Tuesday, June 21, 2011

malice

Well, if you haven't seen this yet, it's not for lack of me telling you about it, that's for sure.




Again, I wish we'd had more time to talk about an issue that clearly could have filled up the whole hour and then some, and I don't think I've ever spoken in public at any point in my life and not wished afterwards that I'd been more eloquent, but...it was fun.  I hope it sparks a lot of discussion, and I hope that people outside of medicine can try to empathize, even just a little bit, with the bigger issues at play.

Since I've started writing outside this blog a little more (see most recently, my stint writing for Psychology Today, where my motto has pretty much been go big or go home, at least in terms of picking highly polarizing topics), I've been struck by how much people seem to really dislike doctors.  As a modern medical trainee, I never grew up thinking that I would be loved or revered as a doctor--I just wanted to do my job and take care of people, and if they wanted to thank me for it, fine, I appreciate being recognized, but the approbation was besides the point.

Still, I'm really taken aback by some comments I've read, not just in response to my piece, but just responses to doctors and their choices in general, that makes me wonder how this sentiment of generalized antipathy towards the medical profession, doctors in particular, has evolved.  We've all gotten used to hearing blanket statements towards other professions ("All politicians are crooks" is probably the most common) and I have to say, some of the blanket statements I hear lobbed back and forth about our profession (that's we're lazy, that we're arrogant, that we don't care about people, that all we want to do is earn a buck or a million of them) seem to be treading awfully close to that territory.  How did this happen?  Do these stem from specific bad experiences that patients have had with particular doctors, or is there something else, something more pervasive and societal, that have not only knocked doctors off their historic pedestal, but put us in the same box as scoundrels and opportunists?

I have not seen this in my particular practice, I should say.  I like to think I have a good rapport with my patients, and while I know everyone thinks its easy for anesthesiologists ("you just put them to sleep,") the fact of it is that we have to inspire the most amount of trust in the least amount of time, so patient relations is key.  I also would like to underline that I don't particularly want to be put up on a pedestal (it's really only in the past few years that I've even become comfortable in being addressed with the honorific--if people call me "Michelle" I'm generally much more at ease), and regardless of how society views doctors, it's still an honor and privilege to serve our patients.  But it's there's definitely a change in the role of doctors in society, and as much as I've been talking about the changing face and culture within medicine, perhaps there's just as much of a change in relating to us from the outside.

Why do people hate doctors? I mean, I kind of hate my dentist, but you know, not really--I just hate the reasons I have to go see him.  But he's a good guy, doing his job, and I don't think he's a criminal or anything.  Wherein does personal experience bleed into societal expectation?  At what point did Norman Rockwell's country doctor become Alec Baldwin in "Malice"?




Thoughts?

39 comments:

  1. Anonymous6:46 PM

    i think we can thank insurance cost and the cost of medical services for patients' hatred-ultimately doctors are the only face patients associated with there not being enough time or money for all the things they need or want. and you know how evil of people who went through anywhere from 7-? years of training (post-college) to want to make a decent 6 figure salary to they can live a decent life and pay off their loans. better give that money to the insurance company it seems. i often wonder whether fewer smart people will go into medicine over time due to the constant husstle of doctors

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  2. Anonymous7:05 PM

    I think society's view of doctors is heavily based on the fact that, yes, some doctors can be jerks. I have heard this one too many times: "they barely talk to me, barely get to know me, barely spend time with me. Instead, they are making tons of $$$ without even acknowledging the patient, and I'm having to pay them an outrageous amount just to get them to see me for five minutes." Ouch.

    Part of the problem is that medical school admissions did not use to put emphasis on humanism in medicine, therefore accepting a lot of med students that, to be honest, had no people skills. And those MDs gave the practice of medicine a terrible reputation. Medical school should not be all about grades; instead, it should be a lot more about becoming compassionate physicians.

    The other part, as mentioned above, is insurance companies and the misconception that we, as physicians, get to keep most of the chunk of the money that is earned - which could not be farthest from the true. Add to that the fact that a lot of young MDs feel compelled to show off their earnings by way of buying expensive cars and homes and the like, at the "expense of the patient."

