Dr. Blog M.D.

No. it is something a hospital does when it does not make much money in a specific area so it can keep its overhead as low as possible.

It is not healthy for the doctors – they need to work 24 hours on day one and 10-12 hours on day two and then repeat this cycle every day for a month or more.

It is not healthy for the patients – the person seeing you is mentally drained and is more prone to making mistakes.

Its great for the hospital – they might only have to hire 2 people to cover that service instead of 3 or 4. No extra pay for the 2 people, just reduced sleep, increased stress, and damage to their personal life. None of which really impacts the hospital.

Check this radio interview out. It was one of the more refreshing things i have heard about the medical proffesion.

http://whyy.org/cms/radiotimes/2010/05/27/the-primary-care-crisis/

The only thing I would add is that, the guy missed one other big factor concerning why people avoid primary care. Call!

Also they Dr never talked about the crappie life and schedule of folks in training.

Here is an excerpt about working long hours

A key impact of long-hours work on the family was the reduction in time available to spend with children. Many of the parents interviewed spent very little time with their children, and, in most cases, felt the absence of this time keenly.

Other impacts for some families included not having family holidays together, children being less able to take part in other activities, an inability to spend special occasions together, a faster pace of life, and much of the family “quality time” being spent in the car.

There were significant impacts on the spouse of the long-hours worker, including being overloaded with all of the parenting and domestic duties, often while simultaneously working full-time, while those spouses outside the paid workforce felt unable to take on paid work or training.

http://www.thefreelibrary.com/Parents’+long+work+hours+and+the+impact+on+family+life.-a0220202599

And here is a JAMA article articulating some of the results of working long hours on families

http://jama.ama-assn.org/cgi/content/extract/292/1/25

And now here is some out of touch old doctor who can’t understand why a resident wouldn’t want to work more than 80 hours in one week

A few months ago, Glen Silas, 40, an obstetrics and gynecology doctor at George Washington University Hospital, wanted a young resident to observe a sophisticated procedure in which a renowned laparoscopic surgeon was operating on a uterine tumor. Silas was certain the resident would eagerly embrace the opportunity.

But as doctors gathered in the staging area, the resident declined, telling Silas, “I am at the end of my shift anyhow, so I will see it another time.”

“Even those at the attending level still learn from this surgeon, so for a resident to say that . . . is a special thing,” Silas said. “I just told the resident, ‘Wow. That is disappointing that the restrictions on your hours keep you from participating.’ I don’t even think I got a response.”

http://www.washingtonpost.com/wp-dyn/content/article/2010/03/17/AR2010031704006.html

If doctors all across the world can work 40 hours a week and still have low mortality rates than doctors here in the US.  Then we know the handoff isn’t the issue.

http://en.wikipedia.org/wiki/List_of_countries_by_death_rate

Just because we are paid well doesn’t mean being a doctor is a good job

So I was reading this article in CNBC that Doctors are still among the highest paid in 2010.  I wanted to understand how many hours on average each job works a week.  Here is CNBC’s top 20

http://www.cnbc.com/id/37151785

These hours for the medical profession seamed low to me.  Specifically for the first, 3 – 7years, where most doctors are working close to 80 hours a week.  And then when we get a job we are the low person on the totem pole and usually get stuck with call schedules that make us work close to 70 hours a week.  It isn’t until about 5 years out that we could get to the average work week numbers seen above.  Mind you, most doctors are close to 40 years old by the time these reduced hours finally hit us. 

In the end I think Dr’s don’t make enough.  But I don’t want more pay, I want fewer hours.  And going forward it looks like it is going to get worse.

http://well.blogs.nytimes.com/2010/04/29/why-some-doctors-dont-like-their-jobs/?scp=4&sq=doctor%20pay&st=cse

http://www.npr.org/blogs/health/2010/04/will_medicaid_payment_follow_u.html

So I like to volunteer.  I am a Dr, so I like volunteering where they need Drs.  So I signed up to help this organization out.

