Oh Those Darn Money-Grubbing Doctors!
Jan 28, 2007 Filed in: Medicine &
Science
Boston Physician Goes After Other Docs.
Author and Physician Jerome Groopman goes after
physicians' "flawed thinking." But Groopman himself
is guilty of flawed logic.
Boston Physician Admonishes Doctors
Professor Jerome Groopman, oncologist at the Beth Israel Deaconess Medical Center, is a man of much accomplishment: author, scientist, professor. His books The Measure of Our Days and Second Opinions were the inspiration for television’s Gideon’s Crossing. He has a new book due this spring, How Doctors Think. But based on excerpts printed in a January 28, 2007 Boston Globe article, I think the title should be How Doctors’ Thought Processes Are Flawed.
Let me start with the premises of the book, as presented in the Globe article, that I agree with:
• Some doctors are arrogant. True.
• Some doctors some of the time rush to judgment and make an incorrect diagnosis as a result. True.
• Doctors are human and can make mistakes. Very true.
• An emphasis on teaching medical students to think rather than regurgitate memorized facts will produce better doctors. True, true, true.
Where I differ from Dr. Groopman, and I hope his book turns out not to be as one sided as it appears to be in the Globe article, is the notion that everything wrong with medicine today is the fault of doctors. Quoting from the article, Groopman details a diagnostic failure: “Groopman tells of a woman who saw close to 30 doctors for a constellation of ailments that gradually sapped the life out of her. She endured excruciating pain and was down to 85 pounds. Her immune system was failing and she had developed severe osteoporosis. All of them missed what was ailing her.” Her disease was celiac sprue, a notoriously difficult to diagnose autoimmune disease. He gives other similar examples, including one that happened to his own son. What all of these anecdotes have in common is the theme that if only the doctor had probed more, had questioned more, had ordered one more test, all would have been well. Only once does Groopman concede: “There is no generic best treatment to a serious problem.” Indeed.
Setting aside the fact that we have no idea what the woman with celiac sprue was telling her doctors about her symptoms, it is rather disingenuous of a physician to speculate, with 20-20 hindsight, on how easy a particular diagnosis was to make. Good medical care, which is of course founded on sound diagnosis, is a process that requires participation and cooperation among many specialist physicians (who must work together in a coordinated fashion), insurance companies (who must be willing to finance the test, procedure or office visit), hospitals, and especially patients. To attack an already fragile patient-physician bond, thanks to our hyperlitigious system of anything-other-than-perfection-and-you-owe-me-big-time, only serves to further shatter the necessary trust that patients must have with their doctors.
We already have an extremely unfair and harmful system of torts in this country, in which any doctor can be sued by any patient for any reason, spurred on by usurious lawyers, with the case to decided by juries that are notorious for handing out gratuitous awards in absolute opposition to facts. Large awards given to patients who have suffered a bad outcome that is not the fault of the doctor because the jury felt sorry for the patient are the bread and butter of the malpractice industry. There are entire legal journals dedicated to informing lawyers how to successfully sue for individual medical procedures, because of a missing or misplaced word in the chart. And now we have a doctor who is going to saturate this fire with jet fuel? To state, or imply, that most medical errors and bad outcomes are the result of shoddy thinking, if not outright laziness on the part of doctors, is not only incorrect, it makes a difficult situation nearly impossible.
I do not wish to impose a Cosa Nostra style Code of Silence among doctors. Open and honest debate is the lifeblood of the science of medicine. But self-serving attacks on the intellect and ethics of the medical profession only serve to further erode trust and make doctors’ jobs even harder. I believe there is no profession comprised of harder-working, more committed professionals. Of course we have our shoddy members, those money-grubbers who care more about dollars than disease. They’re called plastic surgeons. But aside from a few Hollywood-type “doctors to the stars,” in what other profession would you find a group of people willing to endure four years of college, followed by another four years of intense study and training, incurring an average debt of $130,000, followed by three to ten years of bone-crushing servitude, at a wage below the federal minimum wage, to be allowed to enter practice, take call, work all night, carry a pager that anyone can call at all hours of the night for the least of reasons, have a career savaged by lawyers, judges and juries that have never spent a single day in a hospital, for a salary that works out to be about $20 per hour. Sound like a good deal? Don’t all rush up at once.
Just about the most depressing thing a doctor can do is get out a calculator and determine what else he might have done with that $130,000, added to the money he could have amassed working the same hours as he did in residency but at a living wage. The amounts are staggering. No one except a fool does this job for money, so for the overwhelming majority it has to be a personal passion and commitment to patient care. All doctors know this. But unless you have rock-star status as a physician, the popular press is not inclined to listen. If Sam Allis’s Globe article was fawning and at no point challenged the best-selling Groopman’s assertions, surely, you think, the academic press is not prey to such misty-eyed philandering? Think again. Consider an editorial from January 1, 1998, by the normally clear-eyed New England Journal of Medicine, in which Groopman’s book The Measure of Our Days is compared to the Bible!
I don’t argue with Groopman’s assertion that doctors can make mistakes, or that we should do everything in our power to eliminate mistakes. But to hold us to a standard of anything less than perfection is failure will absolutely guarantee failure. Doctors carry a great deal of responsibility in caring for our patients. No argument there. But it cannot be denied that operating with hands tied by the whims of (mostly non-medical) politicians, profiteering by millionaire-CEO-led insurance companies, savage attacks by soulless lawyers, and ever increasing demands of non-compliant patients, the heavy burden of responsibility for improvement of health care does not rest solely on the shoulders of physicians. I hope that Dr. Groopman’s forthcoming book reflects the challenges doctors face more accurately than is seen in his interview with the Boston Sunday Globe.
