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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.
Published in General
I see it that way too. Also, the “inclusion” of the alternative medicine practitioners competing for insurance dollars–from midwives to chiropractors to the naturopathic doctors. We’re paying them too much and traditional doctors too little. Healthcare dollars have been ridiculously broken up. And after that, there are some estimates I have seen that put the cost of administration at 80 percent of all medical expenses.
And I agree that the only answer may lie in the malpractice courtroom.
It’s a mess.
There’s little left for actual doctors who bear the true responsibility. And the responsibility is the bottom line here. Responsibility for the patient is what sets traditional doctors apart from everyone else in the system.
That is not a terribly efficient system for increasing quality of care…
Natural selection just kills short, fat, slow, brightly colored giraffes. It does not add height, speed, or camo to the rest of them unless it’s already in the genes. MedMal plaintiffs’ lawyers can help squeeze out some bad ones but won’t make the survivors any more competent. And if the standard of care itself drops, then it gets harder to prey on the worst.
It is noteworthy that one of those who brazenly looted millions given to BLM has argued that suing him using the white man’s civil justice system is a form of white supremacy. It’s an approach so stupid it just might work and set a precedent and a bar to accountability for others.
Except in capital punishment states.
Neither do I.
Of course, that is because I am actually not a doctor.
You are wrong about most of that. You speak the language which is everything. It is very difficult for patients and family members who are not medically trained to understand anything that most doctors tell them. It seems to me that very few doctors taking care of patients in a hospital setting even want to talk to the patient or family. You have a gift even though you feel unworthy to give advice. Advice is not what friends who become patients want from you.
I actually didn’t give Raj a copy of Being Mortal until this morning. We were sitting aside the courts and another player, Mike, who is a retired family practice doc, saw the book I handed to Raj and said, “That is the best book you will ever read.” It lead to a nice conversation.
But if nobody is willing to accept bad outcomes without blame and subsequent compensation, how does that change?
I think there should be caps on settlements.
Maybe in terms of individual practitioners, but not so much for large conglomerates. Keeping in mind that one of the purposes for things like punitive damages, is to change behavior.
The doctor tax is similar to the plumber tax, the electrician tax, the mechanic tax, etc.
If you don’t drive a silly, city, sissy-boy truck, there is a pickup truck tax.
I’ll never forget the PhD bio-chem professor who quipped that his mother said, “You could have been a doctor!” and said, “But Ma, I am a doctor.” And she said, “You know what I mean.”
There’s a great story about Isaac Bashevis Singer. When he was a child, one day at temple he heard a storyteller and was greatly impressed. He went home and told his mother, that’s what I want to do with my life, I’ll be a storyteller. She said, “Fine, you’ll be a storyteller; on the side you’ll be a brain surgeon.”
What a great post!
Thank you for the book recommendation.
I’ve had great doctors, good doctors, and ones not-so-much. But I have found your statement to be pretty accurate.
I was in the hospital for surgery. The next morning, a hospital doctor poked his head in the room (literally, his feet were out in the hall), asked “You doing okay?”, and (literally) before I could open my mouth he was gone.
And I noticed that the surgeons from my own orthopedic practice spent more time in the hall standing at their wheeled computer desks than in my (or their other patients’) room. Now, I did mostly get what I needed from my surgeon’s visits and maybe having the wheeled desk makes it easier for them to get necessary info. But it wasn’t a good look for them.
We ruthlessly exploit our daughter (RN and soon to be PA) and her surgeon husband for medical advice…but we raised that kid. She owes us.
Admitting that one is a police officer once resulted in dull conversations about the last speeding ticket one’s interlocutor received; now it’s much worse. Saying that you’re a law enforcement chaplain results in pretty interesting chat, at least if you’re interested in sudden, violent, tragic death. Which of course, I am.
One more example of my 70 plus years run of good luck. Never had a bad doc. Can remember the first GP when I was 8. Then dermos as a teen. Only trouble was I was getting very experienced ones. Who retired on me. Finally got a relatively young internist. Who won’t let me call him Dr. It’s Chris. I just ask him to keep track of the liver results.
The best advice I ever got in medical school was never answer a question standing up. I have been to multiple required courses on medical malpractice issues and no one ever gives that advice and when I try to share it with the audience the malpractice experts dismiss me as an idiot.
Forgot to add – later, when I looked at my insurance EOB, he billed me for a visit.
Could not agree more.
Great!