I asked work for a week to go volunteer.  I said I was willing to have unpaid leave but I didn’t want to use my vacation.  Well that was a pipe dream.  They said absolutely not and oh by the way you are not covered by our malpractice while you volunteer. 

Great.  I have to use some of my precious vacation to go do something where someone could sue me and I would be forced to pay out of pocket.  This sounds wonderful.  So I asked the organization if they could cover me.  They responded with they only cover nurses.  Witch riled me up even more, since my hospital was willing to donate quite a few weeks of their nurse’s time outside of the hospital with paid leave. Grrrrr. 

So why volunteer as a dr if you have to use your own vacation and you aren’t covered by malpractice?  You don’t, at least not in this country anyways.  I found out that if you volunteer to go over sees, the receiving hospital will pay you a stipend, my hospital calls it a rotation, and there is not such things as malpractice in several parts of the world.   So the lesson here is, don’t help those people across the street, help those people across the ocean unless you are nurse, and then help everyone. It’s cheaper and looks better.  Bullshit!

http://www.healthleadersmedia.com/content/PHY-248903/State-Looks-to-Protect-Volunteer-Docs-from-Malpractice-Suits

http://www.dentalmalpracticelawyers.org/high-malpractice-rates-may-stop-md-retirees-from-volunteering-laws-vary-by-state-practice-trendsmedical-doctor-an-article-from-skin-allergy-news

I did learn recently that volunteering at federal or state run clinics can be excused from most forms of malpractice liability.  That’s good to know.  But that doesn’t do me any good if I want to help specific organizations.

http://bioethicsdiscussion.blogspot.com/2008/01/little-charity-volunteerism-and-little.html

http://www.accessmylibrary.com/coms2/summary_0286-6055343_ITM

The only time I have off between 9 to 5 is if I am post call or I am injured or sick.  Usually post call I go home and sleep because for some reason people need me between the hours of 2 and 8 am.  Witch in it self is crap 90% of the time.  You could have waited till 8 am to ask that question.  But I digress.

Getting to an average bank – very hard. 

Getting to the utility company to turn my heat on in person Monday through Friday 9-5 – very hard. 

Being home for the cable company to come during their 4 hour window – very hard. 

Going to a Drs appointment – very hard.

Are you getting the picture?  Just about every other job on the planet has to legally provide you with some time (paid or unpaid) to take care of your life inside that 9-5 window.  The nurses get to skidaddle, the hospital administrators get to skidaddle and some time the attendees even skiddadle.  But the interns and residents don’t get to go anywhere.  Its complete shit.  I think that Drs need representation at the national level to set standards.  And one of those standards should be up to 3 hours of personal time between 9 and 5 Monday through Friday so that they can keep their life in order and themselves healthy.  

This does not include post call time when you might have to drive on an hours’ worth of sleep and kill three people on your way to the dentist.   http://blogs.usatoday.com/oped/2006/12/post_40.html  http://article.wn.com/view/2010/02/15/Sleep_Problems_Can_Increase_Risk_Of_car_Accidents_In_Adolesc/

In Oklahoma Drs can now lie to their patient

IN OKLAHOMA DRS ARE NOW LEGALLY ALLOWED TO LIE TO THEIR PATIENTS

LYING TO PATIENTS

It is now time for all women to leave Oklahoma.  Because they can no longer trust their Drs.  It is now time for all Drs to leave Oklahoma so that the medical profession can maintain a high level of patient trust.

http://www.cnn.com/2010/OPINION/04/28/carr.abortion.oklahoma/index.html

Lying to patients has serious consequences outside of the abortion arena.  This law set a dangerous precedence that is both sexist and archaic.  I wonder if I could lie about cancer if I don’t believe in Chemo. I wonder if I could lie about erectile dysfunction to single men because they shouldn’t be having sex outside of marriage.  

What else can I lie to pregnant women about? 

Dr: Do you believe in abortion?

Patient: Yes

Dr: Oh my.  Well then your babies going to be fine. As long as you get it baptized.  Unbaptized babies live half as long as baptized babies.