    Don't get me wrong - I think that, if you work this hard, you should be rewarded just as well at the end. After all, why are we not complaining about CEOs and celebrities making millions of dollars a year? It baffles me.

    Ultimately, I also think that people are always going to find ways to make themselves feel better by bashing at other people that seem to be better off than they are. However, what they do not realize is that being a doctor is A LOT of work; and, maybe, if they are so bothered by this, they should be the ones going to medical school.

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  3. I have had very good doctors and very bad doctors and everything in between. I know it's probably hard to imagine if you have spent your whole life around good doctors, as you probably have. But for those of us who have to just blindly pick doctors off of an insurance website or the phone book, it's the luck of the draw. I've had a pill-pusher, a doctor who I swear was high on coke or something, and several doctors who just absolutely blew off my concerns. Then you have to figure out if it's even worth trying yet another doctor for a second opinion so you can just be dismissed again. It's really depressing.

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  4. Anonymous7:27 PM

    or maybe people expectations are too high - yes, doctors SHOULD listen, take an appropriate history and physical, understand the disease process and how it's affecting your life: no they are not meant to be you 'friends' your 'spiritual advisor' you magic miracle drug cure all peddlar. they can't make a 95 year old grandma live forever ...whereas 50years ago, if grandma had a stroke at 70 then it would be considered 'her time'.

    My parents are always shocked when it takes some trial and error before the doctor they go to finds a medication that works for their blood pressure, or diabetes control etc. "they are wasting my money and they should KNOW which one works! no one cares! no one listens!" but people are not cars and one kind of oil doesnt work for everyone.

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  5. I think it has a lot to do with the idea that all doctors make tons of cash. There's not really an understanding of the low pay of residency. People talk about medicine like you finish med school and make half a million your first year. And with the high cost of health care, it's kind of a perfect storm of anti-doctor sentiment.

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  6. With respect to the money: I honestly think at least once a week to tell people how my plastic surgeon husband packs his own bag lunch every single day in order to save money--but at best it would sound like I was lying and at worst sound like complaining. BUT IT'S TRUE.

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  7. Anonymous8:58 PM

    Off topic, but I also wanted to add:
    1. when leaving medicine or working-part time to take care of family, why does Dr. Sibert assume that these doctors "don't want to work as hard". Motherhood, and taking care of elderly relatives or children with special needs- I would argue that can be much "harder" and more challenging emotionally. It's not like ppl leave medicine or work part-time to sit on their asses at home.
    2. Are people not allowed to change their minds? I would hope that most people are optimistic about liking/loving medicine enough to want to go into it/go through training - but heck even after all the training if it's not for you, it's not for you.
    3. I have known PhDs and lawyers who go into full-time motherhood - though society won't directly benefit from the fruits of non-existent labor, I think society indirectly benefits from having well-educated mothers who put the same amount of energy and dedication that they put into their higher education into raising good children.
    4. Indebted to society - ha! I don't think anyone would ever accept a job similar to residency. "Wanted: Able-bodied person to work 80+. Exposure to infectious disease, q4 30+ hr shifts, needle sticks, violence, rudeness and bickering to be expected. Salary: $42,000 with increases yearly for costs of living. Contract: 3 to 7 years." Heck the PAs (2 years of PA school) that do interns' duties work M-F 8 to 5 and can earn 90K/year. Boggles the mind.

    On Topic: The people that hate doctors are usually the same close-minded, void-of-common-sense haters that one can't have a logical, respectful conversation with. I have met a handful of patients that pretty much hate me because I can't fix them right away despite the fact that they don't do anything to take care of themselves. "Do I need to find another doctor?" says the patient with chronic back and neck pain who spends 10 hrs a day standing and styling people's hair, when she hasn't gone to Physical therapy and wants percocet. My favorite patients are those that recognize that 1. I am NOT a god and therefore cannot perform miracles 2. I am an educated human being that is trained to try to find out what is wrong and to fix it if possible 3. If it is not fixable then my job shifts to trying to help find a better quality of life, however the patient defines this.

