If Doctors Can’t Be Doctors, Why Bother Being Premed?

Session 112

Session 112

In this episode, Ryan and Allison talk about an article on Kevin MD, There Was a Time When Doctors Were Doctors, which primarily, might seem not directly related to premeds.

But reading these kinds of articles may in fact have an impact on how you make decisions particularly about whether you really want to pursue medical school. So it does affect you.

As a physician in the truest sense of it, there lies a responsibility to be respectful of our profession and not be discouraging to the next generation of physicians. All of you are working so hard to move forward in your careers to start medical school and go through training to become the best physicians. But hearing from disillusioned physicians may only make you cynical and that’s the biggest shame of all.

So let’s move on and discuss the sentiments of this one physician which he has so expressed through his article for which we give him no judgment for it but respect for the freedom of speech. However, we find it very important to discuss these things and lay out our insights into the many of the topics that have been brought up.

“There was a time when doctors were doctors. There was a time when young men and women sacrificed the best years of their youth, learning to treat patients and conquer diseases, not to become typists, paper pushers, data-entry clerks, or to have hospitals, insurance companies, and the federal government dictate to us how to practice medicine.”

What Ryan and Allison think:

  • There is a wider age range
  • You do sacrifice some good years but it’s a journey.
  • Anything worth doing is not a sacrifice
  • The author of the article is framing his point of view
  • There is a lot of administrative work but you don’t spend the entire time doing it
  • There might be some work that’s not fun and rewarding but it’s all part of the master goal of how you grow and learn as a physician
  • Electronic medical record vs. writing them down
  • There is not a ton of patient interaction when you’re an intern

“There was a time when doctors were trusted… when we were not guilty until proven otherwise, as viewed by bloodthirsty bounty hunters like the wild dogs of the recovery audit contractor (RAC)…”

What Ryan and Allison think:

  • Sounds like he got bit by some sort of coding issue
  • Medicare fraud – Ex. Physician in Florida worth of $18 million for medical billing where he’s now being audited
  • You can get a complaint file against you about anything but that happens to other professions too.

“There was a time when doctor’s orders were meant to be orders. There was a time when our orders were not subject to endless scrutiny and nonsensical denials by HMOs, pharmacists, hospital formularies, insurance companies, and the federal government.

What Ryan and Allison think:

Just because you have MD after your name, people must do what you say. The letters after your name do not give you any power at all

“There was a time when doctor’s opinions were valued and recommendations were followed…when we were not routinely challenged by our patients, their families, their neighbors, hospital case managers, hospital administrators medical officers of HMOs, or some random doctors on the other end of the phone 3,000 miles away.”

What Ryan and Allison think:

  • It’s important to use your clinical judgment.
  • We should be challenged by our patients and their families and the case managers, etc.
  • “The time when you think you know everything is the time when you know nothing.”
  • The value of being challenged by yourself and other people around you
  • Practicing medicine ideas as a team to bounce ideas off each other.

Here’s a challenge: If your patients are asking you why after you talk to them, then you’re probably not explaining it properly to them or in the best way you can. Take note of it and improve how you’re going to say it to the next patients coming.

  • It’s not a personal attack on you.
  • They are not challenges against you but pulling resources together to really help the patient.

“There was a time when doctors actually wrote orders. There was a time when we did not have to go through 10 steps and 22 keystrokes on a hospital computer just to place a simple order like NPO, which would have otherwise taken 2 seconds with a pen.”

What Ryan and Allison think:

  • Most of the Electronic Health Record (EHR) systems out there are pretty terrible and too much extra work to put in an order.
  • It is frustrating but it does cut down on errors.

“There was a time when doctors were welcomed by the hospitals and the communities they served. There was a time when hospitals assigned more parking spaces to doctors than to their own administrators.”

What Ryan and Allison think:

  • Not all physicians are like this.
  • A growing sentiment about physicians feeling frustrated that administrators are making more money and have more control than they do. – True! But they have bigger responsibilities.
  • The point of being a doctor is not to have the best parking space and the more money.

“There was a time when doctors spent more time thinking about patient care than pushing papers.”

What Ryan and Allison think:

  • They care more about patient care than pushing papers.
  • Practice of medicine may vary from one state to another. (You can’t make any blanket statements)
  • When you’re mad, it’s important to take a step back and find out why and how can you improve it.
  • Get back to why did you start doing this in the first place

“There was a time when patients actually paid their bills. There was a time when the words co-pay, deductible, and coinsurance meant what they truly meant, not some random numbers subject to inventive negotiation and crafty blackmail tactics by some patients.”

What Ryan and Allison think:

If you get to a point that you’re resenting your patients and the time you’re spending with them, take a break and step back.

