Screened Out

  

My finger hovers over the smoking history tab…

Do I click current smoker?

I could lie. Maybe I “accidentally” forgot to hit the right button?

No one would ever know.

Except it does not acurately convey his risk factors. It would not trigger me to ask about if he was ready to quit yet at his subsequent appointments. Not to mention the fact that it is a LIE. 

But…

I don’t want this to count against me! It isn’t my fault. I didn’t light up that cig and hand it to him, you understand.

“Are you ready to try quitting again?”

I don’t get credit for asking, though. I don’t even get credit for recommending cessation. I only get credit for clicking the nonsmoker status.

Why did he have to start smoking again, damn it?

Today I found myself looking at another patient’s hemoglobin A1C (a measure of diabetes control) when I was deciding about firing her for a completely unrelated issue. What should that have to do with it you may ask? I realized I was more likely to fire her if she had a bad A1C. 

Because of those numbers the suits are tracking….

You know what?

I don’t want to be like this. It is not why I got into medicine. This isn’t helping people. 

And I don’t want lies to ever come easily for me.

If there is one thing that blogging has taught me, it is that when I think I am alone in something, I am not. Even when it comes to pulling on my eyebrow hairs when I am stressed out. So how many other physicians out there are feeling the same pressures? How many others are finding themselves faced now with these moral/ethical delimmas?

More importantly, what about patients? Faced with rabid physicians trying to keep their numbers up, are they being less truthful with their doctors? Did they really get that immunization? That colonoscopy? The mammo? Or do they say yes just to shut us up? 

If they lie about it, I’m off the hook, right?

And why can’t patients make their own decisions about what is right for them? What makes ME or any other doctor absolutely right in all things? (Particularly when we keep changing our own guidelines?)

What about the patients that are fired for not getting their screenings done? Who is going to take care of them? Don’t they deserve the same access to care as anyone else?

Humans have the right to make bad choices.

I should be able to make the screening suggestion and facilitate getting it addressed but beyond that, I don’t want to feel like I am wrestling a patient to the ground and punching them in the face until they give in to keep my scores up. I can be *very* persuasive, but my oath was first to do no harm. Harm comes in many forms, something not reflected in those numbers.

Ultimately, this is the way of medicine right now. I don’t see it changing any time soon. That won’t stop me from mounting my own mini rebellion, though. I won’t let them change me into something I detest…

My mind turns back to the computer screen. I click the current smoker option and carry on with the visit…

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115 thoughts on “Screened Out

  1. That is disturbing!
    My dr gets credit when I quit smoking? And my new dr will get credit even though she never knew me as a smoker?!? Well that’s ridiculous. Obviously I get all the credit! And no one was to blame for my smoking! That’s so unethical! I do not envy your position in these matters. People shouldn’t be held accountable for things their own grown children do, let alone their grown patients! Oh my word! I just cannot even!
    So then if we don’t get the bloodwork or the mammo or whatever, you get red Xs?!? Because that is infuriating! Who’s callin the shots here? An insurance company? A hospital network that profits from diagnoses and treatments? That’s dark stuff.
    I have to go, I’ve used up all my exclamation marks.

    Liked by 11 people

  2. Yup, our nurses have to have so many patient contacts a day. It doesn’t matter that our patients have an older and sicker demographic than the rock star hospital across town. Some of our patients come in after finding out five minutes ago that they have cancer and have to have surgery the next day, but we’re supposed to just push them through and ignore their crying (of course we don’t, that’s why our numbers suck.) It makes me sick.

    Liked by 6 people

  3. Yes I struggle with these same issues!! Credit and future pay. I can’t lie either and I won’t fire someone for elevated blood sugar, but I might refer out…although that somehow counts against me, too, doesn’t it? I have to live with myself though and do the best that I can, scores be damned!

    Liked by 2 people

  4. Somehow I will choke back the “this is what happens when MBAs run healthcare” comment. Somehow.

    As a patient, I’m on the other side. If I go to my GI doc, she sends me to somebody else if I have a problem with something not specifically poop related. Then they send me in for tests and/or to a different specialist. All of them cost $30 for the visit, a copay for the drugs, and a parking fee ($7 each time!). So I will admit that I pick and choose what tests I have — and preventative falls behind the necessary.

    Being sick takes too much time and too much money.

    But my doctor shouldn’t be penalized because I didn’t have something done — or because I don’t meet a target. What are they going to do, hit me over the head and drag me in?????