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  8. I think there's a host of reasons, but three stick out to me:

    - the fallacy that doctors should be omniscient Dispensers of Cures - the reality can never match the expectation, and bitterness follows.

    - the lack of clarity around price. Not knowing how much something will cost when you're making decisions about an illness means that you're losing a LOT of control. Even though insurance companies are the main reason for this obfuscation, doctors get blamed for 'setting' the prices.

    - the training that many doctors receive in how to curtail chatty patients is effective, but can often be disrespectful. Friends who've gone through medical school have had to consciously back themselves away from this tendency in social settings, because the rest of us couldn't stand being 'directed'. The (few) doctors I've had who didn't have this tendency were upfront about the time we had available, and the short conversations felt far more productive and respectful from my POV.

    Lastly, much of the derision that doctors now get sounds very similar to what lawyers have gotten for a while now. I think that as more people's medical experiences branch away from Big Life Emergencies towards managing ongoing issues, doctors are seen more as people who provide expensive services and less as people who heal. Some of it may just be a lack of the deference that used to be de rigueur.

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  9. Michelle,

    I love your comment about your husband packing his own lunch bag daily - I do the same! Granted, I'm still in medical school, but I am 100% sure that I will continue to do it for the rest of my life - healthier, better for the environment, and saves money. Can't beat that ;)

    Seriously though, what's with this perception that all doctors are rich and making millions? At the rate of debt I am going, I can only assume that I will live semi-comfortably by the time I'm, oh I don't know, 45 or something, and that's if I pay my loans ahead of time. I'm only 26. Give us a break.

    I am not ever going to feel like I owe society my life, just because they helped me get through college & medical school financially. After all, I'm going to be working my behind off through residency, missing out on life during my youthful years while the rest of my friends are enjoying it, and I'll be paying all the loans back - with added interest, mind you!

    I agree 100% with the post by Anon@8:58. Love it.

    "Dr." G

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  10. I don't have any kind of a medical degree and I don't hate doctors.

    I think the vulnerability of being sick (or the fear of getting sick and not being able to afford all those what ifs) gets taken out on doctors. If I have to, I can learn how to fix my plumbing or my roof or my engine. I can't learn how to do what you do, not by just reading and hit or miss practice. That makes me feel even more vulnerable because I have to trust you to do the right thing for me. Once I trust you, then I have to wait and see if you were right. Who doesn't hate waiting when it's something personal and important?

    It's not fair but I think that vulnerability plays a big part in the judging of doctors.

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  11. Anonymous11:03 PM

    I agree with Loonstruck's acute observations, that a lot of it has to do with fear and vulnerability. I was recently diagnosed with lupus. Getting to that diagnosis consisted of many specialist visits, when previously I've never had to see a doctor for anything more than an ear infection, and I found myself losing patience with even their most reasonable constraints. Because dammit, don't they realize it is ME who is sick? ME! And since I am the center of my world, just as everyone is the center of their own world, obviously my sickness should be as important to them as it is to ME.

    Consciously I knew/know they have a lot of demands, and all my doctors are great, but when you come up against your own immortality, basically The Biggest Deal Ever, it's hard not to blame the person who can't save you and doesn't have all the answers you want immediately. There's a thin line between fear and hate.

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  12. Anonymous11:31 PM

    I wonder if the antipathy towards doctors isn't also part of the general popular culture antipathy towards intellectual achievement and education? There's a lot of antipathy towards what's perceived as "elite" status, no?

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  13. Anonymous11:43 PM

    I don't hate doctors (in fact I think my OB is pretty nifty, however our family doctor and my son's pediatrician...eh, they're okay) but here is what really made me stop and think about why I have issues (sometimes) with some doctors that I have come into contact with:

    I ended up (as the botched result of an action by a PA) spending the better part of my first year of marriage sick from a mystery illness. No one could figure out what the deal was and in seeing no less than 3 different doctors (only because we moved across the country mid-way and then because I had to eventually be referred to a specialist) was pretty much told that I was imagining my symptoms and needed to get over it. It was probably the single-most frustrating experience of my life because no, I wasn't imagining what I was going through (later confirmed through x-rays & a few other tests) and because although I do not get to put the letters M & D after my name, I am fairly educated. I went to college and managed to graduate at several levels and yet here I was being told that I didn't know what I was talking about. I think if I could have connected with a Dr. that took the time to realize that I wasn't asking for drugs/special treatment etc and saw me as a human being experiencing a very debilitating issue vs. a body with a peculiar set of symptoms...it may have left me feeling very different about the whole experience.

