Physicians

A patient’s perspective: Do doctors read?

After monitoring e-patients.net and The Health Care Blog, I have to ask: Do doctors read? And if so, what?

I know four things from my own experience (and watching “Grey’s Anatomy”).

First, physicians are busy often exhausted individuals who deal with life-and-death matters.  For some, a robust sense of importance, if not their institutional setting, makes them deaf to patient input. The work-to-the-max ethic and lifestyle is inculcated since before medical school.

Second, physicians in my daughter’s chain of medical events were highly resistant if not resentful of patient input regarding new sources of information, from medical to newspaper to Internet articles. Regardless of how tactfully the material was presented.

Third, as is clear from my own posts, the ones I encountered don’t read The New York Times.

Fourth, the doctors I know, when they do have leisure time, spend it at the health club, on the ski slopes, at the theater or flying jets. They don’t read for leisure and thus are unlikely to familiarize themselves with the irony, say, of Robert B. Parker’s Spenser novels. Irony is useful here in that it, and the humor in Spenser, arises from the skepticism of a Single Joe dealing with large, but not efficient, corporate and government entities.

So I raise the question: Do doctors read? And if so, what?

Whatever they are reading, or not reading, seems to contribute to the ossification of attitude implicit in David Kibbe’s recent post on The Health Care Blog about his quest to urge physicians to adopt up-to-date Information Technology.  Of all the entities involved in transformation of the health care system, the physician community seems least able to adapt to changing times.

Christine Gray is a patient who blogs at e-patients.net, where this post first appeared.

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28 replies »

  1. My brother suggested I would possibly like this blog. He used to be entirely right. This post actually made my day. You cann’t imagine just how a lot time I had spent for this info! Thanks!

  2. I believe what many of the above posts fail to consider is that EVERY doctor is putting their professional career at stake with EVERY decision they make regarding a patient’s treatment. Be realistic, if you had spent 12 years after high school training just to BEGIN to make enough money to live comfortably, which would put you at least 30 years of age, would you not hesitate to risk all of that work, all of those years spent studying and sleeping for three hours (sometimes, in fact often, less) a night, on a patient’s recommendation for treatment? I have an incurable disease, one which prevents me from ever being able to raise a family or secure a job that pays more than minimum wage, but I know that asking my doctor to risk their career on what I think MIGHT work is not taking into consideration their happiness, their life, their professional opinion. I would also simply say that the WAY information is presented matters a great deal to physicans. Try a little tenderness….so many of these people sacrificed so much just to help cure disease…they could’ve been bankers or teachers or anything else, but they chose to become physicians, nothing more and nothing less. I know, believe me I know, how frustrating it is to be sick and not know if you’ll ever get better, but criticism is a far cry from the best one can do to help alleviate and perhaps even solve a problem. If you want to cure a disease, do what I do; study biology, chemistry, physics, computer science, and so on, and do it the ‘hard’ way….the way doctor’s do it every day: by applying science and doing your/their level best to help. Sorry if I offended anyone, that was not my intent. If you aren’t satisfied with your physician, it’s not like they’re the only person practicing, no? Make some phone calls, read some journal articles, for heaven’s sake…PRAY….if your doctor is too busy to listen and too overworked to help there are people out there who will. Just my two cents…..

  3. Doug,
    Thanks. I really appreciate your thoughts AND the time you spent in thinking them:)
    Check out the more recent commentaries on the Kibbe discussion.
    We may have been examining the wrong part of the elephant in terms of physician frustration with IT (no hind end of elephant jokes please), time/profit etc. It doesn’t address the point of how well physicians listen to something relevant but outside of their own experience — in some circles that might be called new ideas 🙂 — but coming at the problem from another angle (ditto above) might help reframe the problem.
    Some basic points hold true: Patients need to hear of physicians’ feelings and viewpoints to open up communication. That is the other side of the “deafness” issue: the assumption is that patients talk, doctors listen (but try not to waste too much time doing so). How about when physicians talk back to patients in a nice peaceful respectful way? ommmmmmm