“There was a time when doctors were judged by their credentials and by their professional peers. There was a time when our medical school diploma meant more than the reviews on certain online social media intended for rating restaurants, plumbers, and prostitutes… There was a time when young men and women went to medical school because having “M.D.” behind our names was the most honorable and respectable thing to do.”

What Ryan and Allison think:

  • For this physician, having that MD or DO gave him the entitlement and now he is frustrated with the system because the entitlement is no longer there. It should NOT be there!
  • Sometimes it’s difficult to tell patients what they don’t want to hear.
  • Treating all patients with the same respect
  • Alienating patients around you results to poor patient care
  • You should be respected not for the MD in your name but for the way you treat your patients and other people.

Links and Other Resources

Check out our private Facebook group at www.medicalschoolhq.net/group and hang out with us.

KevinMD article on There Was a Time When Doctors Were Doctors

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Connect with us on Twitter @medicalschoolhq

 Transcript

Dr. Ryan Gray: The Premed Years, session number 112.

Hello and welcome back to the Medical School Headquarters Podcast; where we believe that collaboration, not competition, is key to your premed success. I am your host, Dr. Ryan Gray, and in this podcast we share with you stories, encouragement and information that you need to know to help guide you on your path to becoming a physician.If you haven’t yet joined our somewhat private Facebook group, go check out www.MedicalSchoolHQ.net/group and join some of the coolest kids on the block at the Medical School Headquarters’ Hangout on Facebook.Allison is back with me.

Dr. Allison Gray: I am.

Dr. Ryan Gray: Welcome.

Dr. Allison Gray: Thanks. It feels weird for you to welcome me to- it’s kind of my show too.

Dr. Ryan Gray: Sure.

Dr. Allison Gray: Alright, I’m just the lowly little cohost.

Dr. Ryan Gray: You are our token cohost, although lately you’ve been on a lot.

Dr. Allison Gray: Yeah, well, you know.

Dr. Ryan Gray: Is that a good thing or a bad thing?

Dr. Allison Gray: It’s a great thing; I hope it’s a good thing for all you out there, I don’t know.
Dr. Ryan Gray: If you’re listening and you like Allison, come let us know. www.MedicalSchoolHQ.net/112.

Dr. Allison Gray: Love it, love it.

KevinMD Article

Dr. Ryan Gray: Alright. This week we’re going to talk about an article on KevinMD that we had kind of sidelined awhile ago. We saw this article and I put it in my kind of to-do list and I was looking at it today and re-reading it, and I said, “You know what, let’s talk about this one today.” And so I didn’t go in depth re-reading this because I wanted to kind of go live as we talk about it, because as I started reading it, some of the key points may or may not bring up some controversy and we may or may not have some arguments with some of his points. So it’s going to be interesting. And here’s another key point. While this is not directly premed, how to get into medical school, how to ace your classes, and do well writing your letters of rec; when you as a premed student are out visiting these websites and seeing these articles, I think when we talk about them it is directly related to you. Because if you read this and go, “Well if this is what medicine is like, then I don’t want to be a part of it,’ then that’s a bad thing. And so hopefully with Allison and myself talking about this, and agreeing with some of it and disagreeing with some of it, then it gives you a better picture maybe than just one person’s voice.

Dr. Allison Gray: Yeah, it hopefully gives you sort of an informed picture; at least from the perspective of two practicing physicians.

There Was a Time When Doctors Were Doctors

Dr. Ryan Gray: Yeah. Alright. So the title of the article is, ‘There Was a Time When Doctors Were Doctors,’ and that’s on KevinMD’s site. And we’ll have a link to it in the show notes, again you can get at www.MedicalSchoolHQ.net/112. And we’ll go down the list and the way it’s written, he starts off kind of each paragraph, ‘There was a time when, There was a time when.’ And so we’re going to go one by one and talk about each one of these. And so the first one here, it talks about, ‘There was a time when doctors were doctors,’ the title of his article about young men and women sacrificing their time to go through medical school and learn to be practitioners. And not to become typists, as he calls them, or paper pushers, or data entry clerks, or to have hospitals and insurance companies and the federal government dictate to us how we practice medicine. What do you think about that initial kind of jab?

Dr. Allison Gray: Yeah, it’s very loaded. Well for starters I think that it remains a time when young men and women, and sometimes older men and women because-

Dr. Ryan Gray: All you nontraditionals out there.

Dr. Allison Gray: Yeah, and not that you guys are old, but that there’s a bigger age range than the classical age that doctors used to be or medical students used to be when they started. So there’s a wider range, and he says the best years of their youth. Well, I mean you do sacrifice some good years, but- I don’t know, I have a hard time with that statement anyway because it’s a journey and anything that’s worth doing, there’s extra hard work.

Dr. Ryan Gray: I don’t call it a sacrifice.

