Confessions of a Non-Recovering Physician

Craig Joseph, MD
By: Craig Joseph, MD
Date: January 02, 2018

Physicians are sometimes difficult people to deal with. Did you know that? No? If not, then you probably don’t work closely with physicians! I’ve heard lots of interesting explanations as to why docs can be demanding and picky and obstinate, but when I have the conversation about physicians and their peculiarities, I always go back to my medical school experience.

I, like many physicians, trained in an urban medical school. When I was a student at the big university hospital downtown, this happened: I was caring for a patient who had just been transferred from a community hospital for a worsening infection. On rounds, my attending physician said, “This patient has been mismanaged by those doctors out in the community. Those physicians don’t keep up with the literature and just don’t know how to take care of complicated sick people. Luckily for this patient, she’s here now, and we’ll fix her using cutting edge medicine and the latest research.” Message delivered: Doctors at community hospitals are idiots who don’t know what they’re doing.

You may know that medical trainees are moved around a bit both because it’s often necessary to find good learning opportunities, but also to get varying perspectives. With that in mind, where do I find myself a few months later? I’m now rotating at that very same maligned community hospital, and I’m caring for a patient who had been treated in the big academic hospital downtown. On rounds, my attending physician said, “This patient has been mismanaged by those doctors downtown. Up in their ivy-covered towers, they lose touch with the people they’re supposed to be treating. These aren’t research subjects; these are patients. Pay attention, students! We’ll take care of this gentleman using time-tested and proven therapies like we’ve been doing for decades.” Lesson learned: Doctors at academic medical centers are idiots who don’t know what they’re doing.

When I started my residency, I learned a few more tidbits. It wasn’t just doctors at different hospitals who were clueless! When I was rotating through the ED, I learned that the ICU would never take our patients until they were close to death. “If they would just understand the trajectory of this patient’s illness, they could easily predict that she’ll need critical care in the next few hours! But no, we have to wait until she’s intubated!” And sure enough, when I was rotating through the ICU, I was told that the docs on the floor and in the ED were always trying to send us patients who were barely even sick. “What were they thinking? We need to keep these beds open for critical patients!”

Summary of my learnings: doctors who practice outside my institution are questionable and should not be trusted. Oh, and doctors who practice inside my institution but on a different service or floor are questionable and should not be trusted. Maybe I’m just jaundiced and my experience is atypical, but . . . I don’t think so.

What does this have to do with why doctors are demanding and picky and obstinate? Everything! The way physicians have been trained emphasizes self-reliance above all else. I’ll take the high road and argue this is for the sake of the patient. “Doctor, you’re the one who is going to save this person’s life. You can’t trust what others tell you. Always go to the source: the patient in front of you. Double check the story with the patient. Oh, and those normal labs. Did you see the results yourself? And that unremarkable x-ray. Did you review it with the radiologist in person?” Trust no one! Assume incompetence until proven otherwise.

Perhaps this explains some of the pushback you receive when you implement a new electronic health record or push out some new configuration. As the healthcare IT expert, you’re supposed to know it all and come with all the answers. And maybe you do know it all and do have all the answers. But your doctor friends are not trained to believe you. For those of you old enough to remember Ronald Reagan, he often quoted the Russian proverb “Trust, but verify.” Many doctors live by this dictum, whether they know it or not. Trust, but verify.

The next time a physician seems ornery or lost in the details and missing the big picture that you’re trying to communicate, consider that perhaps he or she is trying to verify what you’re saying and make certain that it lines up with what they know to be true. How can you anticipate real needs and address any elephants in the room before your doctor goes off the track? Invest in building trust. If you can do that, you win!

Craig Joseph, MD, is the Chief Medical Officer at Avaap where he works with healthcare leaders to implement and optimize EHRs in order to increase physician satisfaction, improve efficiency, and ensure full value of the technology.

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