  4. Nuts to this. I have to fly to NY on business so I won’t be able to play for a while. But keep checking in.
    The more physicians talk back about the conditions of their lives, and how they feel about things (that would be the F-word), the more patients can learn.
    Meanwhile, check out a Sara Paretsky mystery novel (the early ones), if nothing else, to imagine yourself in the position of educated patient-advocate (yourself in female dress).
    I warn you: Get a gun in case someone calls you “the mom” when they’ve lost a record, or have half scared your kid to death.
    Then they will call you hysterical 🙂
    btw check out the New York Times editorial today on how US health care has failed and also an internal story about how the market has clearly failed, given US health standing via The Netherlands. (Probably works because they have a Queen there 🙂
    THE MARKET DOESN’T work, and it has hurt discussions here in some ways.
    Best to you all. Thanks for chiming in.

  5. I don’t know about all of you, but I am anxiously awaiting Christine’s response. I even made popcorn!
    But seriously, these discussions really need context. We all sound like a bunch of know-it-alls when none of us really knows the half of it. Our healthcare system has deep multi-dimensional problems that span the various stakeholder classes. If there were easy answers, we would have figured this out by now.
    We could easily compile a list of the various stakeholders and the things each could contribute to meaningful reform. We’re already talking about these things! The tragedy is the fact that our collective brainpower is wasted because we never have a true endgame. I suppose blogs are not sufficient mediums for creating reform proposals…

  6. I did not mean to IN ANY WAY IMPLY, by commenting only the underlying time/money dimension to the problem, that any of the information/power/gender/openness-to-other-ideas central issues of this discussion aren’t (a) real and (b) terribly important. I just don’t have great expertise or good solutions for them. If this is Rock Soup, I have one onion to add to the pot.
    And I don’t hear much of anybody disagreeing with any of what you’re saying. I’m certainly not.
    But I’m reluctant to back away from the core of my contributory onion, that any proposed solutions for any of the many woes of health care which fail to consider the financial aspects will fail.
    As was once famously said by the (female) head of a very large Catholic health care system encompassing many hospitals, “no money, no mission.” Even providers with the purest of not-for-profit motives can’t ignore that reality.
    You brought up EMRs. There’s strong reason to believe that wide-spread adoption of EMRs would improve outcomes and efficiencies of the so-called health care system. So why has adoption been slow ?
    Because within that “micro-niche” I referred to previously, the localized cost-to-benefit ratio is (usually) negative. (Or perceived to be that way.) Practices pay hard cash to acquire and implement those systems, then spend more time and money putting data in, and most of the benefits (reductions in unnecessary tests, better portability of patient information, etc etc) accrue to other parts/participants of the system.
    Exact same thing with Physician Order Entry Systems. No question they reduce errors, catch more contraindications and known allergies, etc., and thus improve patient outcomes. Why slow adoption in the face of seemingly compelling arguments? Again, because the perceived cost by the parties (physicians) bearing the operational burden … i.e., time spent doing data entry … exceeds the perceived benefits flowing into their micro-niche.
    We’re (mostly) rational human beings, and that’s a rational decision, given the (?peculiar) reality of the micro-niche. Want people to behave differently ? Re-engineer the micro-niche so that local incentives align well with system incentives, and system incentives align well with global social values. People change readily enough if they receive a net benefit of doing so.
    (I filter my view of human systems through anthropological glasses.)
    Re “are [physicians] deaf to new and imaginative patient input?” …. clearly many/most are.
    And I don’t want to make excuses for what’s inexcusable, such as failure to treat each and every person with respect and empathy.
    But if you were to expand the question to “are [physicians] deaf to new and imaginative input from anyone besides other physicians?” …. IMO the answer would be the same, “Yes for the most part, although there are lots of notable exceptions.”
    Nurses face this, as do administrators, IT people, health policy wonks, etc., so it’s not limited to just patients. The normal ante to sit at the figurative table as a credible participant for any discussion of the non-clinical or clinical parts of how physicians do their work is the initials “M.D.” after your name. No M.D., no cred.
    In thinking about this here & now, I wonder if this attitude isn’t perhaps a peculiar manifestation of the strong “evidence-based medicine” training that’s been in place for years and years. In the medical culture, “evidence” means “published in a peer-reviewed (MDs of course) journal, generally based on a designed clinical trial of some sort.”
    And anything less is, in contrast, merely “anecdotal medicine.”
    Food for thought perhaps. I’m already probably at least ten paragraphs beyond useful and well into annoying. While I’m not really slinking back into the anonymity of the internet, I don’t think I’ll have much more to contribute on this topic.
    regards to all.

