This Won't Hurt a Bit

I'm not sympathetic to the alleged problems of MDs. A nurse wrote in the New York Times about how she is bullied by doctors who don't even recogniz their bullying. She said that doctors frequently assert the hierarchies within their hospitals; doctors bully, blame, and humiliate nurses, and doctors often bully and humiliate patients as well. Please. Give me a break that God Complex doctors are the pathetic, abused agents of the hospital system: doctors have too much power and get paid much too much. This article reads like someone who NEEDS to be a victim even when there is no evidence to support their victimized role. Given doctors' power (which they often abuse) and their excessive pay rates, there is no evidence to show that doctors are victims.

Dear Janet,

Respectfully you have no idea how hard medical training is. Doctors spend an ordinate amount of their prime years spending endless time in lecture halls, late nights studying, taking call, and inevitably having the responsibility to save another’s life while our friends are often getting married, already advancing in their careers, and living life as normal young adults should. You say that our pay is excessive – would you care to repay my student loans or compensate me for working on average 50-60 hours a week? Given all the education requirements and residency training, absurd student debt, and long hours, we make a decent living, but are not paid as much as you think. I do not have a God complex; I am simply a fallible human being that wears a white coat that also happens to know a lot about medicine.

You seem to be obsessed about power differentials and make some rather slanderous claims such as doctors not being congenial with nurses or suggesting that we abuse, bully, or humiliate our patients. I am curious why you choose to denigrate the medical profession.

Dear Janet,
Respectfully you have no idea how hard medical training is. Doctors spend an ordinate amount of their prime years spending endless time in lecture halls, late nights studying, taking call, and inevitably having the responsibility to save another’s life while our friends are often getting married, already advancing in their careers, and living life as normal young adults should. You say that our pay is excessive – would you care to repay my student loans or compensate me for working on average 50-60 hours a week? Given all the education requirements and residency training, absurd student debt, and long hours, we make a decent living, but are not paid as much as you think. I do not have a God complex; I am simply a fallible human being that wears a white coat that also happens to know a lot about medicine.

You seem to be obsessed about power differentials and make some rather slanderous claims such as doctors not being congenial with nurses or suggesting that we abuse, bully, or humiliate our patients. I am curious why you choose to denigrate the medical profession.

Hey everyone,

Thanks for the comments! Though they are a little off topic, it's an interesting topic at least, and perhaps one that I will tackle in a subsequent piece. But for now, here's a link to an excellent and balanced piece on the phenomenon of hospital bullying from Kevin Pho of KevinMD. Enjoy!

http://www.kevinmd.com/blog/2011/05/kevinmd-column-solving-hospital-bull...

As for the viewpoint that doctors are playing the victim, it is hard to talk about the mental hardships of medical training without feeling like one is "complaining" about a job which is, ultimately, an honor to perform. In fact, medical training pretty effectively teaches a "no whining" policy which, for better or worse, becomes pretty deeply ingrained, to the point that I wonder if it contributes to the high rate of physician depression and suicide and to the low rate of medical trainees seeking mental health services. My point is: perhaps the very tenets of humanism that we expect our young doctors to practice on their patients should be applied to the doctors themselves.

I have no disagreement that physicians, like all high power jobs, need some moderation. As a parent of a chronically ill child who is now 16 I am extremely appreciative of his medical team--it has been a long haul. I do think, however, that the compensation levels are difficult to get past. It is hard for me to work hard in education while struggling to pay this medical team, and driving past their mini (and sometimes notso mini) mansions. Their kids seem to have unlimited access to personal assistants, trainers, gadgets, trips while mine lead an austere life still making sacrifices as we continue to pay medical bills. I realize physicians can look to some other professions and think they deserve to make as much as an extremely successful broker, business owner or lawyer. However, the field is a helping profession and the compare and despair philosophy never makes much sense. Ask your patients--life is often unfair. I have a friend who is a stock broker and he says his most difficult clients are physicians. He says that they are a terrible combination of prima dona and competitiveness. They learned to live very frugally during residency (let me point out to you that many of us live long term (and for me I pay student loans too) on a salary comparable to the residency salary doctors disparage.) I think the demands should be lessened on physicians. And compensation should be right sized. Talk to a hospital social worker-- or a school teacher -- see where they live.

