Decline of the American Physician Won’t You Be My Neighbor?

Note:I am admittedly basing this entry on a Wall Street Journal article originally published by Jeffrey Zaslow in 7/07. To read this full article visit:
http://online.wsj.com/public/article/SB118358476840657463.html

A doctor used to be a position of responsibility, respect and power. And while responsibility, especially the legal kind, still rests firmly on the shoulders of most American docs, respect and power are truant comrades. I’ll be a little more specific from a personal standpoint as I go on here. Otherwise you’ll just have to trust me that being a doctor ain’t what it used to be. You can trust me, can’t you? I am a doctor.

This downgrade in physician standing has permeated to the point of being institutionalized. The bureaucracy itself not only condones treating doctors like children, it regulates and endorses it. As a senior resident I remember nurses and social workers passing around red buttons that said “Ask ME! About proper hand washing hygiene”. As if my OCD-ridden mind needed another reminder to wash my hands. Another good example of this blatant mistreatment was our weekly discharge meetings where we would discuss reasons why our patients remained hospitalized. These meetings would typically take place between me, a couple of secretaries, a social worker, a dietician, a physical therapist and a pharmacist. So I would usually rattle off a little: “Pt is a 54 y/o white man w/ hypertension, diabetes, hypercholesterolemia and gout presenting with subacute bacterial endocarditis on day #5 of amp and gent plus vanc as cultures remain negative but clinical suspicion remains high for Eikenella or Actinobacillus and-“

At this point I realize that no one in the room has any clue to what I just said or what the plan for this guy is. Usually someone would condescendingly ask, “Amp and gent, can’t he just go home on that?” To which I would reply, “Not unless you want him main-lining the heroin that gave him that infection in the first place directly into his jugular. Then there’s the whole deafness problem”. And the dissent is not limited to the support staff, oh no!

Even in my first clinical encounters as a 1st yr med student I was shocked at the relationships I saw between patient and doctor. Angry, poor people clearly suffering from some malady I had yet to study barking orders at doctors. That’s right the loonies were running the crazy house, and not in a semi-cool Randle McMurphy sort of way. I remember a particularly pissed crack head ordering up some vicodin. Would you like BBQ sauce and a 6-pack of McNuggets with those opiates, sir?

This situation did not improve much as I advanced in my training. If anything, I grew closer to this diseased mindset of privilege. My friends and I grew to label this the “culture of entitlement”. Succinctly this term applies to generally poor and non-producing members of society (although it’s certainly not limited to poor ass people) who, for reasons not entirely apparent, believe that not only do they deserve goods or services of exceptional quality and expediency, but also if they do not receive said goods or services a grave wrongdoing has occurred. Such is the crack head ordering up narcotics with his #4 extra value meal.

The threat of litigation runs deep in these individuals, though I’m fairly certain the only time they’ve spoken to an attorney has been a public defender who is fortunate enough to pick up their public urination case. These individuals are far too common in medicine. The fact that I trained at a county hospital contributes largely to this belief that I maintain is fact. For some reason the worst off in the community expect the best. As if the chronic low back pain you’ve had for 8 yrs and seen 5 different specialists for is going to magically improve instantly when I see you. The truth is that there are many diseases that modern medicine cannot treat and many more that it cannot cure. Truth is, a lot of the treatments that are available are Carlton Banks expensive, take a long time to show any improvement and have considerable side effect profiles.

But I don’t think that truth is what the self-entitled are searching for. Maybe validation of their station in life, shitty as it may be. I keep repeating it, but I really don’t understand the motivation or cause of this all. Then I read this Wall Street Journal Article.

This well written piece describes, from a college professor’s perspective, what he coins as my culture of entitlement that he noticed in asshole college students expecting to get A’s in all their classes simply by “working hard” and showing up. The author blames, drum roll please: Mr. Rogers.

That’s right, sweater wearing ‘ol Fred is to blame. The reason? He “told several generations of children that they were ‘special’ just for being whoever they were”. The writer elaborates that, “Mr. Rogers spent years telling little creeps that he liked them just the way they were. He should have been telling them there was a lot of room for improvement”. Boy if any of those kids had my Dad in their childhood, they would be experts on this ‘room for improvement’ thing.

I don’t think that Mr. Rogers personally is to blame for this cultural shift, particularly toward physicians. But his message and the way it has penetrated my generation is to blame for the narcissistic tendencies of today’s youth. I’d like to borrow a line from Chuck Palahniuk’s Fight Club when I say to these kids, “You are a not a special and unique snow flake”.

In closing I’d like to reinforce that I never did wear those stupid, “Ask me” red buttons that administrative morons thought every doctor in the hospital should don. As if your doctor wearing a sign that basically reads, “I’m so stupid, I need a constant reminder on my chest so I remember to wash my hands” will inspire confidence in anybody. Using some white-out and a Sharpie I modified one of the buttons to read, “Respect ME!”, but I was always too chicken to wear the darn thing around the hospital. Doctors in the 21st century and me too afraid to wear a stupid pin: oh, how the mighty have fallen.