  7. This post raises a really important point about physicians’ time.//
    No. It raises a point about physician and institutional ineptitude and a dysfunctional and outmoded notions of information exchange which male physicians in particular seem reluctant to address.
    //But I hadn’t seen anything that really focused a flashlight on the underlying tension in the patient/physician relationship that time-based reimbursement inherently introduces.//
    Check out the Kibbe conversation. The tension in these relations is more than a function of time. That is Kibbe’s warning: the patient and e-patient communities are outstripping physicians in terms of innovation and demand for change. They are no longer willing to cooperate with institutional settings which are inherently disempowering, which create and perpetuate a Physician Knows All and Patient Knows Nothing (of value) paradigm of interaction. An interaction which is viewed (by the physician) as one of profit or loss is inherently a lose-lose situation.
    If EMRs increase efficiency, given the sense of ill usage expressed by many physicians in the current economic climate, there’s no guarantee that any gains would pass to the patient. The physician would merely increase the patient load to increase profit, to which the physician believes he/she is inherently entitled because he/she has always been smarter than the average bear, having gotten into medical school and all, having undergone the hazing of losing patients while sleep deprived, etc. The patient would be doing the work of quality control for free.
    I think we have successfully shined the “flashlight” on profit motive in medicine.
    Information is power. When a physician or institution creates active roadblocks to patient education, which is what I encountered in 2/3 of the pediatric hospitals with which I’ve dealt, dragging their feet in terms of records access, the physician stays ril smart, the patient, ril dumb. When that information imbalance is upset, particularly at very sexist and patriarchal institutions (women in service roles instead of positions of authority), physicians go into cardiac arrest. Worse yet, physician error becomes just as transparent, say, as my crabbiness or cold symptoms.
    Which returns to my point in the Kibbe debate: given the dominant institutional culture, physicians are the least likely to innovate.
    So, are physicians’ lives and work so limited by fatigue/expertise/arrogance, the institutional settings so rigid and patriarchical, that they are deaf to new and imaginative patient input?
    As indicated by the above reading lists, there doesn’t appear to be much room for anything beyond economistic thinking. Not a lot of humor, irony (except the cartoons in the New Yorker). Not a strong sense of what it’s like to be disenfranchised.
    Just an idea, but present company might want to take a more objective look at gender factors in your institutional settings. Present company might want to read a Sara Paretsky novel or two, several of which concern medical settings.
    Present company might even want to familiarize themselves with my previous posts. Otherwise, I’m going to start charging for my time.

  8. Christine Gray wrote:
    “Otherwise, you miss the point entirely.
    When does the physician pay ME for educating
    him? What is your response to the specific
    questions? Is it impossible to emphathize with
    a patient perspective ….”
    I didn’t address any of those because I didn’t think I had anything useful to add to the conversation in those areas. But I hadn’t seen anything that really focused a flashlight on the underlying tension in the patient/physician relationship that time-based reimbursement inherently introduces.
    (And remember, in the “business of health care” environment we have today in the US, each physician practice, whether group or solo, necessarily has a large support team to handle medical records keeping, billing & collections from insurance companies, appointment scheduling, follow-up, etc etc. The payment to the physician has to cover all of that overhead. I don’t have figures, but I suspect that 4 to 5 support FTEs per physician would be typical.)
    Bruce’s comment that:
    “The claim of time shortage is specious as
    doctors in grossly lucrative cash fields,
    like fertility, plastic surgery, have the
    same arrogant and rigid stance.”
    …is interesting (and I would not dispute its accuracy as a gross generalization) when you think that specialists in those particular areas have probably self-selected into those particular areas BECAUSE they are pre-disposed towards an income based view of the profession. Their motivation engine (generally) leans less towards “serving humanity” and more towards “financial success.” In that sense, I would argue that the taxi-meter is always clicking in the back of their minds too, even more than is the case for most types of specialists, and certainly more than family practicioners and pediatricians etc.
    Changing human behaviors in complex organizations/systems usually requires understanding both the overt and subtle incentives and disincentives faced by various participants, each operating in his/her little micro-niche within the larger environment.
    Adding time & quality to the patient/physician interaction is a clear WIN for the patient (higher satisfaction certainly, better outcome possibly) but a probable LOSS for the physician (higher satisfaction possibly, better outcomes possibly, but less billings and therefore ability to pay the bills of the practice certainly.)
    How do we get to a WIN-WIN ? Win-Wins are easy to sell. Nobody fights changes where everybody ends up better off than they were before.

