“It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.” - Sir William Osler






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Medicine and the Media, Part Deux


Strap in, people: It's time for another round of controversy. The latest article making the rounds of the medical Twitter world is this piece published in the New York Times - "Don't Quit This Day Job." The author, a female anesthesiologist, makes the case in this essay that women doctors should not be encouraged to work part-time or to leave medicine for family reasons. Since primary care specialties such as pediatrics, internal medicine, and OB-GYN are now largely female, primary care is suffering because of female doctors' choices to either quit or work part time. For her efforts she's been pegged "misogynist" by at least a couple female doctors I follow.

I agree with her. I am not a fan of part-time medicine, and I am one of those annoying old-school docs who feel that a career in medicine is every bit as much of a commitment as a marriage. Full disclosure here: I'm not married myself, never have been. I don't have children and likely never will. I can stay in the office till midnight if I want and I won't disrupt anyone's dinner or miss any Little League games. My father, now retired, was an old school doc who spent a lot of nights and weekends at the hospital - though he made a big effort to come home and eat dinner with us kids, put us to bed, then went back to the hospital to finish rounds. I learned from him that medicine requires total commitment. I never expected anything else. Therefore, feel free to read the rest of this post with a grain of salt.

The part-time medical gig? In my opinion it can't be done, at least not well. Even when you aren't in the office, patients are still calling. Prescriptions need to be filled. Questions have to be answered, labs have to be reviewed. Who's doing this if you aren't? One of your resentful partners who doesn't know the patient, that's who. Face the facts: no one wants to clean up after you. The patients, also, don't appreciate being told that "Doctor So-and-So is out today, she'll call you tomorrow." Trust me, for most patients tomorrow is Not Good Enough. And for a really sick patient, delay can make the difference between being hospitalized and being able to be treated as an outpatient. I think of medicine as a jealous mistress: Anything you do that takes time away from her, she resents. And she will make you pay. But she does reward loyalty.

When I went into practice I joined a group that (in large part) shares my attitude toward medicine. The Firm does employ part-time docs, but we expect people to show some level of commitment to medicine and to your fellow members of the group. If you show up for a job interview and your first questions are about the availability of part time work and how much vacation time you get, you aren't going to endear yourself to the folks who do the hiring around here. We've seen our share of doctors who join the group, get pregnant, give birth and leave the group a year or two later because they find the hours too much (even when working part time). If you're planning a career in medicine you need to know this basic rule: take the number of hours you work per week seeing patients. Multiply it by 1.5 to 1.8. That's the amount of time you're going to spend practicing medicine. The extra 0.5-0.8 goes for phone calls, charting, wrestling with insurance companies for authorizations, etc. It cannot be ignored; you have to factor it in somehow. What I'm trying to say is, There is no such thing as a nine-to-three job in primary care. To quote the author of the NYT piece, "If you want to be a doctor, be a doctor." Don't do this dip-your-toe-in-the-water crap. Be a help to your patients and partners, not a hindrance.

I think often of one doctor who used to be a member of our group. She was a great doctor and a joy to work with, but she left for a hospitalist gig where she could work one 24-hour shift and one 12-hour shift per week and spend the rest of her time with her kids. I can understand her choice, but the group lost a good doctor (after paying for her childbirth leave of absence, I might add) and the patients lost continuity of care. Again. I can't tell you how many times I have been asked by a patient who's been through three or four doctors in our group, "Are you going anywhere?"

I probably should clarify my attitude toward part-time docs here: I respect women who somehow manage to juggle child rearing and work. Frankly, I can't imagine how they do it. No matter what you're doing, you're plagued by guilt that you aren't doing something else: Either your family or your patients are getting shortchanged. Professional women also tend to put off childbearing, so often they are coping with fertility treatments on top of everything else. I absolutely could not do that. But when I hear some of the older docs in The Firm complaining about how all the doctors joining the group want to go part-time, I have to confess my empathies are with the old school. If my fellow doctors are out with fertility treatments/pregnancy issues/sick kids, we have to pay extra to hire locum tenens coverage and/or the other docs in the group get stuck with the burden of caring for their patients. But what about feminist solidarity? I hear from the audience. Screw it, I respond cheerfully. Medical solidarity trumps feminist solidarity. Heck, it even trumps relationships. We have plenty of docs in the group whose careers have lasted longer than their marriages.

But is that healthy? Is that right? they persist. Honestly, it's the way medicine is - at least the way primary care is. The doctor-patient relationship is the anchor of primary care, and if medicine changes to become more family-friendly, it will be the first thing to go. Those of you who disagree: have you had ill friends or relatives? Have you noticed any difference in their medical coverage in the last few years? Are you finding that the doctor you knew simply is not available, or has been replaced by a covering physician whom you don't know? Bet you the answers are yes.

