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I Bet I Know Your Answer

The healthcare system has changed over the past thirty years. Some changes are good and some not so good. One of them is the emotional distance that physicians and healthcare practitioners have placed between themselves and their patients. I remember being told thirty years ago that a good physician stays objective by keeping their distance from an emotional connection with their patients. But I do not think the intention of emotional distance was to create apathy in physician - patient relationships. We are in a crisis of lack of concern on the part of physicians for patients and greed has infected the healthcare industry as a whole.

Our Professors were so harsh to us as medical students and residents in the 1970's. They would berate us as we learned, never paying us compliments. When I was in training, we worked in the hospital overnight every other night to care for our patients. We were sleep deprived and many times, we could not think straight. In the early morning, our medical care team assembled to do morning rounds with our Attending physician. He or she was the leader of our team. Our Attending physician (who had had a great night's sleep), would walk from patient to patient, criticizing our care of new admissions and chastising us for not handling the other inpatients correctly. The nurses would join rounds on occasion, most often siding with the Attending, leaving us physicians - in - training to feel as if we were runt baboons being chastised and picked-on by the females of our colony. Those were the good old days of medicine.

On the positive side of my training, my colleagues and I evaluated and treated thousands of patients before we were set loose on society to practice on our own. Depending on one's desire for further training, some physicians would seek fellowships to further their area of expertise. Some fellowships were twelve months long, some were twenty-four months long, and some were thirty-six months long or more. I chose to commence in a Medical Toxicology/Pharmacology Fellowship which was two years long after I completed my residency. More long nights and countless evaluations of patients who had a drug or toxin related symptoms as well as snake bites, spider bites, bug bites, bee stings, and industrial chemical exposures such as lead, arsenic, and mercury. I worked in a clinical toxicology laboratory. There I learned the ins and outs of measuring blood, urine, serum, plasma, vitreous, saliva, breath, and tissues for drugs, toxins, and poisons.

One thing I discovered while working in my fellowship, people were feeling machines. They were not just some random plasmoid machine operating without regard to their surroundings. They reached out to physicians, but most physicians did not reach back. It was as if patients were grasping for an emotional life line in addition to their physical ailments and the physicians refused to throw them one. The care of patients was unnecessarily harsh and cold. White coats were barriers between the living patient and the emotionally dead care provider. I was told over and over, your care must be void of emotion or you'll get attached and make mistakes. That philosophical construct in the practice of medicine probably took root during the existentialist movement of the early twentieth century; I think; therefore, I am.  

At the same time, when the existentialists were debating about human thought, parenting experts were espousing the virtues of emotionless parenting. Children should be seen and not heard. The great experts of that era proposed that children should not be hugged or caressed in any way because it would diminish their capacity to deal with the harsh realities of nature and human behavior. Picking up a child who had fallen and skinned their knee was forbidden. An emotionally sterile environment similar to an agar filled dish to grow bacteria was espoused to be the healthiest childhood environment for proper child rearing practices. To care about the emotional well being of a child was to sin as a parent.

I believe these constructs of the early Twentieth century have come home to roost. At a time in humanity when need more caring and understanding, we have less. At a time when patients are the sickest I have ever seen, I witness physicians who refuse to do anything other than provide emotionless standard routine care. Patients read countless articles on the internet about their symptoms and possible illnesses, only to be shunned by their physicians for having interest in their health. And specialists truly believe that they are the only ones with special knowledge in their fields of medicine, as if it were a carefully guarded secret, anyone wanting access to the information must have top security clearance. News flash. The internet has opened the once sacred knowledge to the world. And any general physician who has an interest in their patient's health can and should investigate the diagnosis and treatment options for their patients before they send them off to a pack of hungry wolves: specialists and subspecialists.

It takes an emotional investment to be an advocate for a patient. Emotion drives us to be the best we can be in anything we do. Emotion is what makes a man genius as well as insane. When you connect to the emotional distress of a mother asking for help for their child, you cannot help but do everything possible to make that child come back from the dead. It was emotion that caused Jesus to cry when he raised Lazarus from the dead. To be effective as physician, those who heal the infirm must feel the infirm first. Emotion provides the will to listen to the patient's story, order the appropriate laboratory tests, make the correct diagnosis, investigate the best treatment options, and then if necessary, refer to the appropriate specialist. Emotion gives the referring physician the will to argue with the specialist and make certain that all is done in accord with the patient's best interest in mind, not the specialist's uninterested therapy designed to make everything convenient for their practice. Why am I so passionate about emotional connections to patients?

That female teenager who I thought was going to be a patient at St. Jude in my last blog was ultimately referred to a physician at the Cancer Center in Jackson, Mississippi. The experienced physician at the Cancer Center in Jackson was so busy that he could not see her for weeks, so a second, less experienced specialist will see her in two weeks time. The primary care physician practicing in the small town in Mississippi was contacted by St. Jude to make the referral. The St. Jude nurse practitioner in the hematology clinic went around me to refer her out without even one evaluation by St. Jude. Clearly, she did not wish to tangle with a physician who had passion about his severely ill patient. I suspect she thought any hematologist would do in this child's case. Maybe she is correct on this issue. Any hematologist is as good as any at St. Jude. Forgive me for thinking that St. Jude is a special place. They sure seem to advertise that they are.

I spoke to the small town doctor who really had no desire to do anything but refer the adolescent to some other physician. The adolescent girl is now in a game of hot potato.  The small town neophyte physician had no idea what steps needed to be taken to assure that the young woman got the care that she deserved and she did not care. Per our conversation, she was not going to call and speak to the physician she referred the patient to and said she would keep me in the loop. I was kind, but firm. I told her I wanted the name of the physician at the Jackson location, and I would call him/her, requesting a pre-referral discussion about the patient.

When I hung up the phone, I realized that St. Jude uses the emotion card to benefit from charity donation, but when it comes down to it, they're physicians are probably like everyone else in the healthcare system: Unemotional. This is not the first time this has happened with a referral of one of my pediatric patients to St. Jude. It's the second. Third time will be the charm.

And we still have no idea why this child is suffering from a debilitating anemia not responsive to past iron therapy. Without knowing the cause of the anemia, we remain unable to treat her Psoriatic Arthritis. Her mother is genuinely confused about the disrespect of the entire healthcare system supposedly trying to help her daughter. She is watching her daughter swirl down the drain of suffering and each physician other than me has told her, "That's the way it is. She's all right. I know she can't walk up stairs, can barely care for her hygiene, but she'll get better when her blood count gets higher. She's not a candidate for a blood transfusion. Those are for really ill children. We don't treat psoriatic arthritis. That's another specialty doctor called a rheumatologist. And we can't treat pain because she could get addicted to the medicine. That would be bad. Suffering through it is just a part of life."

Denial is a powerful tool used by many of the current uncaring egomaniacs licensed to practice unemotional, marginal medicine. They have taken over the healthcare system. I do not see a change any time soon. The public will have to rebel loudly to get the system changed.

Who do you prefer? A physician with emotion and passion or one that just looks at lab work, CT scan reports and refers you to a specialist based on your symptom complex without any regard to the patient's well being.

I bet I know your answer.


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