Dr. Allison Gray: Yeah, it’s not a sacrifice. It’s part of- it’s a rite of passage as part of what you do. So, I mean just to say I think that this physician is pretty disillusioned and pretty angry and frustrated, and so this is sort of framing his kind of entire point of view, but you can already tell from the get-go that he’s pretty mad. But as for the other part of it, so to become typists, paper pushers, data entry clerks; well, there’s a lot of administrative work in what we do, and does that mean that we’re spending sixty or seventy or eighty percent of our day doing it? I don’t. I don’t think so. But I’m sure depending on how well run the practice is where you work, or the hospital is that you work in, that can vary. So that’s- blanket statements are always dangerous in my mind, and I certainly as a physician do not feel that I am a typist, paper pusher, data entry clerk, or any of the above.

Dr. Ryan Gray: Yeah. But then there’s also that survey or study if you want to call it at John’s Hopkins about interns and how much time they actually spend with patients. But I think that’s a totally different scenario, because you’re in a training institution, you’re an intern, your job is to run around and see the patients and input the data, and talk to the social workers, and learn from your tendings and go to grant grounds. And so there’s not a ton of patient interaction when you’re in that type of setting.

Dr. Allison Gray: Yeah, there should be more, and it’s backwards, but it’s the way that things have become. It’s the way that the training structure has sort of become the lowly man or woman on the totem pole ends up doing a lot of the sort of data entry and- If you look at like a law firm or a business, or if you look at any kind of entry level position, a lot of it sometimes may entail kind of crappy work that you aren’t fond of. So there is this concept of sort of paying your dues and going and doing the work that is not the most fun and rewarding, but it’s all part of the sort of master goal of how you grow as a physician and how you learn this craft. I do think, however- I mean there absolutely is a growing problem more and more with how much focus, even in practice when you’re out in practice, how much focus is put on making sure that charts look pretty.

Dr. Ryan Gray: As far as coding?

Dr. Allison Gray: Well, as far as making sure that everything has been attended to properly and documented properly. So it used to be- okay, and I still see this in practice. There are physicians who still write on paper and then the notes are scanned into the electronic record. It used to be you jot down a note, and I mean I do this now. You’re sitting with a patient, you’re writing, you’re taking notes as they’re talking to you but you’re facing them person to person and some physicians still do that as opposed to typing as you see someone which I hate. I don’t like that, I really don’t care for it because you feel like you’re sort of talking through the computer.

Dr. Ryan Gray: Yeah.

Dr. Allison Gray: But anyhow, so there are physicians out there who still practice that way and are still writing. Nowadays, the problem is that everything is becoming about the electronic medical record. And I do think that that’s a problem with our practice. One of my good friends actually just wrote- who’s an internal medicine resident, he just wrote- we’re going to have him on the show soon too, which is exciting. He just wrote a piece all about his frustration with how much time is spent on the computer and how his thought process changes and how it changes him as a physician in the making or physician in the growing. So it’s a problem. So I think just that one paragraph which is literally like what- it’s two sentences. There’s a ton that you can take away from it and I think some of it has some truth and some of it is really overstating, and he’s just angry, I mean wow.

There Was a Time When Doctors Were Trusted

Dr. Ryan Gray: And it’s followed up with the next paragraph saying, ‘There was a time when doctors were trusted.’ Now that to me sounds like somebody who has been bitten either by a lawsuit, or by something, because he goes on saying that we were not guilty until proven otherwise, as by bloodthirsty bounty hunters like the wild dogs of the recovery audit contractor. So it sounds like he got bit by some sort of coding issue.

Dr. Allison Gray: Perhaps, and that’s one of the things that they also don’t teach you when you’re in training. I mean there is such a thing called Medicare fraud. And there are people out there unfortunately, healthcare practitioners, who are trying to pull the wool over the eyes of the IRS and the federal government, and they may be coding for things- or coding for time spent with patients, coding for disease processes that they may or may not have, and they are then trying to get money from the insurance company and the patient in terms of reimbursement for the services. And what can happen is that people can get audited. And so Medicare can come in and say, “Okay well I’m going to pull these ten charts, or actually 100 charts, and actually look and see if what you documented is actually what happened and what you’re billing for.” And I don’t know if you remember, Ryan, I’m sure you do. There was a few months- well maybe it was years now, it kind of all blurs together. But at some point recently there were a few physicians I think in the state of Florida-

Dr. Ryan Gray: Florida, the Ophthalmologists.

Dr. Allison Gray: Millions of dollars.

Dr. Ryan Gray: Eighteen million dollars I think. He’s now being audited, they’re going back and looking at that.

Dr. Allison Gray: Right, so I mean he’s already in trouble, he’s going to be in more trouble.

Dr. Ryan Gray: The next closest person to him for Medicare billing was like half or something.

