxious and arrogant doctor. I am scared the intense memorization and competition can contribute to mental disorders in doctors, but luckily, you are an example that debunks this myth.</p>
<p>
<p>The screening and application processes merely guarantee that most doctors can optimize grades as undergrads, do well on standardized tests and complete "meaningful" EC's. The thesis that pre-med process itself may be dehumanizing is explored in the 2005 paper entitled "Is premedical education dehumanizing? A literature review" in The journal of Medical Humanities.</p>
<p>The majority of matriculating medical students are in fact decent people, but the medical education process, particularly the PGY-1 year can be dehumanizing. See the article entitled "Breeding Cynicism: The Re-Education of Medical Students" at <a href="http://www.apa.udel.edu/apa/publications/newsletters/MedicineNL/v06n1.htm%5B/url%5D">http://www.apa.udel.edu/apa/publications/newsletters/MedicineNL/v06n1.htm</a></p>
<p>
[quote]
The surgeon-author Richard Selzer writes the following in an introductory piece to a text entitled Ward Ethics―Dilemmas for Medical Students and Doctors in Training:</p>
<p>Medical students are so altruistic and humane when they start and then somewhere along the line they lose it, its beaten out of them. My own training as a surgeon is an example. Training in surgery has traditionally been carried out "en militaire." It was awful when I was in training because the brutality was handed down from the chiefs of surgery all the way to the chief resident, the intern, the medical students, and the nurses. We learned to pass on the brutality because it had been done to us and if you quailed or if you showed any kind of fear or sense of having been embarrassed, then you lost points and you were subject to further ridicule. It was a bad way to become a doctor because it was inhumane. You were brutalized emotionally, and sometimes physically, and it still goes on.
</p>
<p>In my practice at a small community hospital the nicest compliment I've heard is, "You're so nice I didn't think you were a doctor."</p>
<p>WOW!!! That's scary. If being a doctor involves such dehumanization, what becomes of the humanitarian aspect of a doctor in the years to come? Why look for altruism and dedication or compassion in applicants when accepting them means detracting their humanity? This system is really open to criticism.<br>
The screening I mentioned includes personal statements, letters of recommendation, interviews....</p>
<p>BTW, When watching the Health channel, I also saw very tactless behaviors of doctors (sardonic when they should not be, seemingly uncaring...)
Being serious is necessary when practicing medecine, but being stern and harsh is not. Why the hell is the process so dehumanizing?</p>
<p>Well, I can't swear I don't have a mental disorder....I'll take a chance and say this. This statement concerned me a little...</p>
<p>"we were begging so that they cure us...."</p>
<p>I don't believe doctors do a lot of "curing". Mostly they don't get in the way of people getting well. Perhaps you are giving to much power to your doctor.</p>
<p>And this part...</p>
<p>"parade in front of the patient and take their time (sometimes relax an extra 10 minutes) even though they are damn late."</p>
<p>I can't remember the last time I saw a doctor relax.</p>
<p>And finally </p>
<p>"Do you listen to the radio sometimes? All those doctors who are actually SELLING or Promoting "magic pills" (known to us for a long time) publicize frequently."</p>
<p>Do you mean in the US? No, I can't remember ever hearing an actual physican hawking something on the radio or television. Okay maybe some diet thing recently. Oh and some PMS/PMDD thing. Just an actor SAYING she's a doctor.In California, only dentists and plastic surgeons seem to advertise, and only in glossy local magazines.</p>
<p>Thinking back a bit more, intership, and residency were reminiscent of my sorority "pledging" and military training in that each left you with a tremendous sense of being part of something that required intense commitment and fortitude, that others might not be able to understand, and the sense that you had to go on, respond, and do the "right" thing, no matter what.</p>
<p>Well the radio thing was in vietnamese in Houston chanel. But don't you see doctors showing off on TV? What about publicity of doctors on newspapers...? I have never seen this so far, except in the US.<br>
Also, I don't think making patients feel inferior or begging as an appropriate way to make them feel better. At least they should show concern for the patient's illness, or show they are doing their best.<br>
Another point is that the doctors I have seen seem very relaxed. They don't even work as much they claim to. They start at 9:00 AM (which is pretty late; to me an appropriate time to start is 7:30 AM) but arrive at 9:30 to their offices. They leave early, don't work on sunday, take vacations (1 month in the middle of the summer). Half of the time, they are not in their consultation room, but on their office (while patients wait). They leave earlier than the hour written on their schedule. That's pretty unprofessional.</p>
<p>The other behaviors I've seen and can understand, but this one I have never, ever witnessed:
[quote]
makes the patient wait for NO reasons to possibly make the entry into the patient room more "spectacular"
[/quote]
</p>
<p>Well, I don't see why a doctor would arrive 30 minutes late, walk slowly in front of the patient to get into his room and make them wait another 10 minutes (I don't think it takes 10 minutes to put on the doctor's uniform) It was at 9:30, late in the morning where there was not even a lot of traffic.
The behavior of arriving late was so widespread with doctors that I feel it has become a ritual.
Most of the doctor's schedule are CRAZY as I got the impression from CC. To me, their schedule is a LOT more relaxed and flexible than the one of my mother who works at a restaurant.</p>