Because patients are our bosses, and nobody can resist complaining about their boss every now and then, occasionally a doctor will whine about a patient.
I'm sorry... that doctor telling the woman that there is any benefit for her taking a statin is wrong. While statins may help men (with a few DAYS extra in their life), there's no evidence it helps women at all. And then he complains? 😡
Here here for humanism in medicine. Industry/goverment/lawyers have destroyed the system. Soon it will be care extenders only with AI bots. and seeing an actual doctor will be a rarity
I would love to see the article also written in the reverse. The message in the article is very much ingrained in the medical school curriculum nowadays, at least it was in mine. Patients “whine” as well, but I completely understand why. Access is poor because corporate medicine forces an insane amount of new patients onto physicians that we barely have time to care for our current patients. I completely understand why patients get upset when their appointments get cancelled, delayed or it’s difficult to obtain. Their next appt may not be for another 3 months. I distinctly remember getting a bad review when I was pregnant and cancelled clinic due to a surprise induction. I have many of these examples. How about the physician who stayed late to accommodate all those patients you mentioned, but still gets yelled at for running late by other patients or comes home to a disappointed spouse for being late yet again, or another day passes that they didn’t get to see their child when they weren't already asleep. Life stuff happens to everyone, whether you are a doctor or not, and compassion needs to be given on both sides!
First of all, thank you for the article and the video. They are both great, and I really enjoy this Substack.
I am of two minds watching this video. I understand its purpose, and I appreciate the reminder that we never truly know what others are going through. It bothers me that our profession is steadily shifting from a “profession” toward an “occupation.” This shift is reflected in how we increasingly discuss the difficulties we face—
• The sacrifices made to qualify for medical school.
• The challenges endured during residency.
• The demands of patients.
• Even remuneration (I work in Canada).
But I also understand why we’ve arrived here. For decades, administrators have exploited our sense of duty, compassion and empathy to compensate for inadequate resourcing or outright mismanagement. Depending on my mood, I can also interpret this video as a propaganda piece designed to pacify physicians—reminding us to stay quiet, endure, and keep giving.
This raises a few important questions:
1. Is it bad to say or think some of these things? If the trade-off is “bottled frustration” that eventually translates into bad actions, is open venting actually worse than suppressing it? How much should be suppressed?
2. Do patients have some responsibility to put themselves in our shoes as well? If so, how much responsibility, and in what situations?
"Compassion" and "empathy" have been buzzwords for over a decade, but I don't really know what they mean anymore. I also see this weird expectation that "the other person" that has to be compassionate and empathetic - yet people are quick to condemn those not meet their personal definitions, or timeframes, of "compassionate" or "empathetic".
To illustrate my point about "timeframe", take the opioid crisis. Is it compassionate to provide opioids to those struggling with addiction without also providing treatment? In the short term - it probably is, but does it remain compassionate 5 years on, or does is it simply enable the addiction to continue?
So….SO many supposed good MDs/DOs who knew better stayed quiet about the entire COVID scheme….THAT will for ever affect the ethical matrix of doctor-patient relationship….And the OBs pushed the vac for the mothers with developing babies….and the Peds pushed the vac for new borns and older…the greatest travesty to human beings!!….so excuse me…I think MDs and all healthcare providers AND their administers must not just apologize to ALL America and full restitution to ALL people harmed by the vac. The cost for restitution must come from big pharma and the civilian sector…they remained quiet , they were paid off by big pharma and the Govt….our citizens require restitution now!
Treat the patient, not the disease. This principle resonated deeply with me for an extended period. I had a primary care physician (PCP) who possessed intimate knowledge of my personal life, including my marital status, family dynamics, and overall well-being. His dedication to each patient was evident in his consistent tardiness, as he believed that each individual required personalized attention. I found this approach to be patient-centric and did not mind the occasional delay.
One day, he arrived at my appointment with a laptop. He was diligently typing, struggling to decipher medical codes, and subsequently consulted reference materials. His interaction with me lasted approximately ten minutes.
Subsequently, he announced his transition into concierge medicine. Unfortunately, the associated fees were beyond my financial means, and I did not meet the frequency of visits required to compensate for these expenses.
Consequently, I bid farewell to a therapist, a friend, a medical professional, and a sanctuary of comfort and security. The loss was profound and had a lasting impact on my well-being.
Agreed that this applies to all humans but I have to say that when I read some of the reports I see (the ones on my "portal" not the ones they share with each-other)... do not accurately reflect things that I said. I am just another head going through but I am a person in chronic pain. Maybe the PCP or GI is also in pain but we are there to work together. I am trying very hard to find a doctor to work with me.
I’ve had this same experience. I think it has a lot to do with most docs asking what brought you in today, or how has whatever issue been doing since the last visit, and then spending the rest of the visit with their attention focused on the laptop typing away, never absorbing what you’re saying. It’s incredibly frustrating.
I have a doc who uses a scribe. The doc carries around a tablet connected to the scribe. The scribe does all the writing. It was a little weird at first but now I don't even notice it. I feel like I'm getting the doc's full attention. Not perfect but a GREAT improvement!