Dr. Allison Gray: Yeah, so- and you think out there as a premed you’re working so hard right now to try to get into medical school and to begin your journey as a physician as a medical student and then a physician. And how on earth can you imagine then years later actually trying to defraud the government from this sacred, beautiful craft that we do, and that we are so privileged to be able to partake in and practice? I don’t know. I mean I don’t practice Medicare fraud so I can’t tell you. I can’t tell you how some physicians end up there, but it’s sad and you wonder- yes, the guy writing this article. There are other though, physicians who get just audited and maybe get complained about. The sad truth is that you can get a complaint filed against you about anything. My friends who’ve had lawsuits against them and complaints against them, and a physician can literally have a complaint lodged against them with the Board of Medicine of whatever state you are, about that maybe you charge too much. So people can complain and actually he goes on to talk about this later, I think. But you can get audited, you can get- people can complain about you. But again, if you think about every profession out there- if you’re a plumber, if you’re a carpenter, if you’re on Angie’s List, I mean if you’re a lawyer, teacher- people can complain and audit you and try to go after you for what they may or may not think you were doing right or wrong anytime. We live in that kind of society. So suck it up cupcake.

Dr. Ryan Gray: Wow, alright. Now we know. The next one is a hard one for me to read because it just- it annoys me. There’s a book, what is it called? ‘Doctored’?

Dr. Allison Gray: Yes.

There Was a Time When Doctors Orders Were Meant to be Orders

Dr. Ryan Gray: That kind of- I started reading it and we were going to talk about it but we wanted to read the whole thing before we talked about it here on the podcast. But it started off, the summary that we read sounded very similar to this next line. It says, ‘There was a time when doctors’ orders were meant to be orders. There was a time when our orders were not subject to endless scrutiny and nonsensical denials by HMOs, pharmacists, hospital formularies, insurance companies and the federal government.’ And that to me just sounds like somebody who thinks I have MD after my name, therefore you must do what I say.

Dr. Allison Gray: Yup.

Dr. Ryan Gray: And the title, the letters after your name do not give you any power at all. Your judgment, your clinical judgment, your ability to follow the best practice guidelines, what’s in the best interest of the patient based on the best evidence is what goes. Not just because you’re an MD and do what I say.

Dr. Allison Gray: Absolutely. So PE does equal MD. If you pass and you get through medical school and you become a physician, that doesn’t just mean that you can fly by the seat of your pants through the rest of your career and just dictate to other people what they’re supposed to do and they’ll listen to you and you just sit back and sort of- it doesn’t work that way. It’s like anything, you have to work at it and you can’t- I agree with you, it turns my stomach to read. You get the sense that this physician wants to have all the accolades and the prestige and have people kowtowing at his feet.

Dr. Ryan Gray: ‘Yes doctor, yes doctor.’

Dr. Allison Gray: Yeah, and it’s sad. And you know he goes on then in the next paragraph, or next line there, to talk about how there was a time when doctors’ opinions were valued and recommendations were followed and we weren’t routinely challenged by our patients and families and neighbors and case managers and hospital administrations. So some of what he’s saying-

There Was a Time When Doctors’ Opinions Were Valued

Dr. Ryan Gray: Guess what? There was a time when there wasn’t Google.

Dr. Allison Gray: Yeah, right. WebMD, exactly. Some of what he’s saying, yes, am I frustrated when I have to call a physician in a random state who may be practicing with maybe the same guidelines but different practice parameters than I am, and I have to explain why I believe that this patient needs a particular study, or why the insurance company should pay for a particular drug, and the one that I wrote a prescription for- not the generic that’s a lot cheaper but is not going to work well or is not appropriate for that patient. It’s important to use your clinical judgment. And so yes, it’s frustrating when other people don’t really get where you’re coming from and you have to go and explain it and take time out of your day to do that. But all of the other stuff- or all the other pieces there that he mentions. So we should be challenged by our patients. We should be challenged by their families and the case managers. Maybe not their neighbors, I don’t know. Hospital administration. It’s important, right? So if the time when you think you know everything is the time when you know nothing. It’s a quote that you’ve said in the past, and I know it’s not your quote, it’s someone else’s quote. But the point is that it’s important to always be challenging yourself and have other people challenging you to make sure that you’re doing what you need to be from a clinical standpoint. Again, it can feel after awhile as a physician, that you’re being challenged constantly because you have so many things that you need to be doing and people are maybe at you to make sure that you’re dotting your I’s and crossing your T’s and you’re doing all these things correctly. But in terms of patients challenging you- I mean, yeah the days of paternalistic medicine where you said, ‘This is what you’re going to do, this is what you have, this is what you have to do, and that’s that.’ Those days are long over and rightly so in my opinion.

Dr. Ryan Gray: I had a boss once who said, “I want you to ask me questions. I want you to ask me why we’re doing what I’ve decided to do.” He said, “If I can’t come up with a reason why, then it’s probably the wrong decision.”

Dr. Allison Gray: I’m wondering which boss that was, that’s very smart.