    I understand that a Dr's time w/each patient is limited and that they are trying to do the best that they can for their patients within the constraints that the system (unfairly) puts on them--I think it's like alot of professions--there are really fantastic teachers and there are less than stellar teachers as well. I think overall, people need to be more willing to stand up for themselves (not saying that if the first Dr. you go to doesn't do exactly what you want you should go Dr. shopping, but if you feel like continuously that you aren't connecting well with your Dr...maybe it's time to be proactive and see who else is out there) and perhaps some Dr's could be more willing to listen better to the input given by their patients.

    I don't know...it's definitely a broken system (unfortunately like alot of other 'systems' in our society) and I don't necessarily see it getting better anytime soon.

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  14. I do "hate" some doctors. Two to be specific...and I'm Canadian so it has nothing to do with money.

    I also happen to have a few doctors that I would most certainly risk my life to save (sounds kind of backwards, but I would).

    I'm still doing my undergrad, and hoping to go into medicine. As a kid who as been sick for a large portion of their life, I know better than most what makes a good doctor and what makes an abomination of the medical profession.

    The two doctors I most certainly hate and almost turned me off medicine for life were arrogant, and I swear they didn't care if I lived, or had any quality of life whatsoever.

    The ones I would die for actually listen, try to do everything they can to help me, and even when there is nothing that can be done, they are at least comforting. Being a doctor is not all about medicine, its about being a person, its about trust. I can't speak for everyone, but 'bad' doctors do not seem human at all.

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  15. jane doe1:38 AM

    In my country, we're an egalitarian society with a dirty underbelly of the 'tall poppy syndrome', which neatly and brutally cuts people off at the knees if they are perceived to be acting better than their mates. As such, professionally successful people tend to be denigrated - with the exception of sports people, who are universally regarded as gods.

    I also think that doctors get a bad rap because our colleagues openly and loudly indulge in a lot of unfair generalisations. Some (not all) in the nursing profession - perhaps our closest and most frequent colleagues - are fond of nurturing the "all doctors are pigs" stereotype, which does us no favours at all. If the people who work with you the most, frequently bad mouth your industry, mud eventually sticks.

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  16. I've mostly really liked my doctors but as a health insurance actuary I have seen how much variation there is in practice to blindly trust them ever. I do a lot of research and independently assess whether the practitioner I see has solid evidence to back up their recommendations. I also think critically about the risks, benefits and costs of different options and expect that my decisions are respected. I truly believe that most doctors try to do right by their patients - I just don't have confidence that the information and incentives they have support that.

    A whole other dimension to the issue is factoring in cost. In general doctors don't have a very accurate idea of the cost implications of their decisions and even when they do it is rare for them to include that in a shared decision making process with the patient.

    I see both issues (evidence based-patient centered care and efficient use of health care resources) as health care delivery systems issues and not (usually) personal failings of individual doctors.

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  17. I hated the internist I had before I went to med school. She didn't like it when I asked questions, talked to me like she thought I was non-compliant (I wasn't), didn't listen, tried to convince me that there were 48 weeks in a year, and when I told her I was doing an MD-PhD program went on a tirade about how MD-PhDs make the worst doctors.

    (Hi Dr. B!)

    Not all doctors are like her, but I can't say it's rare either, unfortunately. I'm pretty sure that several of my med school classmates are going to end up just like her. I'm guessing that most patients don't have the balls to say, "Are you seriously trying to tell me that there are 48 weeks in a year?" so they leave resentful. Heck, I was resentful and I did have the balls.

    Also, a lot of patients don't know what to say (or what NOT to say) or how to act in order to get good service. Greasing the wheels at the doctor's office is So. Much. Easier. for me now that I know how to get what I want.

