Surgeon’s Death Spurs Painful Debate On Docs As ‘Face Of Health Care System’

Flowers are left outside the Brigham in honor of the slain Dr. Michael Davidson. (Robin Lubbock/WBUR)

Flowers are left outside the Brigham last week in honor of the slain Dr. Michael Davidson. (Robin Lubbock/WBUR)

Shocked and saddened by last week’s shooting at Brigham and Women’s Hospital, Dr. Miranda Fielding wrote a blog post that appeared on KevinMD, a popular site that gets 5 million clicks a month: “The Legacy of Dr. Michael Davidson.”

KevinMD, as founder Dr. Kevin Pho puts it, aims “to share the stories of the many who intersect with our health care system, but are rarely heard from,” including practicing physicians. He adds: “The public often doesn’t know what it’s like to work in our health system. gives them an unfiltered view of our world.”

Dr. Michael Davidson (Courtesy of Brigham and Women’s Hospital)

Dr. Michael Davidson (Courtesy of Brigham and Women’s Hospital)

In the case of Dr. Fielding’s post, that unfiltered view reveals not only deep pain at a distinguished colleague’s death but also a far broader discomfort with serving, as one commenter puts it, as “the face of the health care system” — a system that sometimes harms patients, medically or financially.

In her post, Miranda Fielding — the pen name of a California-based radiation oncologist who blogs at The Crab Diaries — recalls from her own professional past a gentle colleague who was viciously beaten by a former patient, and writes:

When we graduate from medical school, we take the Hippocratic Oath, which in the modern version not only exhorts us to heal the sick, but to exhibit warmth, sympathy, and understanding. Let our patients and their families extend those same traits to us as we complete our daily rounds. Let our clinics and hospitals be places of healing, and not of killing. Please let us do our jobs.

I only wish that I had the answers to the groundswell of anger, frustration and resentment voiced in the comments on my blog.

– Dr. Miranda Fielding

Her post has been shared on Facebook more than 40,000 times, and sparked more than 150 comments. The post, Dr. Pho emailed, “clearly touched a nerve with my audience and highlights the sacrifice that health professionals make every day.”

But the response to the post highlights more systemic issues as well. Among the comments, the most popular, by a writer identified only as “guest,” refers in part to the report that the alleged Brigham shooter had complained in the past about a medical bill for the heart attack that killed his father:

What we as a profession appear to be (willfully) unaware of is that we doctors are the face of the healthcare system. To the extent that we do not speak up, protest and advocate for our patients when they are taken advantage of by hospitals and insurers, we provide a face for patients to blame. Anyone who doesn’t think that corporate executives and hospital administrators take full advantage of the opportunity to hide behind us as they maximize profits at the expense of our patients, is a fool.

We may think that because we go through our days bathed in an aura of self-righteous goodness (Look how we’re the smartest person in the room! How hard we work! How little sleep we get! How many of our child’s soccer games we’ve missed in order to care for our patients! How we do all this without even mentioning it to our patients, because that’s how good we are!), that that is how our patients see us as well.

But they don’t. They see the fancy cars in the parking lot, the children going to elite prep schools, the expensive hobbies like equestrianism, the hospital system charging $8,000 for a 15 minute emergency room visit that ended in death, the collection agency coming after a grieving family. And they blame us for not doing more.

Responded another commenter:

This is a horrible tragedy for all involved — him, his family, friends, colleagues and his other patients. And for other docs out there who are now more afraid. My heart aches for the victim of this violence and for all of us.

But you’re right. This did not happen in a vacuum. Continue reading

State Of Mass. Docs: Primary Care Tight, Fewer Trainees Stay

(From the 2013 MMS Physician Workforce Study © 2013 Massachusetts Medical Society. All rights reserved. Posted with permission.)

(From the 2013 MMS Physician Workforce Study © 2013 Massachusetts Medical Society. All rights reserved. Posted with permission.)

Every year, the president delivers his “State of the Union” address, and every year, the Massachusetts Medical Society puts out what I think of as its “State of our Doctors” report. The president usually sums up the state of the union as “strong,” or “sound” or some similarly reassuring adjective. The Mass. Medical Society report — formally titled the Physician Workforce Study — is now out here, and might be speechified as “The state of our primary care workforce remains tight.” Also, “The farther you get from Boston, the fewer physicians want to go there.”

From the report’s summary:

The Massachusetts Medical Society’s 13th annual Physician Workforce Study found that four physician specialties in Massachusetts in short supply:

Family medicine
Internal medicine

The study showed striking differences in physician recruitment and retention among the state’s five regional labor markets. With the Boston/Greater Boston market as a baseline for comparison, the study shows that it is three times as difficult to fill physician vacancies in the Pittsfield/Western Massachusetts market, twice as difficult in the Springfield market, and more than one-and-a-half times as difficult for the Worcester and New Bedford/Barnstable regions than it is for the Boston/Greater Boston region.