  9. Christine – I’m certainly not claiming that physicians are not playing a role in our healthcare system woes. As reform takes shape, physicians will have to own up to their shortcomings just as insurance companies, patients, the government will. If spoken about that a lot in my blog.
    However some of the generalizations made here are irresponsible and counter productive. I also don’t think physicians should have to read NY Times to get their information. There needs to be a standard decision support tool that they can refer to so that they’re not forced to look in several locations to get information that hundreds of physicians around the country are also looking for at any given time.
    I like the concept of using the Internet to give patients a voice. However, that can only be successful if patients step up their game as well, and work to become more active partipants in their healthcare. You clearly have taken an active role, but you are definitely not the norm. The downside of the Internet, as seen in healthcare blogs, is that someone can make a riduculous negative comment and then we never hear from them again. Unsubstantiated garbage can only be minimized with proper context.

  10. Bruce – The generalizations you make are irresponsible at best. Trying to convince people that all doctors are arrogant, resistent to change and sexist while hiding behind your computer screen is cowardly. Instead of adding something productive, you are taking away from the conversation by adding tension and blame when there is already enough of that to go around.

  11. Doug,
    Thanks for your input.
    Patients need to hear about the reimbursement issues to be better consumers. Physicians need to build in a hierarchy of educators.
    My daughter and I never waste the oncologist’s time. Communication goes through the oncology nurse, who directs the flow of information.
    Otherwise, you miss the point entirely. When does the physician pay ME for educating him? What is your response to the specific questions? Is it impossible to emphathize with a patient perspective apart from assessing profit-taking potential, which is the point of the commentary on David Kibbe’s “Confessions . . . “?
    And yes, it’s interesting to see folks tap around the sexism issues. The elephant in the room.
    Thank you Bruce. (Will you marry me? 🙂 🙂 )

  12. Comments defending doctor ignorance and arrogance are absurd.
    Doctors are indeed resistant to patient input of any kind, and to new information.
    The claim of time shortage is specious as doctors in grossly lucrative cash fields, like fertility, plastic surgery, have the same arrogant and rigid stance.
    God help the informed patient, especially if that patient is a woman, as many male doctors are especially threatened by an intelligent female patient.

  13. Comments defending doctor ignorance and arrogance are absurd.
    Doctors are indeed resistant to patient input of any kind, and to new information.
    The claim of time shortage is specious as doctors in grossly lucrative cash fields, like fertility, plastic surgery, have the same arrogant and rigid stance.
    God help the informed patient, especially if that patient is a woman, as many male doctors are especially threatened by an intelligent female patient.

