The Doctor Tax

 

I realized as soon as I finished medical school that it was unwise to broadcast the fact that now I was a doctor and therefore deserved special recognition. It may not be true that physicians pay more for services than non-physicians but it seemed true to me.

That is not the reason I have been reluctant to tell people what I did for a living, but it was part of it.  Being a physician is a burden. That is the real doctor tax.

Since I retired, I have become the self-appointed mayor of my pickleball community. I try to learn everyone’s name and background. It is hard to do that without sharing my own background. I am reluctant to share because I know the potential burden.

When I first met Karen, the former movie star, it was obvious to me that she had significant lymphedema in one leg. Once she learned that I was a doctor, she told me about the treatments she was undergoing for venous incompetency in that leg. I told her it looked like lymphedema to me rather than dependent edema and asked her if she ever had pelvic radiation and had a recent CT scan of her pelvis. She answered Yes to both questions, but her life ventured into chaos very soon afterward as she developed catastrophic infections from the venous procedures.

Just the other day, my friend Raj, as we were sitting along the pickleball courts, hands me an X-ray report to read and asks, “This doesn’t look very good, does it?” His girlfriend has a pancreatic mass with liver metastasis.

The burden of being a doctor is that you are exposed to an infinite number of problems that you cannot solve. I gave Raj my copy of Being Mortal by Atul Gawande and told him he needed to read it and decide if he wanted to share it with his girlfriend. That was the best I could do.

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  1. Franco Member
    Franco
    @Franco

    I always felt sorry for doctors for that reason and that they seem to have to be available at all times. I can’t stand talking about medical conditions and ailments anyway and if I had any knowledge it would be doubly annoying. 

    You can always claim it’s not your specialty (whatever it is). But I would take an instant dislike to someone who handed me an Xray on a pickle ball court.

    • #1
  2. Southern Pessimist Member
    Southern Pessimist
    @SouthernPessimist

    When I was pediatrician before I became a radiologist, it was not uncommon for parents to pull their car along side of me while I was jogging to ask for medical advice.

    • #2
  3. navyjag Coolidge
    navyjag
    @navyjag

    But you folks save lives.  All lawyers can do, if they are right, is save their client’s money. I think we need more docs. Nephew an ER doc in Illinois and a star.  Daughter an M&A finance star and makes tons more than the nephew.  But does not save any lives.  And  hope the blood doc on Friday and cure my wife’s clots.  

    • #3
  4. EODmom Coolidge
    EODmom
    @EODmom

    Franco (View Comment):

    I always felt sorry for doctors for that reason and that they seem to have to be available at all times. I can’t stand talking about medical conditions and ailments anyway and if I had any knowledge it would be doubly annoying.

    You can always claim it’s not your specialty (whatever it is). But I would take an instant dislike to someone who handed me an Xray on a pickle ball court.

    Fear and desperation make people do things they would never ever consider otherwise doing. The moms who stop their cars are another story entirely. 

    • #4
  5. Douglas Pratt Coolidge
    Douglas Pratt
    @DouglasPratt

    We ordinary people have elevated y0u doctors to a sort of priesthood because we have to. When we come to you, we’re usually scared. And ignorant. You serve the same function as priests while you’re figuring out what pills we need.

    When I found out I was dealing with prostate cancer, I determined to learn as much as I could and be an active participant in the process. I have an outstanding oncology team. Each of them has told me, at different times, how impressed they were with what I knew about it, and how little emotional support I seemed to need. I guess I was unusual in those respects. It just seemed to me to be the best thing to do; when you’re in a war, you gather all the intel you can to support your decisions.

    I have a high regard for doctors and priests. Both professions require great strength, more than I’ll ever have.

    • #5
  6. navyjag Coolidge
    navyjag
    @navyjag

    Same here Doug. As luck would have it, I live 2 blocks from the UCSF Prostate Clinic in San Fran. on Divisadero Street. Caught early; did the 4 cyber knife treatments in Jan. 2020 and PSA down real low. Not zero but no worries. Especially when the doc said I don’t have to give up the port.  Will see what my liver numbers look like when I get my annual physical next month. 

    • #6
  7. Southern Pessimist Member
    Southern Pessimist
    @SouthernPessimist

    “Fear and desperation make people do things they would never ever consider otherwise doing. The moms who stop their cars are another story entirely.”