Medicine is a club - not an elitist club, but you do have to earn your way in. Once you're in you are expected to do your share of the heavy lifting. It's an obligation, but also an honor. The more doctors come to view medicine as a part-time responsibility, the more patients will suffer for it. And remember, we're all patients sooner or later. So are our parents, our kids, our friends. I think this is what the author of the article was trying to say. Instead of slapping the label of "misogynist" on her, it might help to think this through. Can you really say that she's not right?

Labels: If I Ran the Universe, Medicine

posted by Dr. Alice at #

 
Conformity Trumps Iconoclasty


So last night at The Golden Globes Glee picked up several awards. I know several people who love this show; I am not one of them. It's like The West Wing set to music, combining arch, rapid-fire dialogue with an overwhelming sense of political correctness. Multiethnic cast? Check. Kid in wheelchair? Check. Gay character who's "proud of being different?" Check. Character who dresses Goth and is persecuted by those in authority? Check.

These days the gestalt presented by the Glee characters is neither groundbreaking nor courageous. It's all over the airwaves. It's par for the course. You know what would have made the show brave and original? Casting a bunch of untalented Caucasians who can't dance. I'm serious: A show that reenacted the whole Lawrence Welk/ "Up with People" nightmare that was the Seventies (and, incidentally, is still true of Glee clubs all over the country today) would be as watchable as a slow-motion car crash and ten times more fun than the hectoring, nanny-minded show we're stuck with.

The real problem with Glee, in my opinion, is that it propagates the dirty lie that Being Yourself is all you need to do. Why work an after-school job to save up for college when you can dress up like Lady Gaga and prance around instead? Guess what, kids. Those thuggish football players mocking your artistic statements? They're the ones going to college -- on scholarships. You are not. Studying and sports practice may be a drag, but they're investments in your future which will pay off much, much more than waving your freak flag high will ever do.

But Alice, we're talking about a one-hour diversion once a week. Aren't you reading too much into a harmless TV show? I don't think so and I'll tell you why. I know people who center their lives around Glee and other TV shows. Instead of getting out into the world and being themselves, they're watching shows that tell them to celebrate The Wonder That Is You. Their personal lives have narrowed to an incredibly small circle of similar thinkers, both in real life and online. Instead of (dare I say it?) working for a living, they live in semipoverty and spend huge chunks of time on work no one in their senses would ever reimburse them for - like fan websites and fanfiction. Don't get me wrong, these things are fine for a hobby. But at some point, you have to turn the modem off and go make a living. Join the real world!

Oh, and when their parents try to intervene? My family doesn't understand me! Only (sob) you guys do! Yeah, right, only your fellow navel-gazers really "get" the real you. Now let's get back to that Battlestar Galactica fanfic and forget about your mean family, who want you to get a job. News flash: being understood is not as important as you think it is. Too often, in my experience, this phrase translates to "If you don't appreciate me exactly as I am, there must be something wrong with you."

Full disclosure here: I write fan fiction myself. And I know, either in person or online, plenty of people with iconoclastic interests - one of whom is a Star Wars fan who leads a squadron of Imperial Stormtroopers. (Yes, they have all the armor and look completely authentic.) The difference? We do this stuff in our spare time. It adds fun to our lives; it has not become the center of our lives. The Stormtroopers, for instance, show up at the kids' section of the library every once in a while to entertain them. They volunteer their time to help the wider community.

Who sounds more attractive to you: the buttoned-up banker with the stormtrooper soul or the guy who lives in his parents' basement, collecting action figurines and defending the "vision" of George Lucas against all who dare to question it? I know which one I'd choose.

Oh, and to the characters of Glee, I close with the immortal words of William Shatner: GET A LIFE!

Labels: If I Ran the Universe, Pop Culture

posted by Dr. Alice at #

 
Weird Wedding Stuff


Wedding planning seems to bring out any pathologic personality traits people possess. Have you ever noticed that? I can understand that people want their wedding to be personal, but I really think there is a case to be made for standardized wedding ceremonies. (When I run the universe, the standard will be the Book of Common Prayer.) Engaged couples want their ceremony to be "unique," whatever that means. Truth is that all weddings merge together into one hazy, pastel colored, church/beach/garden-at-sunsetty memory within a couple of months...

Unless some horrible disaster takes place during said ceremony. Or unless the couple's plans are outstandingly strange. Like a wedding at McDonald's. Or a Hello Kitty themed wedding. You think I'm joking? Click on the links.

Perhaps you'd like this Super Mario-themed wedding cake?


Why? Why??

I have no wedding on my horizon, but if I did I'd plan something more tasteful and dignified. Like getting married in Las Vegas by an Elvis impersonator. (My mother would pitch a fit. This is sounding better and better!)

h/t Instapundit for the McDonald's link

Labels: If I Ran the Universe, Random Thoughts

posted by Dr. Alice at #