Dr. Ryan Gray: I like it.

Dr. Allison Gray: Yeah it is, it’s good. It is. And that’s part of why we practice medicine as a team, too. Bounce ideas off each other, have the most brains possible, get to the right conclusion.

Dr. Ryan Gray: So the challenge for you as you move forward, and we talked about this before with communication a couple episodes ago and how communication difficulties are one of the leading issues for bad outcomes for morbidity mortality. Make it a game that if your patients are asking you, ‘Why?’ after you talk to them, then you’re probably not explaining it properly to them, or the best way that you can. So take note and go, “You know what? That patient asked me why after I explained the blood pressure medications. Next time when I have that same conversation, I’ll incorporate the why that they asked me into my conversation and hopefully they won’t have any questions.” But they probably will and you’ll change what you say to the next person, and you’ll change what you say to the next person. So it’s not a personal attack on you.

Dr. Allison Gray: It’s absolutely true. And I remember too, if you think about your nurses and other healthcare practitioners and case managers, and people challenging you and your thought process; I remember when I was a med student and very early on in my career when I was in training I thought, “Well gosh, this is so frustrating. This nurse is challenging this about what I’m saying, and this nurse is challenging this, and I feel like people are ganging up on me,” and blah, blah, blah. It’s good and I realized as I grew, as I trained, that it’s so important to take that perspective. They’ve often been doing this a lot much longer time than you have, they know the patient well, they have a lot of different perspective and they’re looking at it from a way that you can’t because you don’t have the same knowledge and the same- like for example, let me give an example to make this more tangible. So a case manager will know so many things about the insurance companies and about a patient’s demographics and home situation and be able to put together where can that patient go when they get discharged, in a way that you would have no idea. You would not be able to figure that out because you just don’t know all the different variables that go into that. You’re too busy working up their COPD exacerbation or figuring out why they’re having heart failure. So it’s important to not take these sort of- I don’t want to say attacks, but that’s the way this author is framing it. But more don’t take all this personally, they’re not challenges against you personally, they’re trying to do what’s in the best interest of the patient, and they’re not- don’t look at it as a bad challenge. They’re trying to- everybody has the same goal, right? It’s just a matter of pooling our resources and having everybody help each other to get to the finish line and to- I’m sorry, it sounds so cliché but to really help the patient. So I think that’s part of, honestly, this physician’s problem is that he’s taking everything personally and he’s feeling like, ‘Hey everybody is supposed to be kowtowing to me, and listening to me and I don’t want to listen to anybody else. I just want to do my job and make my money and go home.’ And it’s just not the right attitude. If you go into medicine thinking that you’re going to be this queen of the village, or king of the village, and you don’t have to sort of have anybody give you any challenges about your thoughts or your decision making; it’s not going to be like that. So don’t disillusion yourself from the get-go when you get out and it’s not like that in the real world.

Electronic Health Records

Dr. Ryan Gray: The next line I kind of agree with. It talks about, ‘There was a time when doctors actually wrote orders instead of going through the ten steps and 22 keystrokes to submit an order through an EHR, through the Electronic Health Records system. And I agree with that, most of the EHRs out there are pretty terrible and it takes way too much extra work to get an order.

Dr. Allison Gray: That is true and you have to- when you go out into practice and training and everything, you have to learn all these different EHRs because unless you stay at the same medical center for the entirety of your career, you’re inevitably going to have to learn different Electronic Medical Records systems.

Dr. Ryan Gray: Even if you stay at one place they’re switching, changing, as new stuff comes out.

Dr. Allison Gray: That’s true, exactly. New things comes out. The only system in the United States of America that has figured out how to do this correctly is the VA. And that is because they have the same system everywhere you go. So when you go to a VA in Bedford, Massachusetts it’s the same thing if you go to Connecticut, or Texas, or North Carolina, or California, or wherever you go. Everybody else, it’s all different. And so you have to be adaptable and be able to learn. And yes, most of them are really crappy and it’s annoying and arduous and a lot of it has to do with making sure that there aren’t errors, there are checks and balances, that your orders are being checked so that you don’t prescribe Magnesium when you meant to prescribe- oh I don’t know, Metoprolol, whatever it is; but it’s frustrating.

Dr. Ryan Gray: It does cut down on errors though, hopefully.

Dr. Allison Gray: It does. I hope so, yeah.

Dr. Ryan Gray: Because most doctors can’t read their handwriting.

Dr. Allison Gray: Well right, so then you think, ‘Well okay written orders were great for the person writing them, but what about the ten people-‘ I still remember in medical school, all the notes at that time where we were training for that rotation, they were all written, everything was written in the chart. And one of our jobs as third year med students was to try to go through the consult notes from all the different services that had been consulted for a particular patient and try to decrypt the handwriting of the various consultants. It was funny, it was like a game. We were trying to figure out what they hell they were trying to say or what they were saying; we just could not interpret. So there is a reason that computers are in existence after all.