    Not really. You are right that fear and desperation are a part of it but everyone wants validation of their particular circumstance. Just imagine what a casual cocktail party is like for a young vulnerable pediatrician.

    At every party, young women, who were not even my clients, would tell me stories about that time that their child was seriously ill and when they finally saw the pediatrician he said: “Thank God, you got here just in time!”

     I knew that was total bullshirt but all I said was that was amazing.

    • #7
  8. navyjag Coolidge
    navyjag
    @navyjag

    Southern Pessimist (View Comment):

    “Fear and desperation make people do things they would never ever consider otherwise doing. The moms who stop their cars are another story entirely.”

    Not really. You are right that fear and desperation are a part of it but everyone wants validation of their particular circumstance. Just imagine what a casual cocktail party is like for a young vulnerable pediatrician.

    At every party, young women, who were not even my clients, would tell me stories about that time that their child was seriously ill and when they finally saw the pediatrician he said: “Thank God, you got here just in time!”

    I knew that was total bullshirt but all I said was that was amazing.

    Curious. Were you a surgeon? Talk about a high stress job. 

    • #8
  9. Southern Pessimist Member
    Southern Pessimist
    @SouthernPessimist

    navyjag (View Comment):

    Southern Pessimist (View Comment):

    “Fear and desperation make people do things they would never ever consider otherwise doing. The moms who stop their cars are another story entirely.”

    Not really. You are right that fear and desperation are a part of it but everyone wants validation of their particular circumstance. Just imagine what a casual cocktail party is like for a young vulnerable pediatrician.

    At every party, young women, who were not even my clients, would tell me stories about that time that their child was seriously ill and when they finally saw the pediatrician he said: “Thank God, you got here just in time!”

    I knew that was total bullshirt but all I said was that was amazing.

    Curious. Were you a surgeon? Talk about a high stress job.

    I was the last pediatrician allowed to retrain as a radiologist in 1986 when the government decided that there were too many specialists and not enough primary care physicians. That governmental decision has worked out about as well as you would expect. There is a huge shortage of general surgeons today but a surplus of hospitalists working for hourly wages.

    • #9
  10. navyjag Coolidge
    navyjag
    @navyjag

    Definitely get this. Virtually all our docs, not our primary, are in “groups” working with United Health and our favorite insurers.  Looks like you retired just in time. 

    • #10
  11. Southern Pessimist Member
    Southern Pessimist
    @SouthernPessimist

    I may be highjacking my own post, but the more I think about professional expectations, the more I think that people tend to end up where they ought to be. My French Canadian wife has a niece who is an accountant who specializes in international mergers and acquisitions. She makes millions of dollars per year but I doubt if her cocktail party conversations are anything like mine.

    • #11
  12. Dr. Bastiat Member
    Dr. Bastiat
    @drbastiat

    To me, the good doctors ARE doctors.  It’s not what they do.  It’s who they are. 

    There are problems with that, of course. 

    But I haven’t found any other way.  If medicine isn’t the center of your universe, you should probably go do something else. 

    To Southern’s point, that can make leisure time and retirement sort of tricky…

    • #12
  13. EODmom Coolidge
    EODmom
    @EODmom

    Southern Pessimist (View Comment):

    I may be highjacking my own post, but the more I think about professional expectations, the more I think that people tend to end up where they ought to be. My French Canadian wife has a niece who is an accountant who specializes in international mergers and acquisitions. She makes millions of dollars per year but I doubt if her cocktail party conversations are anything like mine.

    Hah! I did international tax of the same M&A variety – and I rarely told anyone what I did: not after being told a couple of times how awful it was that I helped offshoring. And those awful hedge fund guys.  Even in Silicon Valley they thought how they made money was bad. The hedge fund guys actually are pretty terrible, but I stuck with taxes. Just taxes. And said I never did our own returns. 

    • #13
  14. The Reticulator Member
    The Reticulator
    @TheReticulator

    Franco (View Comment):

    I always felt sorry for doctors for that reason and that they seem to have to be available at all times. I can’t stand talking about medical conditions and ailments anyway and if I had any knowledge it would be doubly annoying.

    You can always claim it’s not your specialty (whatever it is). But I would take an instant dislike to someone who handed me an Xray on a pickle ball court.

    A little over 20 years ago I was diagnosed with prostate cancer.  I told the urology surgeon, “The book you gave me to read says that a surgeon should do about a hundred of these a year to be good at it.”  “That’s about right,” he responded, without offering any data on how many he had done.  A little later I said, “I don’t want to schedule surgery yet. I’d like to get a second opinion.” Then I went home and wondered, “Now what?” 