I am always somewhat surprised when people say that doctors are overpaid. What, exactly, is your life worth to you? How much do you think you should pay for doctors improving your child's quality of life? One of my professors once said that there are three types of jobs: ones that pay you to make a spectacle of yourself, ones that hurt your back, and ones in which you are paid for your expertise. We are paid because we are experts in keeping people alive, or improving their health to the greatest degree. The only real reason that we scoff at resident salaries is not because of the base amount, but because we have to start repaying our loans. Have you ever seen the monthly payment on $300,000 worth of loans? Many people have loans, but most do not total that much. Admittedly, mine are higher because my medical school was private, but most doctor are at least $150,000 in debt. I agree with you that pay scales are off, but not for doctors. I think teachers, policemen, and firefighters are grossly underpaid. These are people who shape our children, and who protect all of us, and yet our society values professional athletes more than them.

I appreciate your honesty and agree with you wholeheartedly that doctors should be able to make lifestyle choices. They should be free to live balanced lives and I'm glad you've found that balance.

I've been critical of doctors both in my blog at PT and in my book, "How to Be Sick." But I make it clear that one shouldn't paint with too broad a brush. (As a former law professor, I know the harm of that as I see lawyers subjected to the nastiest of jokes even though we're all glad that the plaintiffs in Brown v. Board of Education had a good legal team!)

As a chronically ill person with a hard-to-diagnose and treat illness, my objection is that so many doctors I've seen refuse to admit their limitations. I've seen over a dozen specialists at the best medical schools in the country and my difficulty with most of them has been that they "drop me like a hot potato" or, even worse, "blame the victim" if I don't respond to their treatment regime. (And it's not my manner that results in this treatment. I'm a good patient -- polite, prepared, etc.)

As I write about in my book, my own GP is a gem because he's not threatened by having a patient whom he can't "fix." He's open to treatment ideas I bring him. It's a partnership. I wish that for everyone.

Toni Bernhard
http://www.psychologytoday.com/blog/turning-straw-gold

The amount of doctors who think they are god contribute to the feelings of the patient population that doesn't value a relationship with a primary care doctor. I'm not saying the majority of doctors act godlike, but there are enough of them to drive experienced patients away from wanting an established relationship with a doctor.

Highly paid professionals like doctors, lawyers and engineers used to be shielded from the workaday humiliations and nonsense that the average corporate drone has to go through. But in the new global economy, even those with the most expertise and education are viewed as cogs in the machine whose only purpose is to serve the oligarchy of CEOs, hedge fund managers, Wall Street bankers, and Forbes 400 billionaires. Why shouldn't a factory worker be treated like a human being? Because a factory owner wants to fire him so he can hire a lower-paid drone in China and pocket the difference. U.S doctors are now at the mercy of insurance company fatcats who view them as nothing more than a "cost" just like the factory owner views the widget assembler.

So join the club, doctor. Or better yet, help us form a more perfect union. If other American workers were unionized and compensated better, we would be more than happy to raise the pay of the doctors who heal us.

Don't agonize, organize!!!

If other Americans were unionized and could improve their own working conditions, we would be more than happy to help the doctors who heal us improve their own working conditions too!

yes--I have heard repeatedly the medical school debt explanation and I am not sure I buy it. If the loan payback is so devastating to new physicians, why do they double down and buy the biggest houses (and matching lexus [lexi? lexuses?] in town? Sounds a bit like entitlement. Toni-I have also been the victim of local physicians not wanting to be involved with my child who was referred and treated by a children's hospital team across the state. (they did send clinic notes back to these docs with protocols) They were too afraid of getting mixed up in some imaginary lawsuit to treat a child in pain. It reminded me of when I was trying to get my 1924 house roofed. The roofers kept ignoring the job at my complicated house because they could make better/easier money on a straighforward job in new construction.

I can't imagine how discouraging it must be for our young doctors--who by and larger entered this profession with only the best of intentions, and who work long, hard, thankless hours training to be good doctors in all senses of the word--to read the negative and careless generalizations in some of these comments.