    Then there's the money issue. In general people who have less will always hate those who have more. It's just how the world works, sadly. There's also still a huge misconception about how much money doctors make, so that doesn't help either. Spending a lot of $ at the doctor is also stressful, since the process is hardly transparent, and you don't even know if you're going to get better. A lot of times it can feel like you're getting ripped off.

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  18. Why is it that these discussions of work/life balance center around working MOTHERS? Why is it the mothers that are judged - if you work full time you're an uncommitted mom, if you work part time, you're an uncommitted worker. This goes across all professions - it's certainly not unique to medicine.

    I bristle that it's the woman who is expected to "balance" when really it is that women are expected to be both supermom and superworker.

    At the President's Panel at Wellesley Reunion this year (I'm class of 1 9 9 6 Wellesley RAH!), a woman in the audience asked about work/life balance. How did these three amazing women have children and stellar, high-profile careers as well? (Sidenote: When each was being introduced, the speaker rattled off a long list of professional accomplishments, and ended with the number of children and grandchildren each had. The most audible murmurs of admiration came for the numbers of kids. President of Duke? No biggie. But four kids? WOW!!) And one of the presidents (forgive me for not remembering who - I want to say it was Diana, but it might have been HKB) said "It's harder now." In essence, 10 or 20 years ago, parenting wasn't the full-time, all-encompassing, competitive racket it is now. Now if you don't make organic meals from scratch every day and take your kid to Kumon math and Little Gym, people see you as negligent. Not too long ago, as long as your child was fed, clothed, loved, and not in trouble with the law, that was good enough. The definition of good enough as a mother has changed. And men still get away with being sainted if they are "involved", whatever that means.

    In the discussion on NPR, Dr. Sibert glosses over the fact that yes, men also go part time, but because it's at the end of their careers, it's okay. WTF? Really? If women should be asked to go balls to the wall from beginning to end, then the men should, too.

    Work/life balance is not just a women's issue, and it's irritating that it is still cast in that light.

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  19. Some perceptive comments here about why people make blanket negative generalizations about doctors. (As a fellow member of a hated profession, I feel your pain. I'm a corporate lawyer.) I just wanted to comment to say that I'm sort of shocked that your Psychology Today articles are so controversial. Doctors are people too? Vaccinate your kids? Doctors should be able to choose to spend time with their families? These aren't exactly fringe ideas. How do they inspire pages and pages of vitriol? It seems like no matter what you write, people use it as an excuse to unleash all their complaints about doctors.

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  20. CM -- I think you hit the nail on the head.

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  21. Around here, I think it's mainly three factors that this hate has emerged:

    1) People are absolutely certain that we make HUGE bucks, and since we're paid by the state ie taxes...

    2) People think we're the ones denying or delaying treatment, when it's really the insurance companies by refusing to pay for services or pay for enough of them. (My hospital runs out of L&D money every year in September or October. After that, all deliveries and perinatal care and high-grade MFM care are simply not paid for by anyone. Services are still provided, of course, but then people wonder why there's a huge waiting list for IVF. Might it be because we're having to rechannel funding for more imminent things? Like active labour?)

    3) It's always nice to hate the one who sticks out of the masses and tries to be ambitious and good at what they do. It's been ingrained into our society for several decades, and it's not disappearing any time soon. The mere idea that I might consider getting a higher education than the average Joe and going for a job that requires specialised training, means that I'm a greedy lazy arrogant bitch.

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  22. Anonymous12:56 PM

    Wow, everyone is so rational and has such well thought out answers! I'm impressed with the discussion here. Here are my thoughts.

    When my patients in the ED complain about their doctor ("They won't help me, They don't believe me, etc), I tell them, doctors are people too, we are not perfect, and you have to find someone you connect with and TRUST. It is kind of like dating. You might have to go to several different doctors sometimes until you find the one is best for you. I also tell patients (if I think it is true) that I suspect their doctor was trying to do their best with the resources she had at the time. It's all in the delivery-you have to be sincere (and I am)-but I do think many patients haven't thought about this before and it usually defuses their anger at least in the short term.

