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Commentary – February 2012

Tex Med. 2012;108(2):61-62. 

By Anand Mehendale MD

I am a practicing neurologist in a small town in Texas. Recently, my daughter was accepted to a medical school in Texas. As a proud father, I mentioned my daughter's achievement to one of my colleagues. He looked at me with sad eyes and said, "My condolences. Haven't you been able to talk her out of it?"  

I was shocked by what he said, but I thought it was an aberration. Convinced that their answers would be different, I proceeded to give this news to a number of other physicians. To my shock and dismay, nine out of 10 physicians had nearly identical responses. Incidentally, almost all my patients congratulated me about my daughter's chosen career.  

I began to ponder why my colleagues had such negative reactions. I know that most physicians are good physicians, and a sacred relationship between patients and doctors has existed for millennia. This does not mean that all doctors are good. As with any field, we do have some bad apples. Some physicians are greedy; others practice defensive medicine out of fear of litigation. Physicians, though, for the most part are altruistic. William Osler, widely regarded as the father of modern medicine, said it beautifully, "Medicine arose out of the primal sympathy of man with man; out of the desire to help those in sorrow, need, and sickness." This relationship arises out of the pain and suffering of one person and an offer of hope by another. 

If medicine is such a noble profession, why is there such discontent in the health care industry? It's ironic that we have begun calling the medical profession the "health care industry." It somehow cheapens what we do when we take care of our patients. Industry is when we order a computer from an e-retailer. Industry is Henry Ford's assembly line. Somehow, the moniker "industry" doesn't fit with what we do in medicine.  

Society in general and patients in particular may also play a part in this discontent. Physicians are constantly faced with life-and-death decisions, and we have begun to respond in high-tech ways. Some patients feel that if a physician does not order a fancy new test, he or she is not at the cutting edge of medicine. The fact is that tests are often ancillary and not a panacea.  

To make matters worse, attacks from the insurance industry and from lawyers have created an unwieldy bureaucracy in which it is very difficult for physicians or nurses to spend a good deal of time with their patients and provide quality care. As a result, we treat charts, papers, and test results. I know many nurses who spend a significant amount of their time writing notes and filling out paperwork, all in an effort to protect themselves from frivolous legal claims. Overburdened by paperwork, these nurses have very little time to spend with the actual patient. What is sacrificed, unfortunately, is any discussion about a patient's physical, psychological, and spiritual health. Faceless bureaucrats and malignant trial lawyers have perverted our profession, and a hyper-partisan Congress has held elderly patients and physicians hostage. Politicians are gambling the health of our senior citizens for their self-serving agendas. 

Recently, in the intensive care unit, I saw two patients wheeled in. Both were critically ill and required significant medical attention. As I walked away, I realized that one of them had health insurance; the other did not. While these same physicians and nurses may have offered condolences regarding my daughter's decision to go to medical school, their actions were without the thought of monetary compensation. They were simply doing good for the sake of doing good. In moments like this, I continue to believe in the innate moral strength and humanity of my profession.  

Medicine is still a noble profession, and the sacred bond between patients and physicians will endure despite new storms on the horizon. It has survived attacks from kings, religions, emperors, despots, madmen, and misguided idealists for millennia. Even in these uncertain times, I am proud of my daughter for choosing a giving profession.  

Anand Mehendale, MD, is a board-certified neurologist and board-certified addictionologist with Phoenix Medical Associates in Kerrville. He is on the governing board of the Texas Physician Health Program and is a consultant to Texas Medical Association's Physicians Health and Rehabilitation Committee after being a chair of that committee for four years. Additionally, he is the past president of the Texas Society of Addiction Medicine. Dr. Mehendale has 30 years clinical experience in managing patients with neurological disorders and addictive disorders. 

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