There Was a Time When Doctors Were Welcomed by the Hospitals

Dr. Ryan Gray: Yes. It says- so I’m going to skip one of them because we kind of already talked about it. But the one after it says, ‘There was a time when doctors were welcomed by the hospitals and the communities they served. There was a time when hospitals assigned more parking spaces to doctors than to their own administrators.’ And this kind of goes back to, ‘I’m a doctor. I have an MD after my name.’

Dr. Allison Gray: ‘I’m king of the hill.’

Dr. Ryan Gray: ‘I’m king of the hill.’ And not all physicians are like this. And I don’t know what- if he is like this or if he’s not like this. We don’t know the guy that wrote this. So we’re not judging, we’re just reading and interpreting what was written. But it sounds like there’s a lot of entitlement there.

Dr. Allison Gray: Absolutely, that’s exactly the word that I was thinking. You know there is a growing sentiment about physicians feeling frustrated with the fact that a lot of the hospital administrators and CEOs and presidents are making more money than them, and maybe have a lot more control than they do. And there was a recent article a few months back looking at actually how much money some of these folks make compared to the average internal medicine physician, or the average cardiologist, or whatever it may be. And yeah, some of these guys are making big, big bucks.

Dr. Ryan Gray: Guess what? Their responsibility is a lot more than one physician.

Dr. Allison Gray: Right, and we had this conversation awhile back because I remember talking to you about this article thinking, ‘God it is kind of insane how much money some of these people make,’ and that’s what you said. You have to look at the bigger picture about how much responsibility these people have. Now we could argue for hours or whatever it may be, about whether it’s correct to have medicine within the confines of a capitalist society, and how can these big CEOs make so much money while people on Wall Street make so money; that’s the conversation for another day. But the point, going back to what you said Ryan, I agree with you. It’s not- the point of going to medical school, and the point of becoming a physician is not so that you have the best parking space when you go to work every day. That’s not what it’s about. Right? If you’re thinking that it’s about dollar signs, and the best parking spaces, and people sort of just moving out of your way and letting you parade around the hospital with all of your entourage behind you; you’re in the wrong career. I mean, it’s not about that. You’d probably do better trying to make your way on the Voice and become a rock star or something. It’s not about that, right? It’s about patient care, it’s about working with a team to better the lives of your patients. And maybe you have to park in the subbasement level, right?

Dr. Ryan Gray: No.

Dr. Allison Gray: Maybe in the cafeteria you don’t have a special spot just reserved for you. It doesn’t matter, it’s not about that. So you have to wonder why this guy is so concerned about that kind of a thing.

Thinking About Patient Care

Dr. Ryan Gray: The next one on here says, ‘There was a time when doctors spent more time thinking about patient care than pushing papers.’ And that’s kind of scary because I think about patient care way more than pushing papers.

Dr. Allison Gray: I do too, and the one right above it where he’s saying that doctors don’t use their brains at work anymore. I mean I use my brain every day. I can tell you this week alone so far in these last two days I’ve had some very interesting patients that really challenged my thought process and you know, they were days- really, really interesting and I think I spent a little bit of time doing the orders on paper that I needed to afterwards, and I spent some time dictating, and finalizing my notes and blah, blah, blah. But what I took away from these two days was, man! Those were really interesting patients and I wanted to go read more and blah, blah, blah. So yeah, again you wonder why is he- is he just so angry that he’s sort of finding evidence everywhere he can about what’s wrong with the system and kind of losing touch with how he’s actually spending his day. And if he really is spending his day pushing paper like that-

Dr. Ryan Gray: He needs process improvement.

Dr. Allison Gray: Yeah, exactly. Where are you practicing?

Dr. Ryan Gray: That’s the first thing that popped into my mind.

Dr. Allison Gray: Yeah, like what is the nature of your practice? Why is it-?

Dr. Ryan Gray: He’s a cardiologist in California.

Dr. Allison Gray: Okay, well I don’t know, well what’s going on there?

Dr. Ryan Gray: It’s California, nobody knows.

Dr. Allison Gray: Well California has some great care; I mean Kaiser is out there and they have excellent care in a lot of places. But you know, that’s another thing. So in the United States practicing medicine is so different from one state to another, from one practice to another, even within the same state. So you can’t make these blanket statements, you get yourself into so much trouble.

Dr. Ryan Gray: Yeah. So when I read something like that- and I’ve gotten into these situations where you get so frustrated about something, but then you take a step back and you go, “Why am I frustrated about this? And what can I do to fix it? Can we streamline a process somewhere? Can a medical assistant do some of this paperwork? Can we fill out some of the paperwork before? Does the paperwork even need to be filled out?” A lot of the stuff is just so redundant and a waste that you figure out better ways to do things. And so if you’re anywhere along the lines- if you’re getting frustrated with studying for your biochem test as an undergrad, or you’re getting frustrated studying for anatomy as a medical student, or on down the line. If you’re getting frustrated to a point where you’re just so mad, step back and go, “What’s making me mad about this and how can I improve it?”