    Stupid system.

    Liked by 3 people

    • Right? It pretends to have patient interests at heart but in the end really ends up hurting many. That being said, I dislike primary care physicians who NEVER tell their patients that they are due for a colonoscopy or other preventive care so they never get the chance to decide for themselves.

      Liked by 1 person

  5. I am going to the doctor for the first time in my adult life next month (I know, I know… but I have always been super healthy and never needed to… but since I am 30 now that excuse no longer works, especially since I know better because I grew up with an entire family of nurses and doctors). But I know I will be tempted to lie out of shame, embarrassment or whatever – but I know that in doing so it will cause me future harm down the road and potential future help. Three of the questions I feel are often lied about: Are you a smoker? How many drinks do you have a week? Are you sexually active?

    Liked by 3 people

  6. It’s so shameful that suits address now dictating a doctor’s ability to provide good care because a patient chooses to continue with their life. Fucking Bullshit. Numbers numbers numbers is only code for profit and sub par care by those who don’t care about their patients like you do.
    Please don’t pull out your eyes brows. That would be an interesting topic of conversation if you have to do a woman’s annual. 😉

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  7. I see Elyse is on her MBA bandwagon again – pffft. Policy is driven by shareholder profits – MBAs just get the dirty job of ,making that happen. You don’t blame the sewage worker who gets covered in shit fixing the pipes do you? He may be the one who looks dirty but it ain’t his shit.

    Anyway (*shakes ruffled feathers back into place*) I just want to mention Victo that the MBAs are out there so be careful. There is a statistical test called R squared that is used to compare large data bases. If you try to manipulate patient data for whatever reason it can be detected if it’s done regularly. Even if you code grey areas a similar way, it can be detected over time. But you likely know that anyway.

    As far as dirty little secrets of how the backroom operates – most professions have those secrets that they would really rather the public not know. For instance I was watching an investigative program on pig farming the other day. When a piglet is born deformed or out of spec, the government approved method of terminating the piglet is to grab them by the tail and smash their heads against the concrete floor, I cried.

    When I drove a transport we used to have general meetings with our insurance providers. One of the procedures they stressed was if someone else makes a driving mistake, say wandering onto your side of the road, don’t damage the truck trying to avoid them , even of you can – hit them. That clearly establishes who was wrong and they can collect damages.I pointed out that situations like that happen so fast that if you choose to hit them, you cannot determine how serious it will be. That made no difference to the insurance company. And,in fact some time after I had exactly that situation occur and I did that and the other person died. I still ask myself if that was the right thing to do. I could have left the road and saved his life – I didn’t.

    Liked by 1 person

    • I really am honest on my stuff. It took me aback to find myself even considering being dishonest. I hate that the pressure is so great that I would ever consider not being truthful. In the end we have to do what we feel is right, consequences be damned. The pigs? That’s awful. You and the accident? Not your fault.

      Liked by 1 person

  8. So it’s a bit like teachers being rewarded or punished for their students learning/not learning. There’s government (and I’m a Dem, so I actually think bigger gov’t is better) and then there’s Government, with a capital G. I don’t know what the answer is with health care. We live in a country with socialized health care and there are huge pluses and of course huge minutes as well. A health care system like Denmark’s works great for 75% of the medical issues most people deal with. The problems arise with the other 25%. Somewhere there’s got to be a model that works for the US because the one you’re describing is horrific. I’m sorry you’re in that position.

    Liked by 2 people

  9. My husband “quit” smoking. Went through a program with his work and everything but now when he drinks alcohol…which is once or twice a week…he buys a pack of cigarettes. And rather than just smoking the few he smokes while enjoying his alcoholic beverage, he gets up the next day and finishes the pack. He even hides them from me because he knows I will throw them away. He says it’s a waste of money. I remind him it will be a waste of life if he keeps it up.

    Liked by 1 person

    • I’ve worked as an addictions counselor for 30 years. Heroin addicts have told me it’s harder to quit cigarettes than heroin. As a former smoker, I believe this. But our system/culture doesn’t take treatment for tobacco dependence that seriously. Your husband is not alone. I hope he understands it’s okay to ask for more help.

      Liked by 2 people

    • Thanks to Joanna for commenting to help me catch your comment! The notification never ended up on my app and now that I am looking at it on the screen I see I have missed a few other comments. WTH? I think physicians are generally ill equipped to help with smoking cessation, aside from prescribing drugs. ALSO, Joanna is right that he can ask for more help through his work program or there are some great quitting programs online (or by phone) that he can tap into, too.

