A Day in the Life ScenariosHuman Interest

I’M EMBARRASSED BY MY COLLEAGUES

I am continually embarrassed for and concerned about the medical profession. Yes, I’m embarrassed because of the image of physicians portrayed in the news media and television documentaries. Yes, I’m concerned because of all the negative experiences I hear people talk about, and the slip-shod, complacent methods of diagnosis and treatment doctors use every day. What has happened to physicians? Why have they abandoned the centuries-old procedures used to diagnose and treat? 

Continually, I hear how physicians don’t listen to patients, how they don’t examine patients, how they don’t seem to care, or how they don’t follow through on diagnostic procedures and plans of treatment. Physicians seem to lack curiosity when it comes to deciding if a patient is really sick. Physicians seem to lack diagnostic acumen—the innate ability to sense when something about the patient is not right and put together the several criteria necessary to make a diagnosis. 

Far too frequently, I hear how a patient went to the doctor with real symptoms only to be told nothing is wrong; or their symptoms are due to stress or getting older. I hear how the doctor did a cursory exam and prescribed pain medication or an antibiotic without a clear diagnosis just to appease the patient and get him on his way. I hear how the patient told the doctor his symptoms, but the doctor seemed not to listen and had his mind made up before the patient finished speaking. Or I hear how the doctor ignored red flags and obvious signs of a specific problem. 

One recent example is an 82 yo man with a lump in his scrotum present for several months. He had no fever, the lump was slightly tender, and he wasn’t feeling well. A curious physician with an ounce of diagnostic acumen would suspect a tumor of the testicle. Why? Because the mass was present for months, was not accompanied by fever and was minimally tender. That’s a malignancy until proven otherwise. A concerned doctor would have ordered a testicular ultrasound, or other diagnostic test, and arranged for a biopsy. Instead, his doctor prescribed an antibiotic for 10 days and saw him back. It was only then that diagnostic studies were done revealing cancer in the testicle and nearby lymph nodes.  

Why this “specialist” didn’t first suspect a malignancy and order the appropriate diagnostic studies instead of wasting two weeks taking an antibiotic is beyond me. A testicular ultrasound done the same day could have determined quickly between tumor and infection and pinned down an accurate diagnosis far sooner. Yes, it’s true that two weeks probably won’t make a difference in the long term, but the appearance of not really honing in on an obvious diagnosis makes the doctor look foolish. 

A couple of months ago I wrote a blog on the cable television program “Mystery Diagnosis.” In this program, patients with rare, difficult to diagnose diseases relate how they went to doctor after doctor to get to the bottom of their progressively worsening symptoms. For some it took 5-10 years to finally find a doctor who listened and had the interest and initiative to get to the bottom of the problem. Repeatedly, the announcer asks why it took so long to make the right diagnosis and why so many doctors failed to express concern for the patient. It really makes doctors appear uncaring and ignorant. 

Similar scenarios play out every day all over the country. You may have experienced a similar situation yourself. I hear about shoddy care, physician arrogance, and questionable medical decisions all the time, and I wonder what’s happened to my profession. Doctors don’t listen, don’t examine patients, don’t follow through with plans for diagnosis and treatment, and don’t communicate well with patients. One day last week, the medical assistant in my family physician’s office called me twice in the same day to tell me the results of recent blood work. Amazingly, she didn’t remember she had already called me until I pointed it out. Talk about not being invested in your patients. It’s not like my name is Bob Smith. 

Are the top students still going to medical school? Has medical education deteriorated? Have doctors lost the ability to sense when patients are in trouble? Have doctors, and people in general, stopped caring about other people? Has self-interest overshadowed compassion? Are physicians motivated only by financial considerations? Have doctors’ personalities and ethics changed so much that they no longer care about anything except themselves?

All of these factors seem to be involved in this dilemma. I can’t really make things better unless by pointing out where doctors are messing up, they realize their reputations and prestige are suffering, and major changes in attitude and expertise are in order.  Doctors need to do what they are trained to do. They need to adopt an attitude that every patient has a problem, and it’s their job to determine what it is. Doctors should not assume everyone is a hypochondriac and  their illness is psychosomatic. That message comes through often in “Mystery Diagnosis.”   

The medical profession has a lot of improving to do and needs to get started on its transformation immediately or primary care physicians will be replaced by nurse practitioners and physician assistants. That has almost happened already. Doctors, at least Family doctors, need to be aware their influence and reputation are eroding rapidly, and it has been self-induced. They need to shape up, do their job, use their knowledge, keep current on information, not rush patients, listen, and care about people. 

William M. Gilkison MD

DrGOpines.com

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4 Comments

  1. Your blog on the ER doctor is so well written & a fine tribute to a special gentleman. Thank you for sharing your thoughts & observations.

  2. Major influences, such as Government interference and associated bureaucracy along with insurance requirements, have gone a long way into change the application of the art of medicine. That, as well as treating computers instead of patients, has had an adverse effect. More docs are now employed, and they have quotas to meet.

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