    I think expectation has a lot to do with it too. Expectations by patients often do not match up with the doctor's expectation of the visit. I think, as an ED physician, "Wow, I can't believe that patient came into the ER for that rash. Why do they think I would know what that is? Well, it isn't life threatening and doesn't require admission, it can wait until they see their PCP or dermatologist. Maybe this steroid cream will help in the meantime."

    The patient thinks "I can't believe I waited 4 hours and paid this much and that doctor didn't even help me. She's a doctor and she doesn't even know what this rash is."

    From there, I suspect for some patients it's only a short step to thinking the doctor can barely even stop lining their coffers with gold to tear themselves away to see patients for 5 min at a time.

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  23. It's so nice to read such thoughtful and civil comments! I agree with a lot of what people have written here. I think it has a lot to do both with insurance companies denying treatment and with lawyers whipping the public into a frenzy in order to find cases for themselves ("Have you or a loved one been HURT BY A MEDICAL MISTAKE or THIS VERY DANGEROUS DRUG?") It breaks my heart, because most doctors I know went into medicine to help people, while the same can't be said of some other fields. Doctors make some money while making the world a better place, and people resent that; other professions make tons of money and benefit only themselves, but the public doesn't seem to heap the same vitriol on them. More of my thoughts are here: http://muchmorewherethatcamefrom.wordpress.com/2011/06/22/medicine-vs-motherhood-vs-martyrdom/

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  24. I would also add that the anonymity of the internet has made it easier for someone to fire off all kinds of vitriol on line.... vitriol that the same person would think twice about saying out loud to someone's face.

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  25. Anonymous4:15 PM

    Dr. Au I love you and I think your blog is amazing. I'm so glad you are finding success with your book and career.

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  26. I'm a premed, but I also have two kids, one of which has special medical needs and we've seen A LOT of doctors in her life. We've had good experiences and bad, but the truth is it has nothing to do with the profession itself...it has to do with INDIVIDUAL physician personalities. Some people are awesome, some people are jerks, some people are caring, some people are selfish...and yes, this applies to doctors, too. They are not ALL good, virtuous, selfless people, but they are not ALL rude, heartless folks in it for the money. Sometimes it isn't even that polarizing, some people have bad physician experiences just because the personality types involved don't mesh well.

    I think most people get into medicine because they love medical science and want to help people. I want to be a doctor because I love the science of it, and I hope to become the kind of doctor that my patients will trust and develop a good relationship with...the kind of doctor that WE have had good experiences with. The money (except for eventually paying off the med school debt I will be in) isn't a factor for me, and I think that is also true of many people who go into medicine.

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  27. thank you. i am a soon-to-be third year resident in family medicine (planning to work in an urban health center, so no big bucks for me), and there are so many times when i read these comments and think, "really?" when i was a med student, i remember having people actually say to me things like "you CAN go look at that? isn't that why you make the big bucks?" to which i would calmly reply that i was paying $40,000 a year to be there. i think (i hope) that my patients overall like me, and that we get along, but the overall level of dislike, distrust, and anger is really upsetting.

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  28. I think it's a lack of understanding. Not everyone knows what a doctor goes through. They form their own perceptions. I'm a pharmacy student and most people believe that all a pharmacist does is count pills. They don't know that we go through 6 years of school and actually spend more time studying pharmacology than medical students do.

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  29. "Why do people hate doctors?"

    Because of the internet and ease of access to an overabundance of news information.

    When we constantly read on a daily basis the reports about medicare, medicaid, and other insurance fraud, pill-mills, pharma corruption, mis-diagnoses, incompetence, sexual crimes, and any other crime and corruption being committed by professionals that we admire and consider above reproach, it leads us to falsely believe that "all" doctors fit into this category.

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  30. Anonymous9:52 PM

    >>Why do people hate doctors? I mean, I kind of hate my dentist, but you know, not really--I just hate the reasons I have to go see him. But he's a good guy, doing his job, and I don't think he's a criminal or anything. Wherein does personal experience bleed into societal expectation?

    I'm a 4th year dental student. Ok, I'll admit that it made me a little sad to read that (coming from another hcp), but that kind of sentiment is hardly news with respect to our (and your) popularity with the public.