As I have one specialist who by no means treats me as if I am special BUT he treats me with a holistic (sp?) approach... he understands the body and how one thing affects another. He does not just focus on the particular job that he needs to get done. It is not personal but to him, his job is that the patient have quality of life.
I have found one like this as well, but it took a lot of effort. And I live in a large market with lots of options, many people don’t have that luxury.
That video applies to ALL humans. You never know the burden another is bearing - and I know I would not trade mine for anyone else’s anyway because even those who seem to have it made have struggles. If you live long enough ur gonna have plenty.
Adam, One of your better pieces. There is always a story behind the apparent facts. As I tell my students, just because you do not understand something does not mean that everyone does not understand it -- you just lack facts that would make it clear. When we are all so busy, hard to keep in mind but oh so important.
I worked with a wonderful ENT who would often run behind. Some patients would get so upset. I kindly reminded them that we don’t know the situation- he could be telling someone they have cancer, holding their hand when they tell him their parent (also a patient) passed away or telling a parent that their child needs surgery and they have questions. He’s not in there discussing golf and the latest movie. He’s is so kind most people would wait hours if needed just to see him.
In my experience, the nepo, legacy docs are the worst offenders of whining about patients. I suspect they have, as a rule, much less compassion for their patients.
It is interesting how there is scant research that separates nepo docs from self made docs in the literature even tho it's a well known problem within the industry.
My old boss, while just as elitist as the rest, avoided having legacy doc fellows saying they were lazy and uninquisitive.
You hear it from the nurses, when they say "don't see 《so and sos》son" they produce lots of problems and their patents are spread across different floors to keep their patients from comparing notes.
Those of us in medicine know that there is a problem with docs who get into medical school primarily because their dad was a doc.
It's another kind of problem where the best candidate gets passed over. And once they get into the industry they wield more power than they should due to dad's legacy.
I was in an internal medicine call group , and a 3AM call came in from patient of a colleague . After a few questions , I asked the patient if this had ever been discussed before. He said he had NEVER seen my colleague, but the last page of his yellow pages ad invited patients to "call anytime" ( that ad was changed in the next addition )
I'm sorry... that doctor telling the woman that there is any benefit for her taking a statin is wrong. While statins may help men (with a few DAYS extra in their life), there's no evidence it helps women at all. And then he complains? 😡
My father died of a massive MI aged 67, and my mother has 3 stents. I'm taking my Lipitor.
Here here for humanism in medicine. Industry/goverment/lawyers have destroyed the system. Soon it will be care extenders only with AI bots. and seeing an actual doctor will be a rarity
I would love to see the article also written in the reverse. The message in the article is very much ingrained in the medical school curriculum nowadays, at least it was in mine. Patients “whine” as well, but I completely understand why. Access is poor because corporate medicine forces an insane amount of new patients onto physicians that we barely have time to care for our current patients. I completely understand why patients get upset when their appointments get cancelled, delayed or it’s difficult to obtain. Their next appt may not be for another 3 months. I distinctly remember getting a bad review when I was pregnant and cancelled clinic due to a surprise induction. I have many of these examples. How about the physician who stayed late to accommodate all those patients you mentioned, but still gets yelled at for running late by other patients or comes home to a disappointed spouse for being late yet again, or another day passes that they didn’t get to see their child when they weren't already asleep. Life stuff happens to everyone, whether you are a doctor or not, and compassion needs to be given on both sides!
First of all, thank you for the article and the video. They are both great, and I really enjoy this Substack.
I am of two minds watching this video. I understand its purpose, and I appreciate the reminder that we never truly know what others are going through. It bothers me that our profession is steadily shifting from a “profession” toward an “occupation.” This shift is reflected in how we increasingly discuss the difficulties we face—
• The sacrifices made to qualify for medical school.
• The challenges endured during residency.
• The demands of patients.
• Even remuneration (I work in Canada).
But I also understand why we’ve arrived here. For decades, administrators have exploited our sense of duty, compassion and empathy to compensate for inadequate resourcing or outright mismanagement. Depending on my mood, I can also interpret this video as a propaganda piece designed to pacify physicians—reminding us to stay quiet, endure, and keep giving.
This raises a few important questions:
1. Is it bad to say or think some of these things? If the trade-off is “bottled frustration” that eventually translates into bad actions, is open venting actually worse than suppressing it? How much should be suppressed?
2. Do patients have some responsibility to put themselves in our shoes as well? If so, how much responsibility, and in what situations?
"Compassion" and "empathy" have been buzzwords for over a decade, but I don't really know what they mean anymore. I also see this weird expectation that "the other person" that has to be compassionate and empathetic - yet people are quick to condemn those not meet their personal definitions, or timeframes, of "compassionate" or "empathetic".
To illustrate my point about "timeframe", take the opioid crisis. Is it compassionate to provide opioids to those struggling with addiction without also providing treatment? In the short term - it probably is, but does it remain compassionate 5 years on, or does is it simply enable the addiction to continue?