    A few days later I did figure out that I wanted the surgery for sure, and who I wanted to do it, but it wasn’t as simple as that.  I won’t go into that story here, but somewhere along the way I got a call at work from my physician friend, Rick.  He had heard about my diagnosis and said, “You didn’t call me!”  I told him I had certainly thought about him, but I didn’t want to impose on him because of our friendship.  (As an IT guy I had a pretty good idea how doctors can’t be around other people without being asked for computer medical advice.)  He said, “I appreciate that, but…” and we had a talk about the diagnosis and options.  He said he was learning a lot more about prostate cancer himself, as he had a patient who was going through it. 

    Rick and I had some memorable Boy Scout adventures together with our boys, but as soon as his boys were all done with college Rick and his wife moved out to the west coast where he could resume his interest in mountain climbing. (His wife wouldn’t let him do it before that.)  We stayed in touch — mostly our wives stayed in touch — and then after having a lot of mountaineering adventures and setting several records — oldest person to climb this or that mountain — Rick died in a mountaineering accident this spring.  We all miss him.

    And since my surgery, at least two of my friends have had surgery done by the same urology surgeon who made my diagnosis, and have done fine. 

     

    • #14
  15. navyjag Coolidge
    navyjag
    @navyjag

    The Reticulator (View Comment):

    Franco (View Comment):

    I always felt sorry for doctors for that reason and that they seem to have to be available at all times. I can’t stand talking about medical conditions and ailments anyway and if I had any knowledge it would be doubly annoying.

    You can always claim it’s not your specialty (whatever it is). But I would take an instant dislike to someone who handed me an Xray on a pickle ball court.

    A little over 20 years ago I was diagnosed with prostate cancer. I told the urology surgeon, “The book you gave me to read says that a surgeon should do about a hundred of these a year to be good at it.” “That’s about right,” he responded, without offering any data on how many he had done. A little later I said, “I don’t want to schedule surgery yet. I’d like to get a second opinion.” Then I went home and wondered, “Now what?”

    A few days later I did figure out that I wanted the surgery for sure, and who I wanted to do it, but it wasn’t as simple as that. I won’t go into that story here, but somewhere along the way I got a call at work from my physician friend, Rick. He had heard about my diagnosis and said, “You didn’t call me!” I told him I had certainly thought about him, but I didn’t want to impose on him because of our friendship. (As an IT guy I had a pretty good idea how doctors can’t be around other people without being asked for computer medical advice.) He said, “I appreciate that, but…” and we had a talk about the diagnosis and options. He said he was learning a lot more about prostate cancer himself, as he had a patient who was going through it.

    Rick and I had some memorable Boy Scout adventures together with our boys, but as soon as his boys were all done with college Rick and his wife moved out to the west coast where he could resume his interest in mountain climbing. (His wife wouldn’t let him do it before that.) We stayed in touch — mostly our wives stayed in touch — and then after having a lot of mountaineering adventures and setting several records — oldest person to climb this or that mountain — Rick died in a mountaineering accident this spring. We all miss him.

    And since my surgery, at least two of my friends have had surgery done by the same urology surgeon who made my diagnosis, and have done fine.

     

    Friends did the same. One 20 years ago and doing fine.  But pals who did the radiation also doing fine.  Looks like the one cancer the docs can control. 

    • #15
  16. EB Thatcher
    EB
    @EB

    The Reticulator (View Comment):
    We stayed in touch — mostly our wives stayed in touch — and then after having a lot of mountaineering adventures and setting several records — oldest person to climb this or that mountain — Rick died in a mountaineering accident this spring.  We all miss him.

    I’m so sorry for the loss of your friend.  Not being a climber, I was interested that he was solo climbing.  Is this a common thing?

    • #16
  17. MarciN Member
    MarciN
    @MarciN

    I know you are a radiologist now, but I have three children, and there is no one in the world I have more respect for than pediatricians. Parents are probably a pain in the neck, but just know how grateful we are.

    • #17
  18. Metalheaddoc Member
    Metalheaddoc
    @Metalheaddoc

    I don’t tell people I am a doctor if I can avoid it. Plumbers and electricians get dollar signs in their eyes if I do.