  14. This re-reminds me that a number of health care reform efforts are based on a transparency philosophy, that the free-market purchasing decisions of informed & educated h/c consumers who bear a substantial personal burden of their consumption decisions will drive cost and quality improvements in health care.
    And in policy debates, very little has been said about the likely “equal & opposite” result of a growth of patient demand for more give&take interactivity and information transfer during the patient(or parent) and physician encounter.
    At their heart, all fee-for-service reimbursement schemes for physicians are based on time units … based on studies, on average it takes x-minutes to do a brief exam, vs y-minutes to do an intermediate exam, vs z-minutes to do a CABG, etc.
    So if you were to look at a physician from the viewpoint of a profit-maximizing free-market capitalist business, a good patient encounter is one that uses no more than the nominally included amount of time, and a bad patient encounter would be any that took more than the standard amount of time. (Not that we generally actually know what those standard amounts of time are for any given procedure/service, but they’re structurally embedded in any RVU schema.)
    Fortunately for all of us, most doctors are of course not really profit-maximizing stopwatch capitalists. But they are far from immune to this pressure as reimbursement rates shrink and paperwork grows, so the need to maintain patient throughput keeps ratcheting up.
    Unless/until we change the reimbursement structure to explicitly allow more time for patient/physician discussion, or a way of billing directly for that, then patients with much higher-than-average “information needs” will run the risk of being labeled and reacted to as “high-maintenance.”
    And in the free-market, where patients care fire doctors who don’t meet their needs, doctors can equally well fire patients who consistently demand more time than the doctor is being paid to provide.
    (I’m not taking a position on whether this is good or bad, I’m just saying it’s a logical consequence of the direction we’re going. Unless we address the reimbursement issues.)

  15. P.S. To Jaan
    The folks in my town regard The New York Times as a communist rag 🙂

  16. First, thanks to all who responded. The piece was slightly tongue-in-cheek, slightly not.
    It is important that doctors talk to patients in forums like this. Interactions in medical settings are so confined, it’s hard to know what physicians really think, meaning it’s hard for the patient to know which requests are reasonable.
    For instance, once I learned the fee scale at a hospital where my daughter was treated, a lot of physician behavior made sense.
    The underlying point of the piece was How Do You Get Your Doctor to Listen to New Ideas if he or she is fatigued, overworked, and certain that the patient has little or nothing to offer in the way of relevant input?
    Virtually all of the physician responses assume that patient input above symptoms and health history is time consuming, irrelevant and an imposition, or that reading the material is an act of kindness or reassurance. Am I wrong?
    What is reasonable and relevant? If the doctor is sure he or she knows everything, how does the patient get through?
    Here are a few of the scenarios I have encountered with semi-tertiary care specialists. The problem is, if you don’t give them something on paper, they are highly unlikely to “hear” anything you say if it is at all outside their frame of reference.
    1. How does an “activated patient” (see e-patients.net) inform physicians about the power and capacities of e-communities? I have had physicians laugh outright at the idea — physicians who had total lack of awareness on the subject, and knew nothing of organizations such as ACOR, whose membership is quite sophisticated. How does one present the idea that physicians might want to get a better web presence so their patients can find them or — horror of horrors! – check their credentials and publications to insure true expertise?
    It is still very common to encounter physicians who identify e-communities with holistic medicine, vitamins, etc. or the stereotypic patient who brings them “stacks of [irrelevant and insulting] articles” to read. While the latter may be true, that is not what ACOR members are up to.
    2. How relevant is information on “best practices” on a rare cancer, or any cancer? One physician who claimed expertise in pediatric sarcomas, for instance, was unaware of a recent NCI Progress Review Group on the same, contributions to which were from both adult and pediatric specialists. So what do you do? Hand him the report with attendant recommendations (which he did not follow)? Ask him if he has heard of it? Or fire him?
    3. How about the physician who refuses a second opinion on a suspected cancer? Do you ask it, say it, write it? Do you present him or her with state guidelines and regulations on the same, or give up and move on?
    4. How much time is an imposition? 60 seconds? 30 seconds? How long does it take to read a New York Times health column advising patient proactivity with regard to breast health (and which suggests the exact OPPOSITE approach recommended by the physician)?
    5. How relevant is a short article from PubMed on metastatic patterns on a rare cancer or survival statistics on the same when the physician refuses to address any point beyond “local control”?
    6. How might one inform a physician that MSKCC has developed nomograms which give a rough estimate of survival statistics (note I said “rough”) on a particular cancer? All the patient has to do is plug in basic info. from the path report.
    For lack of a better word, there remains a dominant medical culture of expertise-fatigue-arrogance — a sort of hermeneutic box — ingrained in institutional practice that makes genuine two-way communication between patients and physicians difficult if not impossible. From the perspective of the “activated patient,” or perhaps any patient, this is not an unfair observation.
    For instance, how many patients can be certain that a physician will not take umbrage at a request for a second opinion. How many physicians openly acknowledge error? How many physicians acknowledge or apologize for hours-long waits?
    As my daughter’s cancer case got more complex, my support team debated whether I should inform her oncology docs that I had a Ph.D. (The degree is in social sciences, which wasn’t relevant to the situation at hand, and I don’t generally use the title anyway.) When I did not, I was “the mom” and the information offered was dumbed down and incomplete. When I did, the physicians became anxious and defensive. The folks who weren’t anxious and defensive were the top national experts. When I asked for information, I got it. If I didn’t understand a term or concept, I got my Internet team to clarify it so I didn’t waste the physicians’ time.
    So, how does one break through the box?
    Our current oncology team, which was already Internet-adept, learned from the mistakes of their predecessors. (Please do not omit basic information. We will discover it eventually. Please hand over test results and reports in a timely manner so we can make educated decisions. My daughter trusts me to tell the truth, and I have to trust you to tell the truth, including the bad parts.) We keep small talk to a minimum. We go through the routine; the oncologist knows that I have 2-3 questions, which he answers. I ask him if he wants updates regarding Internet advocacy, which he generally does. As a consequence of these interactions, he joined the e-community. He provided critical input on sarcomas to one widely used (but not sophisticated) pediatric oncology site, and joined the medical board of a patient advocacy group, becoming its first pediatric-AYA representative. I’m not positive that he was not happy about all of this, but eventually he came to see the value of it.