There Was a Time When Patients Paid Their Bills

Dr. Allison Gray: Right, and get back to why did I start doing this in the first place, right? The next one, big one that he talks about has to do with money. And I’m not a fan of this one, either. He says, ‘There was a time when patients actually paid their bills, there was a time when the words copay, deductible and coinsurance meant what they truly meant, not some random number subject to invented negotiation and crafty blackmail tactics by some patients.’ I mean, again you wonder- he’s a cardiologist. I’m sorry but he can’t be that bad off, right?

Dr. Ryan Gray: You can’t really judge by the title.

Dr. Allison Gray: Well-

Dr. Ryan Gray: Yes, the average cardiologist makes a significant amount of money, but if you have a practice that’s run poorly that has poor processes, then-

Dr. Allison Gray: Right, I was just going to say maybe he’s pushing paper all day and so he’s not able to see patients, maybe he’s not doing procedures, who knows what the deal is. And again, not trying to judge this physician personally, not at all, but I just disagree with-

Dr. Ryan Gray: I’m sure there are many physicians out there who feel the same way.

Dr. Allison Gray: Absolutely, I’m just disagreeing with his sentiment. And look, you know if you are in a solo practice and you are trying to pay your rent and you need to pay your staff, and you’re really concerned about making sure that all of your bills come in- or bills go out, and the reimbursements come in from the insurance companies; and yes, it can be frustrating that maybe a patient doesn’t pay their copay. But I think this statement, I mean you get the sense that he feels like he’s being completely screwed by the system and that patients are almost out to get him, or out to screw him over. I mean that’s the sentiment that comes across there. And again, they talk about this in training programs. If you get to a point where you’re actually resenting your patients, and you’re resenting the time that you’re spending with them, even if it’s only 12% of your day, and you’re angry or hateful or whatever it may be, you need to take a break and step back because that’s a pathway to darkness, to physician suicide is something we’ve talked about before. You can get so lost in the upset about what is not working that you completely lose sight of why you started this whole thing in the first place.

Dr. Ryan Gray: And I’m glad I didn’t read all of this ahead of time because a lot of what we’ve been saying kind of pops out at the end here. And he talks about- the last two paragraphs. ‘There was a time when doctors were judged by their credentials and by their professional peers. And there was a time when the young men and women went to medical school because having “MD” behind their names was the most honorable and respectable thing to do.” And so this, we said at the beginning, there’s something that for this specific physician, having that MD or DO gave him the entitlement and now he is frustrated with the system because that entitlement’s not there; and it shouldn’t be there.

When Credentials Meant More than Social Media

Dr. Allison Gray: And he says just before that, ‘There was a time when our diploma meant more than the reviews on online social media intended for rating restaurants, plumbers and prostitutes.’ That is just so offensive, I mean it sickens me. It’s offensive, right? Not only is he saying that he’s better than people who work in restaurants, he’s better than plumbers, he’s bringing up prostitutes; I mean it’s just offensive. Do I like the fact that somebody can go onto Yelp or to an online site and rate how their encounter was with me as a physician? It’s unnerving, it makes me concerned, it makes me anxious. I’m just being honest, I don’t like it, I don’t really care for it because my feeling is the interaction, the encounter between a patient and a physician is a confidential thing, there are so many factors that go into it, and for a patient to go onto a site and basically say, “Well I think this Doctor, Dr. Gray is a horrible physician because she didn’t prescribe the medication I wanted,” or X, Y or Z; there are so many- I mean there was just a recent article on KevinMD, a great article, about how it’s really difficult- or actually I don’t think it was KevinMD, I think it was the Times. About how it’s very difficult sometimes to tell a patient what they don’t want to hear, and how-

Dr. Ryan Gray: Tell them no.

Dr. Allison Gray: Yes, and how that may really turn them against you in some ways, but you have to do what you were trained to do and treat people properly. So I just take such issue with him then going on and saying- Okay so I’m telling you how I feel and I don’t like that, but that said, it doesn’t mean that he should bring up that people who work in restaurants and plumbers and say, ‘We’re so much better than all these people, and they shouldn’t be able to be rated- or we shouldn’t be able to be rated the way they are-‘

Dr. Ryan Gray: He’s basically saying people- customers, patients are our customers, right? So customers shouldn’t be able to judge us but it’s okay to judge a restaurant and a prostitute.

