When people ask me to help them jump the line I say to them, "I am willing to call and beg when it is really medically important, but the reason it works when I call and beg is bc the specialists know that if I am calling, it's for someone who really needs to be seen!" I have yet to have a patient respond poorly to that.
On the other hand, with our more recent new normal I often say "Usually when I call and beg, it doesn't work bc everyone is working harder than they want to. It used to work, but not so much now. Your best bet is being polite to the secretary and calling daily."
Face value. Physicians - I'd choose an older doctor over a younger one as I believe the older had a better education and lots of experience and can relate better to me because I am older. Financial decisions - I'd choose the man in a blue suit and tie over the person in jeans, t-shirt, and purple hair. Did I make a mistake in choices? It's a matter of 'at that moment' and 'face value'.
After watching and reading all sorts of news from Dr. Cifu, Dr. Mandrola regarding the questionable state the UCLA medical school, as well as others, are going through. The controversial practice of med schoo. admissions process. What is happening at Shelf Exams? As a patient who do I trust? Knee-jerk choice is the one in power, as it should be. But what about the people who stand on the "me" attitude. When it's all about you, what about me, your patient?
I understand about the instantaneous crisis, let's say a GSW with a bloated belly and atelectasis. There has to be someone in power to direct actions. But, during a less stressful and immediate situation, should there be the one in power listening and sharing in a specialized group of peers discussion? By releasing 'self' a good decision can be made and then executed by the one in power.
Bean counters will scoff at Dr. Cifu’s reference note…for many years I gave my power away as a patient. It’s still a fine line but I will not castrate my knowledge about my specific case just because I’m supposed to defer to someone “better trained.” I will work collaboratively. But I also come from the school of “hire excellent folks and stay the hell outta their way” which I absolutely insist on doing with my own care providers.
I guess I've watched too many episodes of the Resident on Netflix. The show suggests surgeons employed by the hospital get bonuses or higher salaries based on volume and type of procedures they perform. The producers don't have to kowtow to any advertisers. I found the sloth segment of your post really interesting! Sabrinalabow.substack.com
Not sure all of us “ salaried “ docs have no financial incentives: most are burdened by “pay for performance “ bonuses driven by often unproved metrics dictated by insurance companies.
I wanted to write something about ‘power’ but did not.
I wanted to write about the power differential between my 14-year-old daughter with severe brain damage (from her birth) and the subsequent spastic quadriplegia and nonverbal issues that she and we dealt with during her multiple hospitalizations before she died at 16 1/2 in 2011.
I always feared that the doctors would not value her life as much as we did because she didn’t look great lying in a hospital bed. She was unable to sit or roll over or hold an object because of her physical disability. Every time we had to go to the hospital I would bring photos of her sitting up in her wheelchair and smiling and engaging with life. I was trying to show the world of doctors that to us, she was a typical child with much joy.
I was attempting to seduce them into falling in love with our daughter.
It worked both ways.
The care she received was extraordinary.
When we were trying to figure out how to help her through a respiratory crisis, they would gather us ( without my daughter of course) in conference rooms and talk about the pros and cons of various options.
There was one dark shadow in the weeks and weeks of that hospitalization.
It had something to do with power.
One morning my daughter started to crash and nobody realized it except for the respiratory therapist who then called the rapid response.
She was going down.
The head PICU doctor was there with pediatric residents and she asked me if I wanted her to intubate my daughter.
In that moment of crisis, this doctor asked me if I want to let my daughter die.
“ do you want me to intubate her?“.
“Yes please” I responded.
And they did.
And she survived that crisis.
And OK, yes, we finally realized that the only way forward would be for her to get a tracheostomy.
I waited a few months and then emailed that PICU doctor to explain that my daughter, and many other children like her, had a very high-level of quality of life. They had special schools or public schools that accommodated them and families that could not imagine life without them.
These kids had joy and beautiful lives and I told her that in the email.
I did not accuse her or blame her. I quietly explained what our life was like with our daughter.
She emailed me right back and thanked me.
I hope that she never put another family through that kind of moment.
And yes, there are times when a child has a terrible disease and quality of life and compassionate decisions need to be made but the time to do it is not in the middle of a rapid response.
I am sure that I felt aggrieved for writing an email where I had to make a case for the value of my daughters life, but I did it because I wanted her to know how I saw that situation.
My daughter had a different kind of power. She had the power of personality. And joy. She had the power of connecting with people and letting those people see a different kind of life and how valuable it was.
No one has power over you unless you grant them that power. You can always say no even if the consequences are to be devastating and destructive. I guess it might boil down to the degree of selling your soul to those who have none.
Knowledge is power, I believe this to be true in all of life not just our professionals. I admit that when I need advice I look to the older more experienced human.
Good point. Actually money is the root of all progress. It is simply a medium of exchange that is responsible for the efficiency of economic progress. I would add that love of power is a much greater source of evil. But I agree with Dr. Cifu that neither power nor money have much to do with medical decision-making at the doctor/patient level. Unfortunately both have a significant effect at the institutional and policy-making levels.
When people ask me to help them jump the line I say to them, "I am willing to call and beg when it is really medically important, but the reason it works when I call and beg is bc the specialists know that if I am calling, it's for someone who really needs to be seen!" I have yet to have a patient respond poorly to that.
