Someone is killing our doctors, can we help?

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The suicide rate for doctors is double that of veterans.  The veteran death toll is a disgrace but you likely haven't heard about the docs.  Can we, as patients, help?

There is an increasing dismay in the liver disease community as more people are shocked to learn that they have cirrhosis. A common question within the community is why wasn't I told? How is it possible that my doctors didn't warn me? As this current of dissatisfaction grows there is a counter current in which medical care is being transformed into a process that commonly satisfies neither doctor nor patient. More dangerously it threatens to kill the soul of medical care and to drive out the best practitioners of the healing art.

The most intimate relationship we are likely to have is with our doctors. We quite literally place our very lives in their hands and in a rational world the health and well being of our doctors should be of prime importance to us. We maintain our cars so that when we need them they will serve us well. As a society we should have a similar concern for our doctors as though our lives depend on it. Do we do that? Not so much.

I recently gave a talk which focused on one of the major burdens faced by medicine. Even though doctors are quite remarkable as a group, their ability to learn and apply a vast array of often confusing information is unequaled in any other discipline, they are being overwhelmed by rapidly advancing science. Medical knowledge has been expanding exponentially. It took from 1750 to about 1850 for medical knowledge to double. By 1950 the doubling time was estimated to be 50 years. It had accelerated to 7 years by 1980, and 3.5 years in 2010. Shockingly, it is projected that medical knowledge will double in 73 days by 2020. It is impossible for anyone to absorb the amount of new information that has become a deluge on the medical community. We do, however, expect that since we entrust our lives to these people so that they might protect us. In truth, medical professionals very much want to excel at caring for us so everyone agrees, good to know.

But what is it like really? Modern medicine has become the property of the statistician and the regulators. The money changers guard the temple of health and you and your doctor are but tiny players on a stage that is managed by the faceless and unseen who are moved by spreadsheets and not your suffering or your doctor's ability to provide your care. To those who rule, it is more important that your doctor fill their check boxes on computer forms than whether you are well.

Harsh words I know, but let's consider an example for the holiday. Suppose you had some misfortune with a turkey. Might it surprise you to know that it is more important to the people who matter, that your doctor examine the exact nature of the turkey incident than how you might be concerned. Below is how a doctor is supposed to describe your turkey day. These codes must be entered in their computer lest the doc be chastised and graded as one who provides poor care, and woe be to he who describes it as a turkey when in fact it was a goose all along. As a rational person, might you be tempted to tell such a system to shove their turkey?

  • 4 Contact with turkey
    • 42 Struck by turkey
      • 42XA …… initial encounter
      • 42XD …… subsequent encounter
      • 42XS …… sequela
    • 43 Pecked by turkey
      • 43XA …… initial encounter
      • 43XD …… subsequent encounter
      • 43XS …… sequela
    • 49 Other contact with turkey
      • 49XA …… initial encounter
      • 49XD …… subsequent encounter
      • 49XS …… sequela
  • 5 Contact with goose

Doctors, however, are a tough lot.  Most try to deal with it and try to adjust and accommodate and still give you the care that they promised you when they agreed to take your life in their hands.  The pressure does take its toll. Depression and suicide are rising problems for the profession.  Imagine being told that you must only spend 15 minutes with a patient and in that time enter all of the correct data.  If you can make the patient feel cared for in that brief window all the better as your social media scores will be high.  That is important if you want to be paid.  Exaggeration? Perhaps a bit, but we have all seen the changing processes of the medical office dictated by someone somewhere and the bargain of life and death that you made with your doctor is changing.

We now live in a system created mostly by lawyers and politicians.  We know that politicians are largely incapable of creating functional systems and, coincidentally I'm sure, almost all politicians are lawyers.  Doctors live in a world where at the end of every patient encounter they know that a lawyer could be lurking.  In a world where it is not possible to know all that is known, some lawyers live on the could have known, should have known, pay me money mound of misery. Doctors are the impala on the medical plains knowing that at all times they are the prey.  There are corrupt physicians to be sure but most genuinely hope to serve their patients well.

Before I get beat up over this message let me say that money and the fight for it are key drivers of the processes we find ourselves heir to but that is the subject for another time. Today I'm asking you to consider the down on the ground reality of the doctor/patient relationship that we are creating.

As patients, the only way that we can help, other than voting, is to become better patients.  We must become our own advocates. We must become more knowledgeable about those things that affect our personal health.  We must engage with the medical community as partners in this journey and not just rely on the physician to be our guide.  For better or worse, the systems of the future will not serve well the passive patient.  You need to accept that your health is yours to protect.  The physician can help you as he checks his boxes but the system will not allow you the luxury of personal time.

This does assume, of course, that the physician of the future welcomes the informed patient.  We know from dialog in patient forums, that is not always true today but that must, over time, become the norm.  Toward that end, the foundation seeks to arm patients with the information that their primary care doc may not have the time to learn.  From the fire hose of information, carry that bit of it that informs your situation with you in case your doctor needs that knowledge to help you.  Some docs will resist as the changing dynamic is uncomfortable for all but it must become the way of it.

In our screening project, we provide a liver scan with an explanation of liver health and how things work.  Most primary care docs receive very little training about liver disease so for many our tests are new information and it has not been the way things are done.  Patients don't normally go to a physician with diagnostic tests in hand, but how else are we to deal with the millions of people with asymptomatic and undiagnosed liver disease?  As a matter of policy our society does not screen for liver disease so unless we, as the public, take the matter into our own hands we will continue on the path where the first time a patient learns of liver disease is being told that they have a terminal illness called cirrhosis.  It is our goal to change that by becoming the warning signal which can inform your physician to enable them to be that guardian of your life that you desire.

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