Footnotes
Readers are encouraged to respond to Paul Blumenthal, MD, Deputy Editor of MedGenMed, for the editor's eyes only or for possible publication via email: pblumen@stanford.edu
. 2007 Jul 2;9(3):1.
letter MedGenMed. 2007 Jul 2;9(3):1.
To the Editor:
I have listened to your clip and the associated printed message in Medscape with great interest.[1] I do understand and appreciate your passion, but find myself compelled to respond to some of the included opinions.
I would, wholeheartedly, agree with your concept in an ideal world. I had my medical education in an area of the world where medicine is taught the “old fashioned” way, where physicians are called “Hakim,” which means wise, and medical malpractice does not exist. Where patients seek their physicians for their knowledge and compassion, not to second guess their judgment; where the relationship between a patient and his doctor was more than just a legal contract to provide services. And although I had the opportunity to pursue a different career, I insisted on continuing my dream to fight disease and improve the quality of life of less fortunate people, I wanted to enjoy the satisfaction of achieving success and seeing the grateful smiles on their faces.
The attraction of advanced medical sciences and technology in the United States was too strong for me to resist, which precipitated my decision to come in to complete a residency and postgraduate training. That was about the time when managed care started to infect the medical world, effectively starting the “great depression” of medicine. I was stunned to find that I was not any more a physician but merely a gatekeeper. My responsibility for the patients' care had changed to a concierge distributing tickets to facilitate the entrance to hospitals, laboratories, and physician specialists' offices under the headline of cost control, which, of course, never happened and only benefited the coffers of the insurance companies. All this did not discourage me from continuing my medical career as planned. I am a hopeless optimist; I still wanted to serve humanity and enjoy the satisfied looks on my patients' faces, which I have done for more than 25 years.
With all due respect to your opinion, I strongly believe that the great majority of us are Great Physicians providing the highest quality medical care; we understand the full story. We improve and save the lives of hundreds of our patients on a daily basis despite severe financial and time constraints. I wish I had the luxury of a detailed discussion of the lifestyle and personal goals of each patient I see within the average 8-minute time slot allowed for a patient “encounter.” I wish that I had the time to inquire about all their family members that I was privileged to treat and see through the years, but I simply did not. There are not enough hours in the day to finish a physician's work load. Which you can appreciate, I am sure.
Sir William Osler lived in a different time; I think that he would have a different opinion if he was alive today.
Respectfully,
Reference
- 1.Centor R. To be a great physician, you must understand the whole story. MedGenMed. 2007;9:59. Available at: http://www.medscape.com/viewarticle/553592. Accessed March 26, 2007. [PMC free article] [PubMed] [Google Scholar]
letter MedGenMed. 2007 Jul 2;9(3):1.
To the Editor:
As a member of the American Osler Society I greatly appreciate you comments.[1] Of course, Dr. Harrison placed Osler on the Greatness Scale just below God himself. The first textbook I purchased in medical school was Harrison's Internal Medicine. The preface reads (as I'm sure you know!) as follows:
“No greater opportunity, responsibility, or obligation can fall to the lot of a human being than to become a physician. In the care of the suffering he needs technical skill, scientific knowledge and human understanding. He who uses these with courage, with humility, and with wisdom will provide a unique service for his fellow man, and will build an enduring edifice of character within himself. The physician should ask of his destiny no more than this; he should be content with no less.”
Osler and Harrison both took the path to greatness. Your charge for us to do the same is admirable.
Reference
- 1.Centor R. To be a great physician, you must understand the whole story. MedGenMed. 2007;9:59. Available at: http://www.medscape.com/viewarticle/553592. Accessed April 6, 2007. [PMC free article] [PubMed] [Google Scholar]
MedGenMed. 2007 Jul 2;9(3):1.
I would like to thank both commenters for their kind words. Dr. Garabedian suggested that the majority of physicians are great physicians who understand the entire story. He contrasted that statement with his following lament about having enough time with each patient. Indirectly he has made my point better than I did. My commentary expressed an ideal that many physicians cannot achieve. Our rate-limiting step is time. Obtaining the entire story requires devoting enough time to each patient.
Given our current reimbursement system, spending time with each patient often gets sacrificed. I often rant about the time problem on my blog (http://medrants.com).
So I understand the barriers to spending enough time. All physicians should join to highlight this problem. Patients understand when physicians shortchange their visits.
Dr. Cater's quote from Dr. Harrison is one of my favorites. He remains the role model for medicine at my institution – UAB. I know several physicians who trained under Dr. Harrison. He did not just write those words; he lived those words. We must all aspire to achieve the greatness of Drs. Osler and Harrison.