Monday, June 20, 2011

tell me more

Today's round table for "Tell Me More" was a lot of fun.  Of course, with only 17 minutes of alloted airtime and 4 panelists (Dr. Siebert and I were joined by Dr. Randi Hutter Epstein, medical journalist and author of "Get Me Out of Here"; and Dr. Laura Ment, Dean of Admissions and Professor of Pediatrics at the Yale School of Medicine), there was barely enough time to scratch the surface of the issue, but scratch it we did. Scored it, in fact.

Given the time constraints, there's always things that you wish you'd gotten a chance to say but didn't (though I'm particularly grateful that I didn't say something I wish I hadn't--as sometimes can happen, see: my oral board prep sessions #s 1, 2, 4 and 6), but of all the things we didn't get a chance to touch on, here's the one thing I wish I'd said most of all: it's about choices. The choice to do and be what you want. The choice to become the Dean of the Medical School. The choice to become the Chair of the Department of Cardiothoracic Surgery. The choice to cut back on clinical hours so as to spend more time with one's family. The choice to do good, and "above all, do no harm," in the way that seems best and most appropriate for each individual and those they care for. All talk of indebtedness and societal obligation aside, the mark of an advanced society is the freedom its constituents, and what I really want, above all, is for ability for doctors--yes, even doctors--to make any of these choices, and for these choices to not be so polarizing as to have to inspire a national debate.

Segment will air on "Tell Me More" tomorrow (trimmed for length), and the full roundtable will be available online. Thanks to all my intelligent and insightful colleagues for the rousing discussion, and to the lovely Michel Martin and NPR for getting us all together.


  1. I can't fathom how anyone can possibly disagree with the completely reasonable position you put forth. Is it just a will to be cantankerous?

    Also, I had some fun with your book at work...posted it on your facebook wall. Hope my airline doesn't go ape over that! ;-)

  2. Well, it's VERY GOOD ADVERTISING for Jet Blue! :)

  3. Can't wait to hear it. You are exactly right, everyone (men, women, and DOCTORS) should be able to choose what is right for them. I think what was so shocking to me about this whole debacle is that there are people who don't believe that should be the case!

  4. While I disagree with most of what Dr. Sibert had to day (and particularly dislike the overall tone of her article), I think the reality is that doctors do have an obligation to society that stems from 1) the oath we all take and 2) the funding that society provides for our training. The big question, I think, is just how much of an obligation that is and where our personal desires and values trump that right. To shamelessly plug my blog, I've tried to address this as eloquently as I can here: I would love it if people would stop by and comment!

  5. Yes, Medicare subsidizes residents salary, but let's not forget that in exchange for that, residents work thousands and thousands of hours doing jobs that I daresay would be difficult to hire anyone to do--a constant stream of highly skilled labor without which it would be difficult to run a large academic hospital. That's how we pay back the subsidy. Should doctors be held accountable for this stipend in perpetuity? Interesting question...

    Also, there are many other examples in which education is wholly or partially government subsidized. Should people who attend state schools or who receive government scholarships be similarly obliged to pay back society with the education they have received?

    Medical training is a long, hard slog. People do not take the decision to enter the field--or in fact leave the field--lightly. It's really not as capricious a decision as Dr. Siebert makes it out to be--it can't be. You would never get through the 10+ years it takes to become a doctor if you were just doing it on a whim, viewing it as an easy career to flit in and out of. And while in fact, while I know a good many physicians who work part-time or reduced hours for varied reasons, I can't think of one person from my medical school who is not using their MD at all (unless you count the people who went from med school straight into business school, and those were all men).

  6. Anonymous2:01 PM

    Not only that but speaking from an Australian perspective, my degree is as long (and expensive to the government) asmy brother's mechatronics engineering/law double degree. Does that mean he is indebted to society given the government has paid so much for him?
    What about the student who goes through arts, science, law, a masters, a PhD then leaves it all behind to chase their passion of being a pro-surfer?
    To an extent the government's spending is everyones business but not to the point where we should be micro-managing what people do with their education.
    Similarly what about the person who goes to a private high school then enters a private university and pays their fees upfront? Are they then not required to give the same amount of service as someone who attended state school and a state funded university/teaching hospital?
    We aren't talking about using our medical degrees for evil, we just want to see our loved ones! I feel sorry for my poor wife who after only 3 years in the medical field is starting to say things like "I really miss you sometimes", and can i reiterate that's not from interstate travel, thats from pulling 42 hours of work in a 72 hours time period which happens to me once a month as part of my roster (NOT overtime!)

    Everything in moderation world

  7. Anonymous5:27 PM

    If the idea is to do no harm, then one could also argue that doctors who work long hours because they feel obligated to do so even though they got burned out years ago might be doing harm to their patients - an internist who wishes he could work fewer hours or quit altogether but feels that he can't might not have his whole heart and mind in his job and end up making mistakes for which his patients would pay.

  8. I've read Dr Sibert's original OpEd, her response to comments on the NYT Motherlode blog, and now have listened to her on this piece. I still do not get her point, regarding how specifically mothers working part-time is leading to a doctor shortage & will cause a healthcare crisis. She admits that the shortage is in primary care & in underserved areas. Then she goes on to say that a male doctor going to work for industry or perform cosmetic surgery full-time is NOT contributing to the problem. I just don't get the logic. If you are going to argue that doctors need to pay back their "heavily subsidized" medical training (which is debatable in itself) by providing needed care to society, then ALL doctors should go work in primary care in underserved areas.
    AND at the end of the piece, she mentioned that you shouldn't choose your specialty based on hours or flexibility---yeah, right. Why and how would you choose a profession without ANY thought to the lifestyle? You'd be asking for burnout.
    I'm sure she is a very intelligent women but this argument is completely devoid of logic, and overshadows any of the real important issues that are on the table.