ER Doctor Feels "Used"

Emergency Medicine in the United States is at a breaking point.

Emergency Medicine News published an editorial  recently by Dr. Edwin Leap, an Emergency Physician living in South Carolina. Dr. Leap writes an article that could have been written by any person working in any of the many Emergency Departments in the United States. You can read the full article here .

In the article Dr. Leap discusses how those in Emergency Medicine are manipulated and used by "evil" people who work the system in an attempt to get free housing, free food, and/or narcotics. He also discusses how the government and other groups in medicine abuse the Emergency Department, using it as a means of working up patients to be admitted or as a place to initiate the latest bureaucratic policy.

Emergency Departments around the country are overrun by patients and understaffed. Doctors and nurses working in our nation's Emergency Departments are expected to save the lives of critically ill patients while soothing the egos of the unsick waiting in line for a bed. Patient outcomes have been replaced by satisfaction scores as the means of evaluating caregivers, and good men and women are being driven out of the specialty by burnout, injury, lack of appreciation, and abuse (both verbal and physical).

I appreciate Dr. Leap's honesty and hope that policy makers are listening. For those unsung heroes slogging it out in our nation's Emergency Departments, thanks for your efforts.

Are You An Entrepreneur?

I read a great post recently by Anthony Tjan entitled Entrepreneurial DNA: Do You Have It? on the Harvard Business blog.

In the article, Mr. Tjan argues that entrepreneurs have a distinct profile that is obvious to those familiar with it.  He says,

"Entrepreneurs hold an idealism and risk profile that makes them fundamentally different. They don't think about security--in fact they are often uncomfortable with it. And they have the guts to bet it over and over again. They think less about what they lack and more about what they can achieve with what they have. In a sea of ambiguity, they forge ahead with an incredible fortitude."

It's an interesting read and good food for thought for any physician considering entrepreneurship as a career.

Blogging Doctors

Emergency Medicine News had a recent article looking at the growing trend of physician bloggers.

While some bloggers have been able to monetize their sites, most simply write for fun.  Physicians who blog must be especially careful to protect their patients' privacy if clinical cases are discussed, and physicians must realize that things written on the internet are permanent.

KevinMD.com had a recent post discussing the importance of a physician's online reputation. Blogging can be a useful tool for both physician and patient, but needs to be realized as a potential risk as well as benefit.

If you want to know more about your own reputation online, Joy Tu of Medical Justice wrote this excellent post on influencing your online reputation.

Atlas Shrugged and the American Healthcare Reforms

Atlas Shrugged was written in 1957 by Ayn Rand. Considering all that has happened in healthcare recently the work seems prophetic. Here's a quote by a character in Atlas Shrugged named Dr. Hendricks who retired from Neurosurgery when the healthcare system became nationalized:

"I quit when medicine was placed under State control, some years ago," said Dr. Hendricks. "Do you know what it takes to perform a brain operation? Do you know the kind of skill it demands, and the years of passionate, merciless, excruciating devotion that go to acquire that skill? That was what I would not place at the disposal of men whose sole qualification to rule me was their capacity to spout the fraudulent generalities that got them elected to the privilege of enforcing their wishes at the point of a gun. I would not let them dictate the purpose for which my years of study had been spent, or the conditions of my work, or my choice of patients, or the amount of my reward. I observed that in all the discussions that preceded the enslavement of medicine, men discussed everything - except the desires of the doctors. Men considered only the 'welfare' of the patients, with no thought for those who were to provide it. That a doctor should have any right, desire or choice in the matter was regarded as irrelevant selfishness; his is not to choose, they said, only 'to serve.' That a man who's willing to work under compulsion is too dangerous a brute to entrust with a job in the stockyards - never occurred to those who proposed to help the sick by making life impossible for the healthy. I have often wondered at the smugness with which people assert their right to enslave me, to control my work, to force my will, to violate my conscience, to stifle my mind - yet what is it that they expect to depend on, when they lie on an operating table under my hands? Their moral code has taught them to believe that it is safe to rely on the virtue of their victims. Well, that is the virtue I have withdrawn. Let them discover the kind of doctors that their system will now produce. Let them discover, in their operating rooms and hospital wards, that it is not safe to place their lives in the hands of a man whose life they have throttled. It is not safe, if he is the sort of a man who resents it - and still less safe, if he is the sort who doesn't."

TV News Report on the Expedition Medicine National Conference

The Expedition Medicine National Conference

For those who might be interested in seeing one of our CME conferences in action, I've posted this television news report that was done on our Expedition Medicine National Conference in 2007.  The news station is Fox 5 WNYW out of New York City.

Even though the report was a couple of years ago, most of the information is still current.

From Doctor to Blogger?

Physician's who are choosing non-clinical careers are becoming increasingly common.

In doing background research for our Medical Fusion conference, I began looking around for examples of physicians who have branched out into other areas. Had I done my search even a few years ago, the examples would have been few and far between. In the not-so-distant past, it was very unusual-- almost unheard of-- for a competent physician to leave medicine. The training was too long, and the prestige factor was just too high. Doctors didn't leave medicine unless they were incompetent, corrupt, or very, very unique.

Now the examples are more plentiful, although it still is unusual for a physician to completely leave medicine behind.

All this brings me to the very interesting story of Dr. Arnold Kim. Dr. Kim might be the story of our times-- a Nephrologist from Virginia who gave up medicine to become...a blogger?

Dr. Kim runs a blog called Mac Rumors that he began in 2000. As the site grew, Dr. Kim saw an opportunity to focus on something that he was truly passionate about and that gave him more time to spend with his young daughter. He made the decision and has not looked back.

What makes Dr. Kim's story so interesting is not just that he left medicine, but that he left medicine for a "career" that was not even a possibility until recent years.  Of course, with the rise of the internet, technology has changed how people view work and opened the door to a variety of interesting opportunities.  In upcoming posts I'm hoping to review some of my favorite books on the subject including Free Agent Nation by Daniel Pink and The World is Flat by Thomas Friedman.

The point of all this is not that the typical physician-- or anyone else for that matter-- should begin looking into a career in the blogosphere.  The point is that interesting niches are available for those motivated individuals who are willing to take a little risk and step out of their comfort zones.  

Doctor Discontent

Here's an older but good article in the New England Journal of Medicine entitled Doctor Discontent.

Interestingly, the article was published in 1998, a full ten years prior to where we are now.  I would argue that everything the author says in this article is not only accurate and applicable to today's environment, but today's environment exceeds his even most dire estimations.

At the end of this article, the author discusses the theory that the young physicians coming into the current medical culture would not be as affected by the perceived negatives as their older counterparts. My perception is that this has not been the case.  If anything, the younger generation of physicians is even more prone to leave than the older.  For the older generation, the stigma of leaving medicine is still very strong and they often have no exit strategy.  For the physicians who are just graduating from medical programs, there is little stigma to leaving and the opportunities for them outside of medicine are great.

Unfortunately, the author's call to take doctor discontent seriously apparently fell on deaf ears.  Physicians who voiced concerns were dismissed and even today, much of the health policy change is being driven by those who are overtly antagonistic to physicians and physician concerns.  It is a sad day.

My prediction is that health policy "experts" will win their battle to impose their will on physicians, then look around with wonder when their policies fall flat because there are no clinical physicians around to implement them.