Re: Corporate Culture and the Medical Profession

by The Inmate

The central question to be asked about hospitals–or about doctors for that matter–is whether they inspire the patient with the confidence that he or she is in the right place; whether they enable him to have trust in those who seek to heal him; in short, whether he has the expectation that good things will happen.

—Norman Cousins

Unfortunately, due to my wife’s on going illness, we have been to see a large number of doctors of all types and genders: M.D.’s, chiropractors, acupuncturists and specialists.  There is a lot of ink (and monitor space) given to the mediocrity of HMO’s and the doctors who work in places like Kaiser Permanente, but corporate culture, like some virus, is no respecter of private, communal or public medicine.

Most of the private doctors that we have seen run their offices like an assembly line, doling out shots, advice and prescriptions as if every person who came into their office was simply one more machine with two arms, two legs and a head–and the way most doctors address patients it is apparent they assume the head is empty.  On more than one occasion doctors, during an initial visit, said to my wife, who had been sick for years, something like this, “You’ll be better by Christmas.”  These are the same concerned doctors who never even called to see why she had stopped seeing them, but were quite happy to cash our checks.  The doctor she now sees and who has been the greatest help to her entered into her illness cautiously, listening attentively and asking real questions for well over an hour, then giving her a physical examination and finally displaying a healthy uncertainty about how and when to proceed.

The typical general practitioner’s office is not conducive to this kind of thorough examination.  There is one doctor per half a dozen examination rooms, one nurse, maybe two per doctor, a waiting room with plenty of magazines, though rarely very interesting ones, and a receptionist whose specialty is lying: “The doctor will see you in a moment.”  Patients wait not only in the waiting room, but also in the examination room and then the doctor, who is supposedly deeply concerned about the welfare of the patient (Why shouldn’t he or she be, considering the amount of money they extract from patients?) rushes into the room with charts and test results that the good doctor will read, probably for the first time, his eyes moving from the charts to the patient while at the same time listening to or, more accurately, pretending to listen as the patient answers questions, often the exact same questions the doctor asked the last time the patient was there.  While this is going on five other half-naked patients sit in the five other examination rooms waiting, patiently and impatiently, for the harried doctor who, if they are lucky, will spend more than six minutes with them before deciding that open heart surgery is the best course of action.  Where is Hippocrates when you need him?

Patients pay for a half hour or hour appointment but rarely see the doctor that long.  I remember listening to my doctor, who worked for a well-known, respected clinic in the San Diego area, talk for 20 minutes about his skiing trip (I am not making this up) while I sat on the other side of the door on an examination table.  He then spent approximately 5 to 10 minutes with me brushing aside all of my attempts to explain in detail why I had come.  I wrote several letters to him and the clinic then chose another doctor.  As one of my good friends likes to remind me, at least half the doctors out there finished in the bottom half of their class.  It does, however, take much more than finishing in the top half of the class to make a good doctor.

So on the one hand there are the doctors who in an effort to make as much money as possible convince themselves that what they really are doing is  benefiting as many patients as possible with their unique and incredible medical expertise.  It’s possible they might be unique and incredible if they actually took the time to be so.  They don’t.  Five or ten minutes with a patient is rarely enough time to make an accurate diagnosis.  On the other hand there are doctors who work in a corporate setting who do as little as possible and consider “professional growth” and “quality care” new cancer viruses to be eradicated as soon as possible.

The corporate, business or materialistic mentality has given us busy doctors, doctors who could easily make a comfortable living seeing fewer patients and giving them genuinely decent and humane care, but who, instead, overwork themselves to such a degree that their care is little better, if not worse, than what one can do for oneself in a good library or health food store.

David Duncan, who watched his wife become a doctor, wrote,

“. . . the nation’s teaching hospitals are dangerously overworking and exploiting their medical residents. . . . three years of eighty-to one-hundred-hour workweeks, thirty-six-hour shifts every third or fourth night, and a salary of about $4.30 an hour.” 

He goes on to write,

“According to the research, a physician is two to three times more likely to commit suicide than is someone in the general population and at least thirty times more likely  to abuse drugs and alcohol.” [italics mine] 

The solution he offers: reduce hours.  I would further add that established doctors should reduce the number of their patients.  The cry may be made that if large numbers of doctors saw fewer patients it would create a shortage.  Maybe.  On the other hand if doctors spent more time with each patient and gave themselves more time to think about their patients’ problems there might not be a need for patients to see a large number of doctors in order to find that one good one.

I have mentioned before that Michael Grant, the well-known historian, has suggested that the Caesars’ great evil was caused by a combination of too much power and too much work.  They took little time to reflect calmly and intelligently upon the events of their lives; leisure was not meaningful to them.  If doctors reduced their hours and began to look upon what they do as practice–that is what they call it, ironically enough–they might come before their patients, those glorious human beings that Hamlet calls, “the beauty of the world, the paragon of animals!” with humility and grace.  The best doctors consider themselves students under the tutelage of each individual patient’s symptoms.  They do not come to their patients with preconceived ideas and rote remedies.  They do not make quick decisions, but move slowly and methodically considering themselves apprentices and beginners.  They know all too well that the human body, that life itself, is not without its surprises and that obvious answers are sometimes no answers at all.


works cited or referred to:

  • Cousins, Norman, Anatomy of an Illness as Perceived by the Patient: Reflections on Healing and Regeneration,  Bantam Books, New York, N.Y., 1991, pg. 154.
  • Duncan, David Ewing, “Is This Any Way to Train a Doctor: Medical residencies: the next health-care crisis,” Harper’s,  Vol. 286, No. 1715, April 1993, pp. 61, 63, 66.
  • Grant, Michael, The Twelve Caesars,  unabridged narration on cassette by Nelson Runger, Recorded Books, Inc., Prince Frederick, MD, tape 8, side 2.
  • Shakespeare, William, Hamlet,  Act 2, Scene 2, Line 300

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