    I don’t give people medical advice because I don’t feel qualified. I am a radiologist.  I sit in my basement and read images from far far away.  I forgot my real doctoring a long time ago. 

    • #18
  19. navyjag Coolidge
    navyjag
    @navyjag

    Metalheaddoc (View Comment):

    I don’t tell people I am a doctor if I can avoid it. Plumbers and electricians get dollar signs in their eyes if I do.

    I don’t give people medical advice because I don’t feel qualified. I am a radiologist. I sit in my basement and read images from far far away. I forgot my real doctoring a long time ago.

    Yeah but you still save people’s lives from your basement. We appreciate that.  More than I have ever done. 

    • #19
  20. kedavis Inactive
    kedavis
    @kedavis

    Southern Pessimist (View Comment):

    “Fear and desperation make people do things they would never ever consider otherwise doing. The moms who stop their cars are another story entirely.”

    Not really. You are right that fear and desperation are a part of it but everyone wants validation of their particular circumstance. Just imagine what a casual cocktail party is like for a young vulnerable pediatrician.

    At every party, young women, who were not even my clients, would tell me stories about that time that their child was seriously ill and when they finally saw the pediatrician he said: “Thank God, you got here just in time!”

    I knew that was total bullshirt but all I said was that was amazing.

    I’ve recently been reminded – I don’t remember if it was a YouTube video or something else – that you could have said their stories were “incredible!”  They would take it as a compliment, but it really means that their stories were not believable.  :-)

    • #20
  21. kedavis Inactive
    kedavis
    @kedavis

    Southern Pessimist (View Comment):

    I may be highjacking my own post, but the more I think about professional expectations, the more I think that people tend to end up where they ought to be. My French Canadian wife has a niece who is an accountant who specializes in international mergers and acquisitions. She makes millions of dollars per year but I doubt if her cocktail party conversations are anything like mine.

    Yeah, how much fun can it be to just talk about the size of your bank accounts?  :-)

    • #21
  22. navyjag Coolidge
    navyjag
    @navyjag

    kedavis (View Comment):

    Southern Pessimist (View Comment):

    I may be highjacking my own post, but the more I think about professional expectations, the more I think that people tend to end up where they ought to be. My French Canadian wife has a niece who is an accountant who specializes in international mergers and acquisitions. She makes millions of dollars per year but I doubt if her cocktail party conversations are anything like mine.

    Yeah, how much fun can it be to just talk about the size of your bank accounts? :-)

    Hey ke we are talking docs here. Not the financial wizards who are millionaires. Like my daughter. We can’t wait to move into her Nashville mansion for our last years. 

    • #22
  23. The Reticulator Member
    The Reticulator
    @TheReticulator

    EB (View Comment):

    The Reticulator (View Comment):
    We stayed in touch — mostly our wives stayed in touch — and then after having a lot of mountaineering adventures and setting several records — oldest person to climb this or that mountain — Rick died in a mountaineering accident this spring. We all miss him.

    I’m so sorry for the loss of your friend. Not being a climber, I was interested that he was solo climbing. Is this a common thing?

    I’m not sure. I think most of his climbs of summits are group or team activities, but this type of outing was more for practice and conditioning, as I understand it.  He was several years younger than I am, but old enough to need to take continuous conditioning extra seriously. Maybe all mountaineers do that — I’m not sure. At his funeral a story was told of how he would often be seen pushing (running) a wheelbarrow loaded with heavy weights up the hills in his hilly neighborhood. It didn’t surprise me. 

    I was never interested in joining him and his boys on any of their rock climbing activities, but he was always all-in on an activity.  He planned a 40-mile backpacking trip along Isle Royale for our boys’ Boy Scout troop, and then tore a knee tendon playing basketball.  He needed surgery for it, but put it off because of the scheduled trip, and limped the length of the island with a brace on his knee. I don’t like carrying a pack on my back but went along as a 2nd adult leader.  It was one of the coldest and rainiest July months Lake Superior had, and one wet and chilly night Rick turned to me in our tent and asked, “John, what are we going to do if it gets too  cold?” (We were starting to think about hypothermia.) I told him if it gets that cold, we’ll pile into the same tent with the boys and keep each other warm. Good enough answer, and we went to sleep. That was a night in which I’d wake up shivering, and after shivering enough to warm up a little would doze off again. The boys were fine.  It was my own fault for not wanting to carry the weight of a warmer sleeping bag.