Patient: Really?

Dr: Yes.  Also you are too skinny you need to gain some weight. Are you a vegetarian?

Patient: Yes

Dr:  Unfortunately you are going to have to start eating meat?

Patient: Really?

Dr: Yes.  Do you work?

Patient: Yes

Dr:  I have some more bad news I am afraid.  Women who are pregnant, nursing and or raising children should not be working.  I am going to have to recommend you stay at home.

Patient: Really?

Dr: Yes.  I am a Dr, I know

I am sure there are plenty more reasons why Drs could now lie to pregnant women to forward their specific moral agenda in Oklahoma.  And for that reason I again implore all women to leave Oklahoma and all Drs to stop practicing to keep women, children, and society safe from stupidity.

I also implore all med students to leave the state.  I would like to see all 4^th years slated to start their residency in about a month to reject position if they are slated to start in an Oklahoma hospital.  This type of thinking will set our profession back just when we are looking to expand the role of healthcare across the country.

Nurses are not Drs

OK, Nurse practitioners go to school on average for 5 years then go right into the workforce.  Some Nurse practitioners take the long rouse and go to school for 6 years and then get a certificate.

http://www.womenshealthchannel.com/nursepractitioner.shtml

Drs, as I have complained about go to school for 8 to 10 years and then got to a residency / fellowship program that lasts anywhere from 3 to 11 years before they can get a license to practice.  That gives them a total range anywhere between 11 and 21 years of education and training to earn the right to be called a Dr.

The Drs training involves a 4 year undergrad degree, a lot of memorization for two years, and then as much on the job training as possible over the next 5 to 15 years.  The nurse practitioner degrees includes a 4 year undergrad degree and 1 -2 years of graduate academics with some on the job training mixed in.

http://education-portal.com/how_to_become_a_nurse_practitioner.html

Now I am completely ok with their expanded role in healthcare.  I spend ¾ of my day doing paper work on people who aren’t really that sick anyway.  Plus if they can help the entire hospital go to shift work and stop our crazy schedules that would be great.  BUT, you are not a Dr.  You don’t introduce yourself as Dr. You don’t in most cases have a PHD.  You did not go to med school.  You are NO a DR.  You are an NP.

I don’t care if it makes your patient feel better when you say that you are a Dr as opposed to saying you are a NP.  If you wanted to say you are a Dr then you should have went to medical school.  I know most patients will second guess you and demand a Dr because they have no clue what an NP is.  That too bad.  You need to educate the public on what an NP is or deal with the results of a culture who demand Drs see them for a fricken scratch.

I love my nurses, they do a lot for the patients in the hospital and make my job much easier.  But if I started asking them to call me the master of the universe and I started introducing myself as the master of the universe people would know I am a goof and shouldn’t be seeing them.  But when an NP says hello I am Dr such and such, that patient bestows upon them a lot of expectations with no real reason to assume that the person is just an NP who wants to be called Dr.  As if the patients are sue happy enough.

Can you test well and work while sleep deprived then you are ready to be a Dr.

 Cause that’s all it really takes. 

 Medicine today is all about memorization.  IF you can spend hours and hours memorizing and are not a complete jackass to other people then you can be a Dr. 

Now if you are smart either be a MD PHD or anything that will let you sleep at least 8 hours a night.

http://www.nytimes.com/2010/01/15/health/14chen.html

I have talked about mal practice before.  It drives a lot of costs and a lot of extra torment to people who undergo unneeded tests.  Plus it can put tremendous strain on good doctors. http://www.nytimes.com/2009/12/29/health/views/29case.html?_r=1

I think the new bill will cut ciosts but without tort reform we will miss a big opportunity to cut real costs. http://washingtonindependent.com/55535/tort-reform-unlikely-to-cut-health-care-costs

Dr’s will continue to cover their asses and order tons of tests.  The only way I see that this new bill will do some good in the malpractice arena is if the government makes ordering additional tests so expensive that people will elect not to have them.  This is unlikely.