So….SO many supposed good MDs/DOs who knew better stayed quiet about the entire COVID scheme….THAT will for ever affect the ethical matrix of doctor-patient relationship….And the OBs pushed the vac for the mothers with developing babies….and the Peds pushed the vac for new borns and older…the greatest travesty to human beings!!….so excuse me…I think MDs and all healthcare providers AND their administers must not just apologize to ALL America and full restitution to ALL people harmed by the vac. The cost for restitution must come from big pharma and the civilian sector…they remained quiet , they were paid off by big pharma and the Govt….our citizens require restitution now!
Treat the patient, not the disease. This principle resonated deeply with me for an extended period. I had a primary care physician (PCP) who possessed intimate knowledge of my personal life, including my marital status, family dynamics, and overall well-being. His dedication to each patient was evident in his consistent tardiness, as he believed that each individual required personalized attention. I found this approach to be patient-centric and did not mind the occasional delay.
One day, he arrived at my appointment with a laptop. He was diligently typing, struggling to decipher medical codes, and subsequently consulted reference materials. His interaction with me lasted approximately ten minutes.
Subsequently, he announced his transition into concierge medicine. Unfortunately, the associated fees were beyond my financial means, and I did not meet the frequency of visits required to compensate for these expenses.
Consequently, I bid farewell to a therapist, a friend, a medical professional, and a sanctuary of comfort and security. The loss was profound and had a lasting impact on my well-being.
Agreed that this applies to all humans but I have to say that when I read some of the reports I see (the ones on my "portal" not the ones they share with each-other)... do not accurately reflect things that I said. I am just another head going through but I am a person in chronic pain. Maybe the PCP or GI is also in pain but we are there to work together. I am trying very hard to find a doctor to work with me.
I’ve had this same experience. I think it has a lot to do with most docs asking what brought you in today, or how has whatever issue been doing since the last visit, and then spending the rest of the visit with their attention focused on the laptop typing away, never absorbing what you’re saying. It’s incredibly frustrating.
I have a doc who uses a scribe. The doc carries around a tablet connected to the scribe. The scribe does all the writing. It was a little weird at first but now I don't even notice it. I feel like I'm getting the doc's full attention. Not perfect but a GREAT improvement!
As I have one specialist who by no means treats me as if I am special BUT he treats me with a holistic (sp?) approach... he understands the body and how one thing affects another. He does not just focus on the particular job that he needs to get done. It is not personal but to him, his job is that the patient have quality of life.
I have found one like this as well, but it took a lot of effort. And I live in a large market with lots of options, many people don’t have that luxury.
That video applies to ALL humans. You never know the burden another is bearing - and I know I would not trade mine for anyone else’s anyway because even those who seem to have it made have struggles. If you live long enough ur gonna have plenty.
“even those who seem to have it made have struggles.”
I say this so often.
This is amazing. These things are so often forgotten by us doctors. It makes me feel a little ashamed. We don’t know the battles people are fighting.
Dr. Cifu, This post I really enjoyed. Thank you. Great examples indeed
Adam, One of your better pieces. There is always a story behind the apparent facts. As I tell my students, just because you do not understand something does not mean that everyone does not understand it -- you just lack facts that would make it clear. When we are all so busy, hard to keep in mind but oh so important.
So well said.
Thanks for the post and the video link. A nice reminder in these difficult times.
I worked with a wonderful ENT who would often run behind. Some patients would get so upset. I kindly reminded them that we don’t know the situation- he could be telling someone they have cancer, holding their hand when they tell him their parent (also a patient) passed away or telling a parent that their child needs surgery and they have questions. He’s not in there discussing golf and the latest movie. He’s is so kind most people would wait hours if needed just to see him.
I have put my foot in my mouth so many times after complaining about a patient, I can still taste the rubber.
In my experience, the nepo, legacy docs are the worst offenders of whining about patients. I suspect they have, as a rule, much less compassion for their patients.
It is interesting how there is scant research that separates nepo docs from self made docs in the literature even tho it's a well known problem within the industry.
My old boss, while just as elitist as the rest, avoided having legacy doc fellows saying they were lazy and uninquisitive.
You hear it from the nurses, when they say "don't see 《so and sos》son" they produce lots of problems and their patents are spread across different floors to keep their patients from comparing notes.
Those of us in medicine know that there is a problem with docs who get into medical school primarily because their dad was a doc.
It's another kind of problem where the best candidate gets passed over. And once they get into the industry they wield more power than they should due to dad's legacy.
No offense taken.
Sincerely, Son of a Doctor
:-)
Certainly there are exceptions, but of course you know the more general problem I'm describing since you're in medicine.
I was in an internal medicine call group , and a 3AM call came in from patient of a colleague . After a few questions , I asked the patient if this had ever been discussed before. He said he had NEVER seen my colleague, but the last page of his yellow pages ad invited patients to "call anytime" ( that ad was changed in the next addition )