One of my favorite writers – Dr. Abigail Zuger – writes an interesting piece in the NY Times this week. In it she talks about physicians who leave patient care. Dr. Good Has Left the Building

When people ask me to recommend a doctor for them, half a dozen spring to mind immediately.

They are all intelligent, kind and committed, intellectually imposing but down to earth, practical but visionary, and leavened with a good sense of humor. You couldn’t ask for a better person to oversee your health than one of them.

There’s only one problem: not one of them sees patients anymore.

No, they haven’t retired. They have simply moved onward and upward into the medical stratosphere. They have arrived at positions of power and influence; they do groundbreaking research, set policy, write guidelines and generally shape the health of the planet.

As for figuring out why you can’t stop coughing, forget it. They don’t do that kind of thing anymore.

I stopped seeing private outpatients 5 years ago, because my administrative activities became too time consumng, and I decided to focus my clinical and education activities on the inpatient setting.

Despite being a division chief and the dean for a regional medical campus, I still take 3-4 months a year of inpatient attending (7 days a week for the entire month). I also do morning report 2-3 times each week. Thus, I have not totally abandoned being a physician.

Like Dr. Zuger implies, those who totally divorce themselves from patient care will slowly but surely forget what being a physician really means. I worry about this personally, and have often debated the concept with other administrators.

I went to medical school to help people. While I hope that some of my research has a multiplier effect, that research cannot replace the personal interaction with patients and their families. Sitting at a patient’s bedside and explaining his disease or giving her bad news requires all of my skills and knowledge. I believe (and patients tell me) that I make a difference. I could not personally stop making that difference – even though I do not do as much as I would like.

In other words, a giant study may show that two pain relievers work about the same. But if only one helps Mrs. Jones (the gallant, delightful, terminally ill and utterly impoverished Mrs. Jones) and her insurer pays only for the other one, Mrs. Jones’s physician will quickly come to realize that they are not the same after all.

Doctors who never get to know Mrs. Jones seldom learn this lesson. In fact, after enough years away from the examining table, it is easy to forget that people like Mrs. Jones exist at all.

Some say that’s for the best. Many years ago, a famous professor and researcher interviewing me for a job remarked, in the tones of one imparting a secret of the universe, “Any idiot can make a patient feel better.”

Research was the key to medicine, he continued, to really making a difference. Otherwise, wishes and hopes and idiosyncrasies, both yours and those of your patients, would tangle you up so completely that you would never break free.

At least, I think that’s what he was trying to say. I actually never saw him again, deciding to take a job elsewhere, with a somewhat less famous man who still saw his own patients, one of the few graying heads in a sea of young medical grunts.

“Keeps you honest,” he said.

We who accept medical adminstrative positions must (in my opinion) continue our own patient interactions. If we forget what patient care requires and who the patients are that we try to help, then we become frightfully disingenuous. When I no longer can function as a good physician, I will retire from medicine – even from medical administration. We entered the profession for patients – and our knowledge of them, how disease affect them, and their social constraints must inform everything we do.

Related posts:

1. What should we teach in the first 2 years of medical school?
2. It should always be about the patient
3. Why make medical school miserable?
4. More on personality and medical school success
5. Happy’s daily checklist for medical inpatients

Related posts brought to you by Yet Another Related Posts Plugin.