    It's too easy to say that I HATE MY ______, for there are countless others (in real life and especially on the internet) who would agree and add their own stories and assumptions and judgements. The profession becomes a faceless evil entity that is up against the welfare of all. There is a sense of unity, I guess, for people to rally together to stand up to that perhaps once paternalistic structure of professionalism. People bond over a common disdain for things. I get it.

    We could say it's ignorance. Lack of understanding. Lack of the desire to understand. Does it feel like an uphill battle when presumptions are already made about me before they sit down in my chair? It's unfair, disappointing, and sometimes I wonder why I even bother.

    But really, at the end of the day, I do my job honestly, with kindness -- I'm saying that not because I'm patting myself on the back, but because that is what I am, and it is part of my job.

    Do I wish that my/our profession would have better PR? Of course. Have I ever thought about not practicing so I don't have to deal with unrealistic demands, malpractice lawsuits, difficult patients, insurance BS etc etc? All the time. In my naivete, I feel that I don't deserve this irrational and unfair hate.

    But I also think, if I can come home and say to myself, hey, I did some good today, at least for now, that's all I'm asking for.

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  31. (I don't really hate my dentist! I just hate my teeth and their tendency to misbehave! I FLOSS AND EVERYTHING.)

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  32. Anonymous9:33 PM

    I just found out that being a doctor raises my car insurance because...people in an accident are more likely to sue me...just because I'm a doctor. Another moment of bliss about my career choice.

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  33. Anonymous8:46 PM

    As a medical-services-consumer I can tell you that there are Drs out there who rock: who are upfront with information and let you know where they're going with their thinking and why, who make you feel as though you are on the same team & working toward a common goal, and who are more than willing to level with you when they are up against a challenge that is keeping them on their toes. Those kinds of doctors can't be spoken of highly enough. They are (to me) the epitome of professionalism while also being real people that you can respect, relate to and trust.

    Then there are doctors who don't hesitate to let you know where you sit in the Dr-patient hierarchy (you lowly patient you), who refuse to share their thinking with you since you lack a medical degree (regardless of any other education you might have) - you are by default too stupid to understand, who act as if they have some kind of ownership rights to your body, and who tend to be less helpful at the end of the day than the Drs who work *with* you. They tend to give off an air of smug infallibility and any input you might have as a patient is unwelcome. This kind of Dr is becoming more common and they have a knack at chipping away both your respect & trust for them as individuals and for the profession as a whole.

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  34. Anonymous8:55 PM

    Actually, to be fair I should post-script that - the part about the second kind of doctor becoming more common - because maybe it's not entirely accurate and I'm biased by my own frustration. I have recently moved internationally and I am struggling to find the first kind of Dr in my new home. I used to be spoiled for choice, I wish flying back home for healthcare was an option!

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  35. Dr. Au, I just wanted to thank you for making your views on Dr. Sibert's article public. I'm an M2 and was kind of horrified by the way the burden seems to be placed solely on the woman doctor who wants to do right by her patients and her family. It's especially disheartening as I'm at the point where I really need to start thinking about about specialty and whether I can be as good a mom to my [future, still-only-a-concept] children as my mother was to me and still work in a field with demanding hours.
    I firmly believe in choice (I'm a liberated woman, gosh darn it!) but I wonder what sort of effect views like Dr. Sibert's will have on residency committee's decision--that's a pretty scary thought, especially when I think I'm working just as hard as the boys.

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  36. Sonic8:16 PM

    Your husband may pack his lunch every day, but if he WANTED to, he could probably afford to each out at a relatively nice restaurant every day.

    That's the difference between him and someone who needs to save money. It's not bad that you have money, but own up to it, you're richer and therefore more privileged than some people in our society in that regard.

    Also, people hate on mothers because it's easy and they're sexist - they blame mothers because they see women as either two things: workers or moms. If you're not one, you have to be the other. If you're one and you fail at the other, you're a failure as a woman.

    But for men, our society has lower expectations for them as a parent. In fact, to a lot of people, it'd be WEIRD for a man to stay at home. So if he's not that great of a dad...oh well, at least he's a fantastic CT surgeon!

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