I am a new physician, almost finished with my first year as a primary care physician in a suburb of a big east coast city.

compensation: Well with my student loans, non-paid maternity leave, new baby, rent, commuting costs and now childcare we are pretty much live paycheck to paycheck. Saving for a house is a lot tougher than I expected. I am working 50-60 hours a week (trying to do a chunk it when baby is asleep, thank goodness for off-site access to notes/chart). My husband, who is not in medicine, and I have a combined income of mid-100K. It's a lot of money to most people, but considering the sacrifices we have made and continue to make, it would be nice to have a little left over to save for a house. All I am saying is that not all doctors are rolling in dough, not by a long shot. My husband drives a used car, I drive my trusty 8 year old corolla.

Humanity: As a new working physician mom, it really pains me to leave my child in the morning. I've already had my personal cry sessions in the car, and wish it were feasible for me to stay home at least for a few years. I never realized how much I would love being a mom. But I also love some of my patients (in the doctor-patient way, duh) and don't want to let them down.

Respect: It is amazing to me how we treat one another. Whenever I find myself getting frustrated with a patient, I think to myself, "This is someone's father/daughter/son/mother, etc." and this has saved me from getting short or disrespectful. But I can't say that I have been shown the same courtesy. The sense of entitlement runs both ways; a significant chunk of my patients seem to think that I am providing them with a service and that if I can't "fix" them right away or I'm not giving them the medicine they had expected to walk out with, they have a right to be angry and throw a fit. Please. I am someone's daughter, wife, mother, sister, friend, too.

First, regarding unions - I am not a lawyer, and don't fully understand the facts here, but I believe that physicians are not legally allowed to unionize. At least when it comes to insurance companies, if we got together and said "we will only accept XXX insurance if you pay us $50 for a 30 minute patient visit" that would violate anti-trust laws because of price fixing. So please do not get mad at individual physicians for what is wrong with the health care system as a whole. Our medical associations lobby for us, and for our patients. (I don't envy them that job!)

Second, I love the nurses I work with, and consider many of them to be true friends. Most younger doctors work well with nurses - again a generalization, but one I hope to be true. Nowadays, we are taught that there is a 'health care team' that cares for the patient. This team includes the patient, the family, the bedside nurse, the pharmacist, the respiratory therapist, the social worker, the primary doctor and consulting doctors, as well as anyone else involved. This is not universally true, and I have been very disappointed with statements made by some of the older physicians I've come across. But to have people automatically assume that because I have an MD, I have a god complex is actually quite hurtful.

And I think that is the point of Dr. Au's article. We're people. We hurt, we worry, we get tired, we get happy, we get frustrated, we have lives outside of the clinic or hospital.

When you are the patient (or the patient's parent), you are with the illness all the time. It stinks. Especially if it is a chronic, painful, or complicated illness. In an ideal world, every patient would get 100% of the doctor's attention and skills until the ultimate goal was reached. In reality, the doctor has to fit the patient into the big picture, which includes other patients, administration, office staff, insurance companies, and their own personal lives.

I'm not trying to play a victim here, and I certainly don't think Dr. Au is. I guess I'm just trying to say to have a little compassion for doctors when/if they aren't doing everything you need them to be doing.

Oh, and doctors are notoriously bad with money. Unless they are super specialized or a surgeon, they probably can't afford those Lexi and mansions. (again with the generalizations!)

First, regarding unions - I am not a lawyer, and don't fully understand the facts here, but I believe that physicians are not legally allowed to unionize. At least when it comes to insurance companies, if we got together and said "we will only accept XXX insurance if you pay us $50 for a 30 minute patient visit" that would violate anti-trust laws because of price fixing. So please do not get mad at individual physicians for what is wrong with the health care system as a whole. Our medical associations lobby for us, and for our patients. (I don't envy them that job!)

Second, I love the nurses I work with, and consider many of them to be true friends. Most younger doctors work well with nurses - again a generalization, but one I hope to be true. Nowadays, we are taught that there is a 'health care team' that cares for the patient. This team includes the patient, the family, the bedside nurse, the pharmacist, the respiratory therapist, the social worker, the primary doctor and consulting doctors, as well as anyone else involved. This is not universally true, and I have been very disappointed with statements made by some of the older physicians I've come across. But to have people automatically assume that because I have an MD, I have a god complex is actually quite hurtful.

And I think that is the point of Dr. Au's article. We're people. We hurt, we worry, we get tired, we get happy, we get frustrated, we have lives outside of the clinic or hospital.