From WBUR and the AP:

Massachusetts Medical Society President Ronald Dunlap says it’s the eighth consecutive year the survey has found critical or severe shortages in family medicine and internal medicine, the two primary care specialties.

“Twenty, 30 years ago, people would love to stay here because it’s such a great region, most people would take a discount to stay in Massachusetts,” Dunlap said. “But more recently we’re less competitive. So we train more residents than any other area but we retain fewer of them than we have in the past.” Continue reading

Patient Seeks Doctor To Express Gratitude

Boaz Tamir today

Boaz Tamir today

Please help a grateful patient find a doctor from his past in order to say “Thank You.”

Here’s the back story:

Last week, former Beth Israel Deaconess Medical Center CEO Paul Levy wrote a post about 20-year-old Boaz Tamir, who in 1973 was the leader of a defensive tank group on the Golan Heights in Israel when the Syrians attacked. “In the course of the battle, he was blinded by shrapnel and taken to the closest hospital for treatment,” Levy writes. In that small hospital was a “young American doctor” who was able to treat Tamir and remove the metal particles from his eyes. With his eyesight restored, Tamir “‘escaped’ from the hospital and rejoined the tank battalion as it began the counter-attack toward Damascas.”

Levy continues:

Because Boaz left in such a hurry, he never had a chance to thank the doctor. He later tried to track her down but was unable to find her.

Now, 40 years later, Boaz told me the story. I said that, with his permission, I would begin a search for this doctor [who may be an eye specialist, a general surgeon, or something else] using our social media tools.

So here we are. If you know a female eye surgeon (or perhaps a general surgeon) who spent some time in Israel during her training and might have been in Tiberias during the Yom Kippur War of 1973, would you please submit a comment on this blog post? Continue reading

Survey: Docs Healthier, With Better Habits, Compared To Others

Doctors appear to be taking their own health advice and as a result are in better physical health compared to those in other professions, even nurses, according to a new Gallup survey.

The survey of 1,984 physicians and 7,166 nurses found that overall, the doctors scored higher on the “Gallup-Healthways Well-Being Index” which looks at both general health and health-related habits. The questions include 18 items on a “Physical Health Index” which looks at sick days, disease burden as well as “health problems that get in the way of normal activities, obesity, feeling well-rested, daily energy, daily colds, daily flu, and daily headaches. The four “Healthy Behavior” items on the survey include smoking, eating healthy, weekly consumption of fruits and vegetables, and weekly exercise frequency.

(Notably lacking here are questions about mental health. I wonder how the docs would fare if they were asked about burnout, faith in the medical system and their response to new and ever-growing paperwork related to various health reforms?) Continue reading

Workplace Bullies As Health Threats, Especially In Health Care

Normally, we do our best to ignore artificial news events like “disease-awareness” days. But when it crossed my screen that this is “Freedom From Workplace Bullies Week,” I jumped at the chance to write about the devastating mental and physical harm that a bad boss — or co-worker — can wreak.

Over the last couple of years, I’ve watched three friends suffer through jobs turned bad by bully bosses. It was horrifying and infuriating, to see three virtuous, diligent, intelligent people laid low in ways that struck not just the wallet but the deepest sense of self. Said one:

“It was a feeling that never left, that didn’t lift when I went home for the night or weekend. It was starting to color all of my experiences. And I had real suicidal thoughts for the first time since my junior year in college, 22 years earlier.”

Another started to lose sleep and even hair: “It was awful and threw my entire system out of whack.”

The third entered a state of prolonged panic and anxiety-induced exhaustion. I fantasized about writing a letter to her boss: “Do you understand the pain you are causing, not just to her but to her entire family?”

This was not just a flukish statistical cluster. A Zogby International poll commissioned this year by the nonprofit Workplace Bullying Institute — slogan: “Work Shouldn’t Hurt” — found that 35 percent of the American workforce had been bullied at work, and another 15 percent had witnessed it.

Now for the health aspects: The research found that among those being bullied, 45 percent reported related health problems. They are so common that on the Workplace Bullying Institute’s FAQ, the fourth question is: “Is it normal for my health to be falling apart?” (The answer begins, “It is not good, but it is typical.”)

Law professor David Yamada of Suffolk University

David Yamada, a professor of law and director of The New Workplace Institute at Suffolk University, is a leading legal scholar on workplace bullying, and has been helping to lead a new push to pass a law against it in Massachusetts. (His blog is here.)