On the other hand, with our more recent new normal I often say "Usually when I call and beg, it doesn't work bc everyone is working harder than they want to. It used to work, but not so much now. Your best bet is being polite to the secretary and calling daily."
Face value. Physicians - I'd choose an older doctor over a younger one as I believe the older had a better education and lots of experience and can relate better to me because I am older. Financial decisions - I'd choose the man in a blue suit and tie over the person in jeans, t-shirt, and purple hair. Did I make a mistake in choices? It's a matter of 'at that moment' and 'face value'.
After watching and reading all sorts of news from Dr. Cifu, Dr. Mandrola regarding the questionable state the UCLA medical school, as well as others, are going through. The controversial practice of med schoo. admissions process. What is happening at Shelf Exams? As a patient who do I trust? Knee-jerk choice is the one in power, as it should be. But what about the people who stand on the "me" attitude. When it's all about you, what about me, your patient?
I understand about the instantaneous crisis, let's say a GSW with a bloated belly and atelectasis. There has to be someone in power to direct actions. But, during a less stressful and immediate situation, should there be the one in power listening and sharing in a specialized group of peers discussion? By releasing 'self' a good decision can be made and then executed by the one in power.
Bean counters will scoff at Dr. Cifu’s reference note…for many years I gave my power away as a patient. It’s still a fine line but I will not castrate my knowledge about my specific case just because I’m supposed to defer to someone “better trained.” I will work collaboratively. But I also come from the school of “hire excellent folks and stay the hell outta their way” which I absolutely insist on doing with my own care providers.
I guess I've watched too many episodes of the Resident on Netflix. The show suggests surgeons employed by the hospital get bonuses or higher salaries based on volume and type of procedures they perform. The producers don't have to kowtow to any advertisers. I found the sloth segment of your post really interesting! Sabrinalabow.substack.com
Thanks Sabrina.
Adam
I’m retired after 37 years of clinical practice in ID and Critical Care. I fully get it.
Not sure all of us “ salaried “ docs have no financial incentives: most are burdened by “pay for performance “ bonuses driven by often unproved metrics dictated by insurance companies.
That pay for incentives really fueled the opiate crisis, too.
I wanted to write something about ‘power’ but did not.
I wanted to write about the power differential between my 14-year-old daughter with severe brain damage (from her birth) and the subsequent spastic quadriplegia and nonverbal issues that she and we dealt with during her multiple hospitalizations before she died at 16 1/2 in 2011.
I always feared that the doctors would not value her life as much as we did because she didn’t look great lying in a hospital bed. She was unable to sit or roll over or hold an object because of her physical disability. Every time we had to go to the hospital I would bring photos of her sitting up in her wheelchair and smiling and engaging with life. I was trying to show the world of doctors that to us, she was a typical child with much joy.
I was attempting to seduce them into falling in love with our daughter.
It worked both ways.
The care she received was extraordinary.
When we were trying to figure out how to help her through a respiratory crisis, they would gather us ( without my daughter of course) in conference rooms and talk about the pros and cons of various options.
There was one dark shadow in the weeks and weeks of that hospitalization.
It had something to do with power.
One morning my daughter started to crash and nobody realized it except for the respiratory therapist who then called the rapid response.
She was going down.
The head PICU doctor was there with pediatric residents and she asked me if I wanted her to intubate my daughter.
In that moment of crisis, this doctor asked me if I want to let my daughter die.
“ do you want me to intubate her?“.
“Yes please” I responded.
And they did.
And she survived that crisis.
And OK, yes, we finally realized that the only way forward would be for her to get a tracheostomy.
I waited a few months and then emailed that PICU doctor to explain that my daughter, and many other children like her, had a very high-level of quality of life. They had special schools or public schools that accommodated them and families that could not imagine life without them.
These kids had joy and beautiful lives and I told her that in the email.
I did not accuse her or blame her. I quietly explained what our life was like with our daughter.
She emailed me right back and thanked me.
I hope that she never put another family through that kind of moment.
And yes, there are times when a child has a terrible disease and quality of life and compassionate decisions need to be made but the time to do it is not in the middle of a rapid response.
I am sure that I felt aggrieved for writing an email where I had to make a case for the value of my daughters life, but I did it because I wanted her to know how I saw that situation.
My daughter had a different kind of power. She had the power of personality. And joy. She had the power of connecting with people and letting those people see a different kind of life and how valuable it was.
Do you see how lucky we were?
jodygelb.com
No one has power over you unless you grant them that power. You can always say no even if the consequences are to be devastating and destructive. I guess it might boil down to the degree of selling your soul to those who have none.
Knowledge is power, I believe this to be true in all of life not just our professionals. I admit that when I need advice I look to the older more experienced human.
Money is not the root of all evil, it’s the love of money, 1 Timothy 6:10.
Good point. Actually money is the root of all progress. It is simply a medium of exchange that is responsible for the efficiency of economic progress. I would add that love of power is a much greater source of evil. But I agree with Dr. Cifu that neither power nor money have much to do with medical decision-making at the doctor/patient level. Unfortunately both have a significant effect at the institutional and policy-making levels.