When you are the patient (or the patient's parent), you are with the illness all the time. It stinks. Especially if it is a chronic, painful, or complicated illness. In an ideal world, every patient would get 100% of the doctor's attention and skills until the ultimate goal was reached. In reality, the doctor has to fit the patient into the big picture, which includes other patients, administration, office staff, insurance companies, and their own personal lives.

I'm not trying to play a victim here, and I certainly don't think Dr. Au is. I guess I'm just trying to say to have a little compassion for doctors when/if they aren't doing everything you need them to be doing.

Oh, and doctors are notoriously bad with money. Unless they are super specialized or a surgeon, they probably can't afford those Lexi and mansions. (again with the generalizations!)

First, regarding unions - I am not a lawyer, and don't fully understand the facts here, but I believe that physicians are not legally allowed to unionize. At least when it comes to insurance companies, if we got together and said "we will only accept XXX insurance if you pay us $50 for a 30 minute patient visit" that would violate anti-trust laws because of price fixing. So please do not get mad at individual physicians for what is wrong with the health care system as a whole. Our medical associations lobby for us, and for our patients. (I don't envy them that job!)

Second, I love the nurses I work with, and consider many of them to be true friends. Most younger doctors work well with nurses - again a generalization, but one I hope to be true. Nowadays, we are taught that there is a 'health care team' that cares for the patient. This team includes the patient, the family, the bedside nurse, the pharmacist, the respiratory therapist, the social worker, the primary doctor and consulting doctors, as well as anyone else involved. This is not universally true, and I have been very disappointed with statements made by some of the older physicians I've come across. But to have people automatically assume that because I have an MD, I have a god complex is actually quite hurtful.

And I think that is the point of Dr. Au's article. We're people. We hurt, we worry, we get tired, we get happy, we get frustrated, we have lives outside of the clinic or hospital.

When you are the patient (or the patient's parent), you are with the illness all the time. It stinks. Especially if it is a chronic, painful, or complicated illness. In an ideal world, every patient would get 100% of the doctor's attention and skills until the ultimate goal was reached. In reality, the doctor has to fit the patient into the big picture, which includes other patients, administration, office staff, insurance companies, and their own personal lives.

I'm not trying to play a victim here, and I certainly don't think Dr. Au is. I guess I'm just trying to say to have a little compassion for doctors when/if they aren't doing everything you need them to be doing.

Oh, and doctors are notoriously bad with money. Unless they are super specialized or a surgeon, they probably can't afford those Lexi and mansions. (again with the generalizations!)

First, regarding unions - I am not a lawyer, and don't fully understand the facts here, but I believe that physicians are not legally allowed to unionize. At least when it comes to insurance companies, if we got together and said "we will only accept XXX insurance if you pay us $50 for a 30 minute patient visit" that would violate anti-trust laws because of price fixing. So please do not get mad at individual physicians for what is wrong with the health care system as a whole. Our medical associations lobby for us, and for our patients. (I don't envy them that job!)

Second, I love the nurses I work with, and consider many of them to be true friends. Most younger doctors work well with nurses - again a generalization, but one I hope to be true. Nowadays, we are taught that there is a 'health care team' that cares for the patient. This team includes the patient, the family, the bedside nurse, the pharmacist, the respiratory therapist, the social worker, the primary doctor and consulting doctors, as well as anyone else involved. This is not universally true, and I have been very disappointed with statements made by some of the older physicians I've come across. But to have people automatically assume that because I have an MD, I have a god complex is actually quite hurtful.

And I think that is the point of Dr. Au's article. We're people. We hurt, we worry, we get tired, we get happy, we get frustrated, we have lives outside of the clinic or hospital.

When you are the patient (or the patient's parent), you are with the illness all the time. It stinks. Especially if it is a chronic, painful, or complicated illness. In an ideal world, every patient would get 100% of the doctor's attention and skills until the ultimate goal was reached. In reality, the doctor has to fit the patient into the big picture, which includes other patients, administration, office staff, insurance companies, and their own personal lives.

I'm not trying to play a victim here, and I certainly don't think Dr. Au is. I guess I'm just trying to say to have a little compassion for doctors when/if they aren't doing everything you need them to be doing.

Oh, and doctors are notoriously bad with money. Unless they are super specialized or a surgeon, they probably can't afford those Lexi and mansions. (again with the generalizations!)

Physicians are also really bad at leaving comments only once. Or that could be just me...