His “Healthy Workplace” bill died in the latest legislative session, but plans are afoot to re-launch it next year, he said. Organizers are meeting at Suffolk later this week to strategize.

So what is known about the health effects of workplace bullies?

Summing up dozens of studies, Prof. Yamada said that “At a minimum, we’re talking about all sorts of stress-related disorders; clinical depression; in more serious cases, hypertension; at least increased risk of cardiovascular disease; evidence of impaired immune systems. We are seeing symptoms very consistent with Post Traumatic Stress Disorder.” Continue reading

Daily Rounds: ‘Biggest Loser’ Study; Denial of Insurance; ‘Myth Of CSI’; Hospitals Lure Doctors; Vaccine Language

'Biggest Loser' workouts drop fat without losing muscle mass –“The grueling boot-camp workouts on NBC's The Biggest Loser help contestants lose large amounts of body fat while preserving their muscle mass, a new study shows.”(USA Today)

Insurers Denied Coverage to 1 in 7 – “The four largest U.S. for-profit health insurers on average denied policies to one out of every seven applicants based on their prior medical history, according to a congressional investigation released Tuesday.” (Wall Street Journal)

The myth of CSI – The Boston Globe “The quality of American crime scene forensics is wildly inconsistent: many labs have poorly trained investigators, antiquated equipment, and cases backed up for weeks. In some labs, investigators have purposely altered test results in order to get findings that favor the prosecution.” (Boston Globe)

Hospitals Lure Doctors Away From Private Practice : NPR “Last year, half of new doctors were hired by hospitals, according to the Medical Group Management Association, a professional organization for physician practices. According to a 2009 report by the American Medical Association, 1 in 6 doctors works for a hospital, and the number is quickly growing.” (

Supreme Court Hears Arguments in Vaccine Case Against Wyeth – “Much of the argument concerned the meaning of the word ‘unavoidable.'” (The New York Times)

Top 10 Now Top 16 Reasons Doctors Over-Order

Commenters sent in some wonderful additions to our Top 10 Reasons Why Doctors Over-Order:

11: Double-ordering. In the age of collaborative medicine, patients are often transferred from service to service, floor to floor, hospital to hospital. Their records are supposed to follow them… but do not always arrive swiftly, easily, or in a convienent format. Masses of rubber-banded paper; bulky X-ray films; software incompatabilities… the number of ways one doctor’s test result can fail to reach the next in the chain is endless. And sometimes, doctors even know that their colleagues have ordered a test…. and re-order it anyway, because it’s easier to do the test over than find the result in the mountain of records.

12 and 13: You don’t trust the lab results from a different facility and redo it at yours. And it is part of a templated set of orders and it’s just ordered along with the rest of the orders. Continue reading

Top 10 Reasons Doctors Over-Order

Just recently out of medical school (and the Kennedy School of Government as well) Dr. Neel Shah has a particularly keen eye for medical culture and its tendency to overlook what things cost. He founded the Boston-based non-profit Costs of Care last year to try to change that culture. We wrote about the group’s essay contest yesterday; for today, we asked Shah, currently a resident in obstetrics and gynecology at Brigham and Women’s Hospital, for his top 10 reasons that doctors might over-order tests or treatments. What do you think? Would you add or subtract anything from this list?

  1. How we’re taught: Doctors are taught to consider whether a procedure is safe and whether it’s likely to work. We’re almost never taught to consider cost — it’s considered taboo.
  2. Trying to do our best for the patient: We’re worried. Often we over-order because of our personal risk aversion.
  3. Pre-emptive ordering: For residents, who do much of the ordering of tests in hospitals, it may be more efficient to order tests now rather than later. Standard practice might be to order a relatively cheap screening test and then if it’s positive, order other expensive tests. Instead we sometimes just order everything at the same time so we don’t have to wait.
  4. Covering all bases: In medical culture, doing more is equated with being thorough. If there are five possible conditions that may explain a patient’s symptoms, and it’s probably going to be one or two of them, we might order tests for all five conditions right away.
  5. General unawareness: We just don’t know what things cost. When you talk to people and say, ‘Do you know a magnesium level is $70?’ it blows their mind.
  6. Continue reading

Survey: 94% Of Doctors Use Smartphones

More than double the rate of the general public. Lots of iPhysicians: 44 percent on the iPhone.

Spyglass Consulting Group reports:

Ninety-four percent of physicians interviewed were using smartphones to
communicate, manage personal/business workflows, and access
information including medical reference materials.  Physician
smartphone adoption is occurring more rapidly than with the general
public which is evidenced by a recent AT&T announcement reporting 42
percent of their subscribers were using smartphones.  Forty-four percent
of physicians interviewed using smartphones had adopted the Apple
iPhone followed by 25 percent who had adopted the RIM Blackberry.