      Liked by 2 people

  10. Ironically, insurance companies go against our oath of “first, do no harm”. Don’t really have much to add to this wonderful post Victo. The reality is disturbing and the more we talk about it the more patients and other doctors will become equally disturbed. Your rebel heart is very much appreciated, at least by little docto-to-be me. You’re an inspiration ❤

    Liked by 2 people

  11. I hate the numbers game. We play it all the time in Home Care and then we also have to meet our ACH rate. The hospitals are spitting out people too soon, we get them and we have to keep them home or we all get dinged. All numbers and not always at the best in patient centered care…. seems that goes out the door too often!

    Liked by 1 person

    • I feel for nurses. Hospitals have robbed nursing of its integrity. I had a patient who is a nurse in the VA system tell me that they are required to give a speech at to each patient that goes something like this: “I am about to leave as it is the end of my shift. You may be receiving a survey in the mail. We only get credit if we are given the highest score. Is there anything I can do for you to help you rate your stay with the highest score?”

      Liked by 1 person

      • Oh my goodness. Times have really changed since I retired not quite 6 years ago. That is simply awful but does not surprise me how far the government will go to ty to improve its patient care image. I am so glad I am out of that rat race. It was getting really bad by the time I left when my husband only had a few months to live. I worked for VA system for a total of 35 years. Toward the end it felt like pure hell.

        Liked by 1 person

    • The MBAs are just doing the dirty work for the shareholders – don’t kid yourself. No one wants to criticize the shareholders because with mutual funds these days, you may find that you ARE a shareholder and you might have to look at your own behavior and change it. Right now you can just invest where you get the greatest returns and let someone else get their hands dirty. The truth is that responsibility follows the money – and the money goes back to the shareholders. And I am willing to bet that you or someone close to you have shares (in some form or another) and you have no idea what the company is doing with your money..

      Liked by 1 person

      • A) I have no shares, not my immediate family. I don’t speak for anyone, though.
        B) Blame can go back and forth, no one is asking MBAs to do this dirty work for getting a few extra dollars. And they’re not doing it for shareholders, they’re doing it for their bonus packets, don’t kid yourself.
        C) Healthcare isn’t the place to maximize profits, which most MBAs epithet don’t understand or choose to ignore.
        D) MBAs aren’t qualified to assess Healthcare performance, you cannot use statistical tools developed for hotels and port it to Healthcare.
        E) It’s not as if doctors are entirely above blame, not by a long shot. The difference between them and MBAs is one of proportion of bad eggs, quality of their wrongdoings, and capacity to cause harm to a greater or lesser number of patients. Guess who comes off worse?

        Liked by 1 person

      • Whew, you have been sold a bill of goods hbh. Look if you had kids and you hired a lumberjack to take care of them, would you be surprised if you came home and found them without clean clothes, eating only sandwiches, swearing, drinking, and smoking? Would you say’those lumberjacks they are terrible’?.Of course not – YOU hired the lumberjack. In today’s economy anyone will try a job if they are offered. Someone HIRED the MBAs and gave them direction and gave them bonuses to run the healthcare on money. They knew what an MBA was best at , just as you knew what a lumberjack was best at. Why run down the MBAs? It is the shareholders who make these decisions. An MBA is just an expensive tool – if you pick the wrong tool or refuse to take responsibility for the actions of that tool, then you are the one responsible. The shareholders use the MBAs to give them deniability. They just want to make money and don’t want to know how it is made. This is so typical today when big companies commit crimes or unethical deeds and then blame the employees. If more darned shareholders spent time behind bars for what their companies did, maybe more care and attention would go into directing their companies.

        That said when I did an Executive MBA, it was scary. the tools they gave us to manipulate money that could so easily be used in unethical ways. In fact even as we were doing the course the guy who sat next to me went to prison for defrauding the government of millions. I used to rail on the university regularly that they were not emphasizing ethics. They since instituted an ethics course, but there is a fundamental problem. We had exemplary professors who were all academics. Our marketing prof was an MBA – none of the rest were. So it was like building a high tech fighter jet – all the guys doing it are engineers and mechanics and electronics specialists. And they all do their little bit and go home to their lives. When they are done, they have constructed a weapon of war that can and is used to project deadly force. In this metaphor the pilot is the MBA graduate -with all these deadly weapons at their finger tips and a whole lot of surprised engineers on the ground asking themselves: “What have we done?” Someone is directing those weapon platforms – don’t jail the pilot when he hits the targets given.

