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Don’t Squeeze, Tie, Slap or Bite the Hand that Feeds You

Dear Health Care Business Leader,

I am writing to you in a spirit of cooperation, because the way health care works today, it is too complex a business to manage “on the side” while also taking care of patients. And I hope you don’t have any illusions about medicine being so simple that non-physicians like yourself can manage patients’ health care without trained professionals who understand medical science and can adapt the science and “guidelines” of medicine to individual patients with multiple interwoven problems with disease presentations that seldom match their textbook descriptions.

We need each other, at least under the current “system”. So I ask you to view us as allies, because we actually do the work that ultimately pays your wage or your profit, and is the basis for your own performance metrics. We are in this together, like it or not, so let me ask that you don’t do some of the things that several of your colleagues are doing:

Don’t squeeze us too hard.

When you do, the quality of our work, the health of those we serve, is in jeopardy. Instead of just imposing productivity targets, quality thresholds or pay-for performance schemes, listen to what we need in order to keep our patients healthy. Invite us to the table; we actually know a lot about how to work smarter, faster and better, so don’t be afraid of our participation. If we feel squeezed and abused, you will get perfunctory performance, but if you partner with us, we can, together, make patient care much better.

Don’t tie our hands.

I know you mean well, but when you pick or design tools and workflows for us to use, you often make it harder for us to do the work that patients need us to do well.

Don’t give us EMRs that cut our productivity in half, when computers have streamlined work in other sectors; don’t make assumptions about how doctors think and how we process information. For example, let me read CT scan reports and other test results, without scrolling, right when I see my patient in follow-up, import them into today’s office note, and “sign off” on them right then and there, not after my office hours when I should be spending time with my family. And, also, when I am in today’s patient note, let me see all recent results, consultations, calls and refills WITHOUT clicking on several “tabs” that may not have any results under them. Data is meaningless without context, and a good computer system should enhance the context behind the data.

Don’t slap our hands.

Doctors are highly motivated individuals, who generally work harder than anyone asks them to. If we don’t seem to do what you want us to do, it is either because we think you are asking us to do the wrong thing or because you haven’t given us the tools to do the right thing. We don’t need to be prodded along like cattle, and we don’t respond to being slapped.

Don’t bite.

Don’t inflict pain and don’t threaten us with it. Our first inclination will likely be to take care of our patients and ignore you, but we will ultimately respond if threatened or attacked enough. You may think of health care entrepreneurs from the business community as introducers of disruptive change, but consider the possibility that physicians, if pushed too far, could be the ultimate disruptive force in health care.

Bitter Medicine

“Where there is love of humanity there will be love of the profession.”         Hippocrates


Reading some of the blog posts and comments on the Internet today, you might get the impression that a majority of American doctors hate their jobs. Actually, according Family Practice News, only 35% of my colleagues are unsatisfied with their careers, but that is still a remarkable number.

Are Hippocrates’ words implying an answer to why some doctors today don’t like their jobs? Don’t they love being able to help their fellow human beings enough to overlook the imperfections of the health care system? Or, put another way, is the health care climate in some places so horrendous that some doctors and patients cannot find enough common ground for a caring relationship to develop?

I have read comments by both clinic doctors and concierge doctors that describe their patients as unreasonably demanding and next to impossible to work with. You don’t have to look far to see equally unflattering comments by patients about their doctors.

It seems clear that these imperfect unions are being poisoned by outside influences, which create prejudices or unrealistic expectations. If these unhappy doctors and patients were married couples, we might tell them to split up, get counseling or go on a vacation or retreat and get to know each other all over again. Staying together without changing the bad energy won’t lead anywhere. And just like unhappily married people, if they split up and start over with someone else without learning what part they themselves played in the failure of their relationship, they are at a very high risk for finding the same unhappiness with their next partner.

Who, then, has forced their way into the doctor-patient relationship and turned the two against each other? And why did doctors and patients allow this intrusion?

The intruders promised both of them freedom from responsibility to each other – for the patient, access to doctors without having to pay – for doctors, freedom from asking their client for money, freedom from patient judgments about the dollar value of their services.

The intruders also told doctors and patients what they deserved from each other, instead of letting them iron out their expectations on their own. Patients and doctors were seduced with images of perfect and pliable partners, no more realistic than romantic fiction.

Hippocrates’ words build on love of man and a sense that ours is a noble profession. First, if we imagine our patients at least as distant relatives, we are partway where we need to be in our relationships. Our job begins with finding the common ground that makes relationship building possible. Second, if we don’t accept that our profession has a higher purpose than to do technically good work and reap the financial rewards we deserve, we will never be happy.

If we cannot feel joy and satisfaction when we are able to move a fellow human being in the direction of better health and enjoyment of their lives, we need to return to our own source to feed our souls and renew our spirits.

Ultimately, this is about soulfulness in our work. Many doctors today seem to feel that their work doesn’t matter on some deep level to their own sense of purpose. Relating to our patients as fellow human beings is the very first step in finding that purpose. Without that foundation, everything we do turns too abstract to provide professional pride and satisfaction. It is not sustainable to work as hard as we do if the only ones we help are the insurance companies or the clinic bottom line. Our job is to help people, real people with real problems.

Paraphrasing Psalm 127:1, unless our hard work serves a higher purpose, it is all in vain.


Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.



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