As humans, we judge the people that we meet even before we know anything about them. Even before we hear what they have to say, we have categorized them in a box – “nice”, “stupid”, “racist”. When we hear bad or unpleasant news, it is tough for us to separate our feelings about that news from our feelings about the news-bearer. Several studies show that the more a patient knows about their poor prognosis the less they like their physician. I have had first-hand experience with patients who have been hostile to me on our first encounter because they have a chronic infection, let’s say a prosthetic hip infection, that has made their lives miserable for years. I don’t make the situation any better when I tell them there’s nothing I can do to prevent their infection from flaring up now and then.
In medical school, we are taught how to communicate bad and upsetting news, and how to absorb the patient’s reaction to such news. However, we are not taught how to survive a shooting. In my orientation to the several different hospitals and medical offices I have worked in, I have not participated in an “active shooter drill”. What am I going on about? What kind of paranoia am I suffering from?
But can you blame me? I live in the United States of America, a country which its own president, President Obama describes as having “a pattern now of mass shooting … that has no parallel anywhere else in the world”. After the latest San Bernadino shootings earlier this month, several news outlets were quick to report that there had been 353 mass shootings so far this year. This is frightful. More disturbing is the seemingly inability of US lawmakers to do anything about it.
I write this blog in memory of Dr. Michael Davidson, the highly respected cardiovascular surgeon at Brigham &Women’s Hospital in Boston, who was gunned down inside the hospital earlier this year. The shooter was a “nice man” who had no history of violence and had a license for his gun. He was however a man disgruntled with the American health care system and unhappy with the death of his parents, specifically that of his mother two months earlier. His mother had been a patient of Dr. Davidson. The incident was not much talked about in the media, except to say it happened, but it weighs heavily on my heart and thoughts as well of those of many of my medical colleagues.
On top of the misinformation and lack of trust is the culture of litigation. Of course, I live my professional life with the threat of being sued, rightfully or not, but not until now did I think I could lose my life for a bad patient outcome. The fact that there was little outrage about Dr. Davidson’s murder signals to me that we should expect to be killed for being doctors. Am I now to live in fear of my patients”?The American health care system is broken. This country spends more health care dollars than any other Western country for mediocrity. I can understand how patients are angry. In 2012, Medicare enacted Value-Based Purchasing which ties a fraction of a hospital’s reimbursement to quality measures such as patient satisfaction. We are moving towards tying physician reimbursement not just to patient outcome but also to patient satisfaction. Imagine that. So far, studies have shown that higher scores on a patient satisfaction survey does not correlate with better health outcomes. So far, the most satisfied patients have incurred the highest costs and have the highest mortality.
As humans we will get sick. Newsflash! We will in fact die. We have had amazing growth in the achievements of “Western medicine” in the past century but we have not yet prevented death. Prolonging the path to death? Yes, we can do that!
I feel that the American public has come to believe that every disease is curable and that every outcome should be a positive one. We are a society unwilling to accept death as a natural part of life. Heck, we are a society that even refuses to come to terms with our own decay and to accept decrepitude as part of life. We are all to be young and beautiful and if we need refurbishment, we should come out good as new. We think that more treatment, more tests, more medicine is better care. Sadly, this is not true. Unnecessary tests find incidentalomas and unnecessary treatment leads to adverse effects that only prolong suffering and increase cost.
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