        By the way, MBAs do work for NGO’s, non-profits, they volunteer for charities, they fund raise for the poor and disadvantaged, and use their skills in many beneficial ways. If a mechanic did a poor job for me,I wouldn’t say that all mechanics are assholes. Same for MBAs – some of us do care and the ones that don’t find jobs where the shareholders want just profits and are rewarded for those profits.

        Liked by 1 person

      • Technically the corporation I work for is a nonprofit…. so there are no share holders. That being said, there are physicians in the leadership who have forgotten who they work for (the patient) who continue to allow the perpetuation of this silliness because of pressure to look good (you can only measure numbers) and for the $ (they see very few if any patients so they have a bonus structure arranged around it). Interestingly, these physicians all have MBAs…. 😉

        Liked by 1 person

      • In Canada this degree is not considered academic and the student pays full freight. Victo, it is like entering a different world when all the tools they have given you start to click together. It’s like you come alive on the plain of money – suddenly you can see the big picture and how to better it or how to steal from it. It is an epiphany in money – i kid you not. You feel like a different person – it is a gestalt where the sum of parts comes alive and grows like a living thing. In a way it is scary mostly because you can feel the power flowing through your body and limbs. You know that no matter the situation you will be able to see its structure and manipulate it – as you please. And unless someone else has an MBA they will never out-think you regardless of their training – there is something very special and otherworldly about this degree. And scary.

        Liked by 1 person

      • Let’s take this one at a time, Paul.
        A) I never said all MBAs are a-holes or anything. I never say all *any group* are any one thing.
        B) (Yes, I like lists) for the lumberjack, to carry your analogy further, if someone is stupid enough to hire one as a nanny, don’t you think the lumberjack should say., “Um, you makin’ a BIG mistake!”? Would you not say a doctor was guilty if he/she got a patient killed because they were meddling in a speciality they knew little of (and that’s not as poles apart as nannies and lumberjacks)? Would you or any court in the land say it’s the patient’s fault for getting treatment from the wrong doc?
        MBA’s like any other professionals, have to take the responsibilities for their actions. They aren’t sheep being herded towards evil, they are active participants (as are some doctors in HMOs, I know). They are adults, and sane and with a decent set of morals or judgment re: the same.
        C) Ethics courses, I don’t know. My views on them are more cynical than I would like to admit. I doubt anyone refrained form wrongdoing because of what they learned in ethics classes.
        D) Air force pilots, like other soldiers are liable for war crimes, this was a principle upheld in the Nuremberg trials (no, I’m not raising HItler in an argument). Soldiers are liable for the civilians they kill, the unarmed populace they murder. Their culpability is a lot more than the mechanic who assembled their guns or filled their gas tanks.
        E) I repeat I never paint any group with the same brush. I don’t say MBAs are evil, nor do I say all docs are angels. But MBAs running HMOs and their equivalents are responsible for crippling healthcare. Services like medical ones cannot be run on the profit motive alone, but ask any doctor if they think what is happening is any different from that. MBAs work for NGOs, doctors work for MSF and the Red Cross and so many others. That’s not the point here. Healthcare in the hands of people other than doctors is set for failure, healthcare run on profits is set for exploitation of the patient.

        Liked by 2 people

  12. I love this. I think I may be one of the rare patients who “gets” this side of medicine. If something is up with myself or a loved one, I am compelled to learn as much about the possibilities as I can. No one should be so foolish or intimidated that they expect another human–doc or not– to “devine” all their symptoms and issues. It wouldn’t be fair to my doc, and it wouldn’t be prudent for my own interests. Figure it out people, you can’t stand on the sidelines, procrastinate, ignore or hide when it comes to your health. Doctors are human, and contrary to television, don’t read minds

    Liked by 2 people

    • Correct, doctors don’t read minds. That is one of the reasons I DO expect them to read the nurse’s notes (from the conversation I had with her during this SAME appointment) and I do expect them to ask me questions and actually listen to the answers. And in fact if I had to do a medical history update online a few days before the appt, they should have reviewed that. None of that happened for my most recent appointment. I can communicate honestly and fairly articulately, but if the provider on the other side isn’t listening, it doesn’t matter a bit. (Rant over. Thank you for listening…)

      Liked by 2 people

    • Not accepting medicare or insurance will get you there. But that only allows you to treat a small subset of people. Not working for a larger corporation will also help but negotiations of contracts has become such that as a primary care physician you almost have to have someone lobbying for you with the weight of a large group of physicians.