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Professor Jerome Groopman, oncologist at the Beth Israel Deaconess Medical Center, is a man of much accomplishment: author, scientist, professor. His books The Measure of Our Days and Second Opinions were the inspiration for television’s Gideon’s Crossing. He has a new book due this spring, How Doctors Think. But based on excerpts printed in a January 28, 2007 Boston Globe article, I think the title should be How Doctors’ Thought Processes Are Flawed.
Let me start with the premises of the book, as presented in the Globe article, that I agree with:
• Some doctors are arrogant. True.
• Some doctors some of the time rush to judgment and make an incorrect diagnosis as a result. True.
• Doctors are human and can make mistakes. Very true.
• An emphasis on teaching medical students to think rather than regurgitate memorized facts will produce better doctors. True, true, true.
Where I differ from Dr. Groopman, and I hope his book turns out not to be as one sided as it appears to be in the Globe article, is the notion that everything wrong with medicine today is the fault of doctors. Quoting from the article, Groopman details a diagnostic failure: “Groopman tells of a woman who saw close to 30 doctors for a constellation of ailments that gradually sapped the life out of her. She endured excruciating pain and was down to 85 pounds. Her immune system was failing and she had developed severe osteoporosis. All of them missed what was ailing her.” Her disease was celiac sprue, a notoriously difficult to diagnose autoimmune disease. He gives other similar examples, including one that happened to his own son. What all of these anecdotes have in common is the theme that if only the doctor had probed more, had questioned more, had ordered one more test, all would have been well. Only once does Groopman concede: “There is no generic best treatment to a serious problem.” Indeed.
Setting aside the fact that we have no idea what the woman with celiac sprue was telling her doctors about her symptoms, it is rather disingenuous of a physician to speculate, with 20-20 hindsight, on how easy a particular diagnosis was to make. Good medical care, which is of course founded on sound diagnosis, is a process that requires participation and cooperation among many specialist physicians (who must work together in a coordinated fashion), insurance companies (who must be willing to finance the test, procedure or office visit), hospitals, and especially patients. To attack an already fragile patient-physician bond, thanks to our hyperlitigious system of anything-other-than-perfection-and-you-owe-me-big-time, only serves to further shatter the necessary trust that patients must have with their doctors.
We already have an extremely unfair and harmful system of torts in this country, in which any doctor can be sued by any patient for any reason, spurred on by usurious lawyers, with the case to decided by juries that are notorious for handing out gratuitous awards in absolute opposition to facts. Large awards given to patients who have suffered a bad outcome that is not the fault of the doctor because the jury felt sorry for the patient are the bread and butter of the malpractice industry. There are entire legal journals dedicated to informing lawyers how to successfully sue for individual medical procedures, because of a missing or misplaced word in the chart. And now we have a doctor who is going to saturate this fire with jet fuel? To state, or imply, that most medical errors and bad outcomes are the result of shoddy thinking, if not outright laziness on the part of doctors, is not only incorrect, it makes a difficult situation nearly impossible.
I do not wish to impose a Cosa Nostra style Code of Silence among doctors. Open and honest debate is the lifeblood of the science of medicine. But self-serving attacks on the intellect and ethics of the medical profession only serve to further erode trust and make doctors’ jobs even harder. I believe there is no profession comprised of harder-working, more committed professionals. Of course we have our shoddy members, those money-grubbers who care more about dollars than disease. They’re called plastic surgeons. But aside from a few Hollywood-type “doctors to the stars,” in what other profession would you find a group of people willing to endure four years of college, followed by another four years of intense study and training, incurring an average debt of $130,000, followed by three to ten years of bone-crushing servitude, at a wage below the federal minimum wage, to be allowed to enter practice, take call, work all night, carry a pager that anyone can call at all hours of the night for the least of reasons, have a career savaged by lawyers, judges and juries that have never spent a single day in a hospital, for a salary that works out to be about $20 per hour. Sound like a good deal? Don’t all rush up at once.
Just about the most depressing thing a doctor can do is get out a calculator and determine what else he might have done with that $130,000, added to the money he could have amassed working the same hours as he did in residency but at a living wage. The amounts are staggering. No one except a fool does this job for money, so for the overwhelming majority it has to be a personal passion and commitment to patient care. All doctors know this. But unless you have rock-star status as a physician, the popular press is not inclined to listen. If Sam Allis’s Globe article was fawning and at no point challenged the best-selling Groopman’s assertions, surely, you think, the academic press is not prey to such misty-eyed philandering? Think again. Consider an editorial from January 1, 1998, by the normally clear-eyed New England Journal of Medicine, in which Groopman’s book The Measure of Our Days is compared to the Bible!
I don’t argue with Groopman’s assertion that doctors can make mistakes, or that we should do everything in our power to eliminate mistakes. But to hold us to a standard of anything less than perfection is failure will absolutely guarantee failure. Doctors carry a great deal of responsibility in caring for our patients. No argument there. But it cannot be denied that operating with hands tied by the whims of (mostly non-medical) politicians, profiteering by millionaire-CEO-led insurance companies, savage attacks by soulless lawyers, and ever increasing demands of non-compliant patients, the heavy burden of responsibility for improvement of health care does not rest solely on the shoulders of physicians. I hope that Dr. Groopman’s forthcoming book reflects the challenges doctors face more accurately than is seen in his interview with the Boston Sunday Globe.
Return to Home Page
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