    • #23
  24. Doctor Robert Member
    Doctor Robert
    @DoctorRobert

    I’m a physician at the end of my career.   Practicing medicine is expensive and getting paid is difficult, I am barely making expenses much less investing for retirement.  A pox on all the attorneys, accountants, plumbers and contractors who have overcharged me over the years.

    • #24
  25. MarciN Member
    MarciN
    @MarciN

    I think the first victims of the American socialists–that is, the Democrats–were American doctors. It is a gut-wrenching story. 

    • #25
  26. Bryan G. Stephens Thatcher
    Bryan G. Stephens
    @BryanGStephens

    Dr. Bastiat (View Comment):

    To me, the good doctors ARE doctors. It’s not what they do. It’s who they are.

    There are problems with that, of course.

    But I haven’t found any other way. If medicine isn’t the center of your universe, you should probably go do something else.

    To Southern’s point, that can make leisure time and retirement sort of tricky…

    My Dad still does it. 

    I get something similar as a therapist. “Can I talk to you about something?” is never followed with good news from the person. It is a request for help from someone desperate. 

    In Bible Study I am often asked “What is your take on this as a therapist”. My profession has more than a touch of being secular priests. 

    That is who I am. I think it counts as much for me and I agree it does for good Doctors. LIke the good doctor Bastiat. 

    • #26
  27. Old Bathos Moderator
    Old Bathos
    @OldBathos

    I don’t know whether to blame capitalism, managerialism, or socialism but the forces of evil seem bent on forcing medical services into identical defined packets, all tech, no art or intuition that can be delivered by automatons and correspond to billing and productivity tables.

    One of worst parts of growing up was being unable to use my pediatrician for primary care forever.   It was not just that he had seen everything and diagnosed in a flash but his manner was overwhelmingly reassuring. More than once, I overheard him gently interrupt some mother’s agitated and likely lengthy saga with a question then, with a few words calm and change the tone.   

     

    • #27
  28. MarciN Member
    MarciN
    @MarciN

    Old Bathos (View Comment):
    One of worst parts of growing up was being unable to use my pediatrician for primary care forever.

    My son has said exactly the same thing. :-) No doctor he has had since has ever measured up. :-)

    My kids had the best pediatricians there could be.

    • #28
  29. MarciN Member
    MarciN
    @MarciN

    Old Bathos (View Comment):
    I don’t know whether to blame capitalism, managerialism, or socialism but the forces of evil seem bent on forcing medical services into identical defined packets, all tech, no art or intuition that can be delivered by automatons and correspond to billing and productivity tables.

    Pure speculation, which probably has no place on Ricochet, but I’ve always blamed the malpractice laws as the start of the financial crisis for independent doctors. It was almost (no offense intended to the lawyers on Ricochet) as if there was a wealth shift from doctors to lawyers. Just a longstanding impression I have had about what happened. The outlandish settlements hurt everyone except the malpractice insurance companies and the claimants’ lawyers.

    • #29
  30. Old Bathos Moderator
    Old Bathos
    @OldBathos

    MarciN (View Comment):

    Old Bathos (View Comment):
    I don’t know whether to blame capitalism, managerialism, or socialism but the forces of evil seem bent on forcing medical services into identical defined packets, all tech, no art or intuition that can be delivered by automatons and correspond to billing and productivity tables.

    Pure speculation, which probably has no place on Ricochet, but I’ve always blamed the malpractice laws as the start of the financial crisis for independent doctors. It was almost (no offense intended to the lawyers on Ricochet) as if there was a wealth shift from doctors to lawyers. Just a longstanding impression I have had about what happened. The outlandish settlements hurt everyone except the malpractice insurance companies and the claimants’ lawyers.

    Malpractice premiums, expensive hi-tech equipment, and costly insurance reporting requirements requiring clerical staff have all contributed to the modern overhead burden that meant that one could no longer just buy a few bottles of isopropyl, some cotton balls, and a box of tongue depressors and hang a shingle.  The romantic, idealized solo practice like the one that Michael J. Fox accepted in Doc Hollywood (1991) is probably fiscally, technically, and logistically impossible to be common, much less the norm even though many patients and docs claim to yearn for it.

    With standards in medical schools dropping fast to accommodate woke ideological dictates, the plaintiffs’ med mal bar may have to take on an added responsibility to weed out those that never should have been issued M.D.s, and thus do the vetting that the profession increasingly declines to do.

    • #30
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