Dr. Allison Gray: Yeah, exactly. And how dare he sort of say that he’s so much better than all of these other people. I tell you Ryan, I mean I really stand by this very firmly, when I walk through the doors of any medical institution; whether it’s my office, or a hospital, wherever. I try to treat the people who work there with the same respect no matter what they do. If they are environmental services, meaning that they clean patients’ rooms, maybe it’s the president of the hospital, maybe it’s the nurse or care coordinator. Whatever it may be, it does not serve you as a physician- it will never serve you to walk around, parade around and think that you are better than people around you. It’s not the point, all it will do is just alienate people around you and it will result in poor patient care.

Dr. Ryan Gray: And poor job satisfaction as this article obviously shows.

Dr. Allison Gray: Yeah, absolutely. So if you are out there listening, and I doubt you are if you’re this cynical already, but if you’re out there and you’re thinking, ‘Well I’m going to go to medical school because I want everybody to look at me and have so much respect for me and to think that I am the best and that I- maybe I was bullied or picked on and I want now to be the best of the best,’ and I absolutely- I should pause and say I don’t mean any offense to people who have been bullied. It’s a horrible, horrible thing and something that we’re trying to correct in our society. But I just mean if you’re trying to sort of show people, ‘Well I’m the best and I’ve been wronged so I’m going to be better than everybody and everybody’s going to listen to me and do what I say,’ it’s just- it’s not like that. It shouldn’t be like that.

Gain Respect for the Right Reasons

Dr. Ryan Gray: It shouldn’t. You should want to be respected, but not because of the initials after your name. You should be respected for the way that you treat your coworkers, your team members, and your patients, and your patients’ family members, and your patients’ neighbors and whoever else he mentions at the beginning of the article. So, wow that was a good one.

Dr. Allison Gray: Well it’s hard. I mean it’s- the way I look at this is a physician who writes something, or who speaks- we are all ambassadors of our profession. And so for someone to go out there- Look I believe very strongly in freedom of speech, it’s incredibly important that we all are able to speak our minds and talk about things. That’s how things get better and things move forward. And that said, I feel that I have freedom of speech to disagree with him. And you know-

Dr. Ryan Gray: Don’t feel bad for disagreeing.

Dr. Allison Gray: I don’t feel bad, but I just- I think that we need to be good ambassadors. I think that we need to be respectful of our profession and not be hateful and angry and just discouraging, honestly, to the next generation of physicians. That’s another biggie here; it’s the fact that all of you out there-

Dr. Ryan Gray: And that’s why we’re talking about it.

Dr. Allison Gray: Exactly. All of you out there are working so hard to move forward in your careers to start medical school to go through your training to become the best physicians that you can be. And my fear is that all of these physicians growing out there- who are growing more and more disillusioned are going to make you cynical and make you not want to continue on this path. And it’s- that would just be the biggest shame of all.

Online Reviews of Physicians

Dr. Ryan Gray: Yeah. It’s funny, something that popped into my head, this whole kind of Yelp-ish scenario where patients can go rank you on a website. Think of IMDB, Internet Movie Database, and how when- I know you and I, when we want to know if we want to watch a movie, that’s the first place we go. What does IMDB say? IMDB is a- gives you a number from thousands of peoples’ reviews, right? Reviews from people like you and I. I wonder when IMDB first came out, what James Cameron or these other big shot movie directors and producers thought of, ‘Why is this [Inaudible 00:35:53] person, who doesn’t know anything about making movies, why are they going onto this website and ranking my movie? It should be peers that rank my movie.’

Dr. Allison Gray: Absolutely. And I’m sure if you own a small business out there, too. I mean it must be very scary to have somebody go onto Yelp and write a really, really nasty review or- I mean sometimes it’s hilarious. There was that person awhile back who wrote that review about a restaurant and the owner actually wrote back and really showed the person up, it was really funny. But the point is nobody likes to be called out and to be told that they’re doing a bad job so publicly. But yes, physicians had been protected from sort of public scrutiny in a sense for a long time, and maybe it’s not the worst thing in the world that patients can go on there and say how they feel. The key then is if- is to respond appropriately, and if somebody is really calling you out, maybe take a step back and say, “Maybe I am doing something that’s turning people off, or that’s making them run for the hills.”

Final Thoughts

Dr. Ryan Gray: There you go, that’s the take home. I love it. Alright Allison, thank you again for joining us.

Dr. Allison Gray: You’re welcome, I feel like I was very heated today.

Dr. Ryan Gray: No, it was a good one, I like it. How did you like it? If you liked what we were talking about, go to www.MedicalSchoolHQ.net/112 and continue the conversation in the comments section below all of the words and stuff on the paper on the page. So I hope you got a ton of great information out of today’s podcast. I hope you go to www.MedicalSchoolHQ.net/group and join our awesome Medical School Headquarters hanging out Facebook group and as always, I hope you join us next time here at the Medical School Headquarters.

[End of Audio 00:37:57]

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