  17. In this swamp of generalizations and assumptions (I have a reading list similar to docanon), let’s not forget two things:
    -with regards to professional education for doctors, I do think that the US is rather on the demanding end. I trained in Germany a decade ago and can tell you that there is not much coercion to do CME, and to my knowledge, that hasn’t changed. It would be interesting if someone has some other countries for comparison.
    -the info provided by patients are of very varying quality, from nonsensical advertisements to very appropriate medical literature (most is somewhere in between). I am a specialist and currently have the luxury of having 60 min. for a new and 30 min for a follow up patient. I can accomodate almost all requests, but I can understand that a lot of physicians, esp. PCPs, simply cannot.

  18. This “question” is convulated and poorly-phrased/worded. As to what doctors read in their spare time, it is none of my business or their patients. Now the issue of professional development or CME is another one entirely as is information that is presented to them by patients by I would group these items all in seperate categories because their purposes are quite different.

  19. All of this just points to the need for an evidence-based decision support tool for physicians that is updated frequently with best practices and current research data. Currently, the data is too scattered and therefore, not always utilized.

  20. Interesting but all these comments, so far, miss one key problem; information overload. Every professional in every industry today is inundated with more that any human can possible absorb. We all filter and many of us use very effective techniques to filter and condense what we need to know. The truly informed person today is the one who can filter out all the crap that is written, focus on the critical information and scan the universe for the important key new ideas.

  21. As a customer relations expert and a concerned healthcare observer, I must comment on doctor’s turning a deaf ear to patient input.
    Two things to remember:
    -You don’t have to read an entire stack of articles that a “patient customer” brings you. To minimize how often this happens, give them more *undivided attention when you see them, more empathy, and much more clear updates on their condition. If they are bringing you a stack of articles, it is one sign that you have not earned their trust yet. Else they would more likely just ask you if you were familiar with xyz info.
    -Turning a deaf ear to patient customer is disrespectful and breeds long term mistrust of the entire medical community. Mistrustful customers are tougher to deal with next time. Many doctors (not all) like to be in control. They frequently present options as must haves. Answer our questions doctors, present options, and make your recommendations — without the attitude that you have something better to do. The sooner you do it, the sooner you will be free to move on to what is next in your schedule and your life. It takes less time when you give patient customers your focus and your respect — not more. Listen to the questions and answer them clearly. Then your patient customer will relax.