      Like

  13. Everything is numbers. A sorry world we are living in.
    And it’s so expensive just to get by, we need our jobs, so for most of us, small rebellions are all we can afford. How did we get to this police state? Because that’s what it is. I’m not sure when it crossed the line, but it was during my lifetime for sure. (K)

    Liked by 1 person

  14. You’ve talked about this before and I find it really disturbing. It can ultimately lead to people who become ‘untouchable’. They can’t find a doctor because no one will want to treat them. The system is soooo broken 😦

    Liked by 1 person

  15. I really can’t think of another health issue that is as cut and dried as that of smoking. That it shortens life and degrades health (and makes your skin wrinkle prematurely) is as certain as the sun rising in the East. So, I’m puzzled why this should be any kind of employment problem for the physician.
    I’m wondering what kind of pressure you’re getting from your employer? Do you have a financial incentive to up your non-smoker stats? In any case, you don’t need to beat it into them, just tell them the facts and then let it go. As I see it, it’s immoral not to tell them the brutal facts.

    BTW, speaking from experience, cold turkey works best. Anything less means you aren’t serious about quitting. “Make a decision! Have some backbone!” You could also offer some pictures of lung cancer and early wrinkles. “Think of your family!”

    Liked by 1 person

    • When dealing with a chemical and emotional addiction quitting is much harder than just quitting, sadly. Addiction defies reason or logic. 5% of my income is tied to these types of measures. Some physicians have more at stake financially. There is also the fact that the government wants to rate us publicly based on these measures. Telling people to quit smoking is not the problem. Helping them quit is not the problem. Requiring the physician to make them quit is.

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  16. I have a friend who is a pediatrician and she regularly asks parents whether they have a firearm in their home. I told her it was none of her business but she insisted that her business was the health and safety of her patients who don’t have the financial resources to buy a safe and secure their weapons. Where will this madness end? Will doctors get paid for persuading their patients to hand over their firearms! What about removing sharp knives from the kitchen and installing fire alarms?

    Liked by 1 person

  17. I always like that my MD has to ask again, and really appreciate that she doesn’t push…I realize she has to ask, but she is wonderful about respecting my wishes….if she is really worried about a specific test then we talk about it and she leaves me to go home review and make the final decision…I feel for you and all your associates having to keep your numbers up…its like selling cars….so sad….good for you for not folding….keep you dignity….no matter….kat

    Liked by 1 person

  18. I did not know doctors are being penalized if their patients don’t do a, b, c, d, or smoke, drink, and have lots of sex. IS THIS A FRIGGING NIGHTMARE? Hell yes! I’m sorry to hear about your end of the stick, as you know ours. I now feel bad for my doctor who puts up with me and now I have much more respect for him then I did before I read your post. I was actually kicked out of a doctor’s office for refusing to take all the drugs they wanted me to take and because I would not have the flu shot. I received a certified letter in the mail telling me I was no longer able to not only go to this doctor but the entire HUGE establishment this doctor worked out of. It’s disgusting what medicine has turned into. This is why I am so serious about preventive care and learning how to take care of myself with natural means. It scares me senseless to even think of going into the hospital. I was a patient in 1994, treated horribly even being an RN, and I could not even imagine what it would be like now. I really do feel awful for the doctors in this rabid system who truly have healing abilities and have a good heart. This government sucks for what they did with medicine! !!!!!! and !

    Liked by 1 person

      • No it does not. All it does is create anger and fear. Patients get to a point they are truly scared to say no or to make their own decisions. Same holds true for animal medicine. I”ve been kicked out of an animal hospital for bringing to the attention to the owners animal abuse that happened with one of my cats. It’s horrible to be treated like this by the very ones we are told to trust. I’ve learned and still am learning to stand up for what I know is right for me and for my animals. I’ve gotten my head bashed in a lot for doing so. Victo, I know you know the nightmares. And just like you said, I don’t see things getting any better either. It’s all about BIG business and MONEY. Life somewhere along the way became dispensable. I’ve told you before and I will say it again …. I don’t know how you hold up under the pressures and the stress and ugliness you are exposed to. (((HUGS)))

        Liked by 1 person

      • Doctors getting kicked out of practices for failing to deter patients from smoking? Now you’ve exceeded the limits of my credulity. I can’t think of any reliable metric to base such a decision on, and certainly checking arbitrary blocks wouldn’t do it, which was my problem with this. But let me be clear, I do not think the government is being in any way sinister or overbearing in trying to motivate people to quit smoking, they just haven’t come up with a smart way to do it. I would suggest upping the ad-campaign dollars. Social pressure works.

