Doctors, patients, research and teaching

From Lewis S Blevins, Jr MD  –  A “triple threat” used to be a term to describe the consummate academic physician who, second to none, possessed excellent teaching skills, demonstrated a successful productive research program, and clinical intuition with patient care abilities that were admired by all. It is a rare “breed” in today’s world of academic medicine as a result of changes in the landscape fronts of academics and medicine. Plenty of folks excel at two of these three components of the “triple threat” in academic medicine. That’s fine. And perhaps as it should be. Others excel in only one realm of this triptych. That’s fine, too, provided that their weaker areas are not counted as liabilities.

This evening, while having a burger at a restaurant within “stones throw” of my institution, I had the frank displeasure of sitting outside alone amongst the folks awaiting a table. Displeasure you ask? Yes. For thirty minutes I had to listen to a UCSF physician complain about having come to UCSF to do research, being asked to see patients, serve on committees and to teach. He clearly had no regard for the fact that his negative comments about being required to see patients and to teach were heard by others. I was both shocked and saddened to hear how he related dismissing patients that he did not wish to care for. Further, his comments illustrated that he felt teaching was a waste of time. He is also a misogynist having discussed his attitudes and actions towards women in medicine.

Threat? You bet! This guy is a threat to the very fiber of the profession of medicine and what it represents to be a physician and teacher. Some refer to those doctors who rarely see patients as “hobby doctors” as they practice medicine as a hobby. It’s a real but tragic testament to the fact that there are people at great institutions, such as my very own, that I believe we must work to protect patients FROM with vigor. I suppose this guy is one of them. He may do great research. If so, give him a lab and ask him to stay put. Nose to the grindstone.

There is no substitute for physicians with tremendous experience. Who do you want to see? The cocksure doctor who won the prizes in research and gets all the accolades who has little patient experience? Or, the doctor who has spent thousands of hours solving real problems for his or her patients? I can answer that question only for myself.

This is not to imply that experienced doctors are always good. The annual reports from state licensing boards contain pages of names of physicians, many of them seasoned clinicians, academic and private or group practice, who have recently been disciplined for alcoholism, drug use, inappropriate prescription writing, and other unmentionable conducts. Further, doctors and patients are just like spouses, family members, co-workers, etc. Sometimes they will just not get along. So, when you read something on the internet suggesting a physician is sub standard, that doesn’t imply the doctor is not a good doctor. It simply means that particular patient and that doctor did not have a good relationship and the patient decided to voice a complaint for the world to see. Of course, as physicians, we take feedback seriously. We do, however, recognize when people are just grinding an axe or attempting to make a physician “pay” for not providing something the patient wanted to obtain from the encounter. For every five dissatisfied patients who write about their experiences on the Internet, there probably another 5000 satisfied patients. If you’re not getting along with your doctor then find another one. Conversely, if you’re looking for a doctor don’t believe everything you read on the Internet in regards to negative commentary.

What about board certification? The truth of the matter is that probably only about half of all practicing physicians are certified by their appropriate medical specialty board. Lack of board certification, especially in the day where physicians must recertify every 10 years, and for many physicians the process is arduous, time-consuming, detracts from their practice and their daily lives, and is expensive, does not imply that the physician is not adequate, or well–trained, or competent to practice medicine. I do not find the failure to maintain certification to say anything whatsoever about the abilities of the physician. Furthermore, I have seen plenty of physicians who are board-certified who are not worthy of the MD at the end of their signature line. Then, there are people like me, who devote their lives to the evaluation and management of patients with pituitary disorders, and occasional disorders of the target glands, who, though board-certified in endocrinology would be the very LAST person on the planet you would want to see to manage your diabetes, metabolic syndrome, hyperlipidemia, etc. It’s almost laughable that I am board certified to practice all of endocrinology and metabolism when I have spent my life in the realm of pituitary disorders!

There are plenty of traits that are necessary and required to grow into a seasoned clinician. Compassion, understanding, and ability to listen, intellect, dynamic thought processes, experience ……..and the list could go on and on. One of the things that I see as essential is the physicians recognition of his or her limitations. “I don’t know about that…..let’s refer you to someone else.” “I don’t understand headaches. I want to refer you to a neurologist.” “I don’t treat that problem. See your primary physician.” The physician who says these things is a wise and experienced physician. Trust them. Believe them. Stick with them. For they recognize their weaknesses, and probably also their strengths, and really and truly have your best interests in mind.

My advice is to research your physicians. Ask questions as to their experience and commitments to the practice of medicine. Don’t assume research prowess and fame correlate with an ability to practice good medicine. Don’t believe everything you read on the Internet, and especially the negative commentaries, until you see for yourself. Be willing to find another doctor if the “fit” is not right for both you and the physician. Trust your instincts. If you find a good set of doctors stick with them and make a few friends for life.

photo by NEC Corporation

© 2015, Pituitary World News. All rights reserved.