  22. …not to paint all physicians with a broad brush, which it appears I did.
    Apologies to all the good, dedicated doctors who earn every penny and then some.

  23. With all due respect. I’m on call 24/7 at a time. I respond to emergencies and deal with resistant customers, all grumpy and annoyed and blaming me for their mistakes, including doctors. Any mistakes I make can affect literally hundreds of clinical people at a time, and their patients, in real time.
    But I manage to keep up with my industry, which is exceptionally complicated, changes literally every month, and shows no sign of ever stopping. Doctors work on known systems.
    We technologists are like vets working on a cat who turns into 7 cats before morphing into an spider.
    And yet I’m informed on current events, latest trends, all the stuff that doctors are complaining they don’t get paid for.
    No. I don’t either, and I get paid a metric buttload less than a doctor, too. I don’t feel I can take a vacation because someone just will have to drop their tablet and scream that they’re being monetarily murdered. It’s part of my job to know what I’m doing.
    And when we get paid what we’re worth, companies import technology people from elsewhere so they can drive down the labor costs.
    And yet I read. I even write.
    I have to wonder what would happen if hospitals flooded the physician market with, say, Indian doctors, who are well-trained and have excellent work ethics. Nah. That’d never happen in the good ol’ USA where we respect our workers.
    Why are physicians protected so much? Is it just because we’re all thinking we can cheat death?
    And if this is a market, what’s the value of your life, yours and yours and yours out there, if you’re in cardiac arrest? Isn’t it infinite? If this is a market, as so many insist, shouldn’t a doctor be able to attach your earning for the rest of your life?
    Well why not? What the heck. That’d cure everyone of the habit of living, eventually.
    But this illustrates the fallacy of a supposed free market health system. And doctors complaining they’re too busy indicates to me there’s not enough doctors, not that they’re excused from keeping their knives sharp.
    Try being an engineer over 40 years old and you’ll see the importance of that…

  24. Thanks for responding to this post. I was reluctant to run it because I think it paints a rather narrow portrayal of doctors. I do think, however, that we’re missing the patient voice on THCB and Christine provides that perspective.
    I know a lot of doctors, and most do read and have broad interests beyond medicine. That being said most want to spend their free time with family and friends — not any different than the rest of us.
    Sarah, editor THCB

  25. This post raises a really important point about physicians’ time. When a patient brings me a stack of articles to read, I think “how long will this take?” I’m a pretty savvy reader of medical literature, and even at a fast clip, I can’t give a article due professional diligence in less than about 20 minutes.
    Then you have to remember, I’m not paid for any of this. I don’t read patient-related materials for pleasure. It’s work, and make no mistake about it, I’d rather be doing other things with my free time. So if I read your stack of articles, I’m giving you the equivalent of an enormous cash gift…not to mention the huge gift of my taking the time to ponder them and then explain my thoughts on them to you (maybe I can bill for the explanation, but only if I trap you in the exam room with me). Phone calls and emails are completely unpaid.
    Remember, your lawyer will bill you for every minute spent reading whatever you bring to him or her. Only a concierge-type practice arrangement approximates this for doctors.
    So when you ask a physician to read something, you’re asking for a cash gift. The reaction shouldn’t surprise you.
    On a different note, do we read for pleasure and general professionalism? Can’t speak for all of us, but here’s my current regular reading list:
    New Yorker
    Newsweek
    NYT (online)
    NEJM
    JAMA
    Annals of Internal Medicine (every other week)
    Archives of Internal Medicine
    Assorted nonfiction…lately, it’s been behavioral economics and U.S. revolutionary war history
    …and I don’t ski.

  26. Are we willing to give docs paid time every week to devote to reading/investigating/learning? Will getting away from FFS compensation (at least paritally) allow a more relaxed atmosphere to get docs to be information current? Can hospitals afford this? If each patient presents to the doc information they have come across for their own condition (“Ask your doctor.”) will this lead to information overload that is not constructive but has the doc just chasing dead-end leads?

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