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      • Patients being kicked out? Hmm. You can’t help someone who wants no help, so my point remains. They should be encouraged to want it. No man (or woman) is an island.

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      • I actually disagree with you here. Getting someone who is addicted to a substance to quit is not something that occurs based on one or two visits. And it certainly does not occur by kicking them out of your practice. That just helps your numbers and gives the appearance of doing a good job. I discuss smoking cessation with all of my smoking patients at every visit and when they are ready to quit they will let me know. When they DO quit, that gives me a great sense of satisfaction. I would rather keep patients who smoke in my practice and help them quit than to have pretty numbers. The powers that be don’t see it that way. There are wonderful, lovely people who smoke. Their worth as human beings is not diminished simply because they smoke. I fire people for being rude to staff not for being a smoker.

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      • I’ve been thinking about this post and I have come to the conclusion the only way things will change is IF both patients and doctors present a UNITED front and say NO! to Big Pharm and Government. There is never NOT any room for HOPE that people, and we represent a HUGE number, will start coming together to bring about change so that medicine becomes a healing art and people have the right to choose what they want for themselves. Doctors do not have the right nor the power to make decisions about our bodies. Only we the patient have that right. It’s time we ALL start working together, putting our differences aside, and to move towards a Greater Good. This is the only way I see any change come about. Yes that will mean overcoming our fears about locking “horns” with the establishment which seemingly towers over us as a heartless dictator. Hope dies with my last breath that change can really happen!

        Liked by 1 person

  19. Thank you for the info. It reminded me that my previous doctor mentioned to me (some years ago) that the cholesterol numbers were set or changed by the pharmaceutical industry….

    Liked by 1 person

  20. In the early 80s I worked as a dental insurance examiner at Prudential, they had a few people in DIC which stood for dental in-house consultants.. I’m not confident they were dentists but they’d come in a few days a week to review high dollar claims that were flagged questionable as to whether they were necessary.. They weren’t denying claims for fraud or policy, just strictly whether the work was needed.. I never had a claim go unpaid, because I fought for my insureds.. They’d deny and I’d follow up getting the patient’s dentist to send me more records backing up the necessity.. It was frustrating but the procedures were expensive and necessary and I think I just wore DIC down each time.. lol.. As they saw my determination more and more, claims seemed easier to get approval for.. And that’s about the time hmos and ppos became popular.. I was suspect of them.. I felt it was taking the quality out of the healthcare that we all pay premiums for the best care.. Unfortunately I was right.. What I didn’t see coming back then was the forced healthcare we now have and have to prove to the IRS (sic) that we had ample insurance for the tax year or face paying a fine ! I don’t care what “seemingly sane” excuse they use, that is flat out racketeering and people go to jail for it but it’s ok for the government to practice..
    The world is flipping where right is wrong and wrong is right..
    I honestly don’t know how you struggle with the obstacles you face as a doctor and stay sane and committed to your patients..

    Liked by 1 person

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  23. I have been a nurse for 9 years. Never before have I been in an industry to full of people who started out with noble intentions, who after just a few years become complete cynics. From front line nurses to most MD’s, PA’s and nurses behind the scenes. The few that seem to get along just fine are people who view it as just a way to make money, not much heart in it. Why does an industry that has human caring at its very core drive a vast majority of its providers to the very opposite? Maybe medicine would perform better if we just viewed it as another assembly line nothing more noble. Find a way to decouple profits from health and you will be poor but fulfilled.

    Liked by 1 person

      • I’ve seen an iteration at rite aid/CVS. But it’s more a walk in low grade urgent clinic feel. Definitely hospital care has become measure and score driven. I can only imagine the angst and anger of today’s pcp’s. Unless the modern med school can crank out machines who use computer generated algorithms, medicine will become alot less art (humanity) and more data generation

        Liked by 2 people

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