During fellowship, I witnessed a very unusual thing: the questioning of an internist in a courtroom in a malpractice suit. The plaintiff’s lawyer was asking multiple questions, most of which were inquisitive about the nature of our work or the meaning of certain medical terms. The physician was being questioned by a lawyer before a jury lacking expert knowledge in both medicine and law. Since then I have been asking myself this question and what it really means to be “good” or “bad” in our profession.
Shortly after that experience, I began my work as a pediatric emergency physician. I witnessed similar situations where a physician’s knowledge was evaluated by individuals who lacked similar knowledge and experience. The most common example was a patient (usually a minor) or a guardian who would judge your knowledge despite their having sought your help in a matter about which they commonly have limited or no information. After all, if they knew what was happening, they wouldn’t have ended up waiting in the emergency room. Other examples include medical students and residents evaluating their supervising physician.
Don’t get me wrong. Evaluations are valuable tools in recognizing trends in specific competencies, like communication and professionalism. But is it valid for someone outside the medical profession to evaluate medical knowledge? After all, most of these evaluators are biased after a busy and often frustratingly long wait in the emergency room visit.
I may sound like an idealist who has been influenced by Thoreau’s belief that “the majority may be powerful but it is not necessarily right.” And if we look further into the history of medicine, we will recognize practices that were defined as the gold standard of care only to have time and research prove them wrong.
What governs us in this field is our conscience. This inner motivation of doing what’s best in our knowledge, to provide help to whoever needs it, is the ultimate goal of our profession. We should base our practice on doing no harm and advocating for our patients’ needs. Does that require treating our patients to the amenities of 5-star hotel? Does it require us to provide a doctor’s note for few days off for a patient with the common cold? Should we aim to make them happy by avoiding important aspects they don’t want to hear? Physicians and institutions are being judged daily on “Yelp” similar websites which do not provide a real measure of physicians’ knowledge. And these websites go a step further by listing dubious awards that influence how patients evaluate you. Our professionals have started to drift into a glamorous world of publicity where the masses follow the unsubstantiated gossip they hear about this physician or that institution. I wouldn’t be surprised to see a website in the near future – if one doesn’t already exist – that compares prices and benefits of care by one institution/physician versus another!
How about a physician in an inner city treating its poor? Don’t we think that the probability of complex delayed cases increases with such location? And of course the bad outcomes that come with that? Does it mean that this brilliant physician has less knowledge or is less skilled?
We now worry about lawyers, patients, students, residents, nurses and other people thoughts of us rather than worrying about doing what is best for our patients. We should try to educate persons outside the medical profession about the realities of our practice, but at the end of the day, we should not let people control our health care decisions.
Please share your thoughts and experiences.