Nurse Vs. Doctor

There's an interesting piece in the New York Times about the hierarchy of doctors. It claims that the vanity of some older doctors could potentially jeopardize the health of their patients, and that it's important for younger, less-experienced doctors to be heard, and not feel like they're whistleblowers when they disagree with their elders.

The article discusses this problem in a hospital environment, but it can also be true in smaller, office practices. At the last place I worked, a young nurse caught a mistake an older doctor had made. On the surface, he was grateful, but there was an obvious resentment that played out over time.

She was new, this nurse, and so there were some mistakes she made as part of her learning curve. The older doctor caught many of them and often rudely corrected her in front of the other staff. He was the lynchpin of the practice, the senior doctor who brought in the most patients, so no one told him to lay off, even though we all knew what he was doing. Eventually, she quit.

There's a lot of unspoken behavior in medical offices. I'd like to think that because we all have firsthand knowledge of life's fragility, our vanity and ego could be punctured like a children's balloon. Sometimes, that's true, but more often than not we function on an obvious but unacknowledged hierarchy.

Which makes sense. After all, I'm not a doctor. My opinion regarding the health of a patient is never going to carry the same weight, nor should it. The beauty of our office (and I'd suspect most offices) is the doctors maintain their authority by listening and questioning themselves. There isn 't one among them who wouldn't lend an ear to a colleague--doctor or nurse--if they had a serious concern.

And that's how it should be. The practice of medicine is not about glorifying the doctor. It's about treating the patient, by any means necessary. What do you think?

Would the Last Generalist Please Turn Out the Lights?

Came across a great article in Time about how doctors who are generalists are becoming increasingly rare. The reason cited was economic. It pays to specialize. Also, the workload is less demanding, as is the ability to know as much as possible about one particular area. When it comes to medicine, patients often prefer a specialist who can see their problem to the exclusion of everything else.

But the article makes a good case for worrying about the lack of generalists:

"So whom do you go to for what? Unless you have a close friend or relative in medicine, you still need a good generalist — someone who knows you and knows the ropes. This is going to take effort and maybe some money; there are fewer of them and HMO fees are so low that many won't take on new patients except as a favor. This is especially true for the good ones who really spend time and develop a relationship with their patients. Internists vary tremendously. Some treat everything, some just do check-ups and referrals. If competent, the former will save you a lot of anxiety, waiting-room time and money. They will treat the pneumonia or the backache themselves, instead of sending you to the pulmonary doc or orthopod."

My late doctor cousin is the reason I work in a medical office today. He was a generalist. The only doctor for miles in the rural town where he worked. We often laughed over how he accepted eggs from a chicken as payment, or perhaps some repairs to his barn, or work on his farm.

He lamented the maze and nightmare of modern medicine brought on by insurance company behemoths. To him, it was crucial to know how to set a broken ankle or treat an ear infection or whatever else came his way. That was his job--his place--in the community.

I remember him comparing himself to an auto mechanic that way, saying he expected the local garage to have the know-how and diagnostic tools to fix any make of car, so why shouldn't his mechanic expect the same of him?

I miss my cousin more and more these days.

What are your thoughts?