As usual, my best ideas come from readers. After my last post, Fees Drive Quality, Incomes Drive Envy, someone wrote:
“Trust me, if the Toronto Star did not get lots of mileage/sales and clicks from their articles about doctors, they wouldn’t keep beating this horse.
The problem is with the public that ‘consumes’ these stories about our profession.
Doctors are nothing more than free, taken for granted, envied and hated pieces of garbage who make too much money no matter what it is because…well…because they are doctors.”
He has a point. Why is doctor bashing so popular?
Do Toronto Star readers despise doctors and look to consume all the hateful, spiteful news they can find?
Do they secretly envy doctors and enjoy bad news about them? Is it schadenfreude?
Do readers consume doctor bashing in the way people look at car wrecks? Do rubberneckers look because they dislike car crash victims or because they cannot resist?
Or is it a bit of all this?
Hate, Envy, or Entertainment
Victorians averted their gaze as a way of life. Though uncool these days, most people still have enough modesty to look away sometimes.
Most never make spectacles out of the misfortunes of the unfortunate.
But misfortunes of the fortunate and successful are fair game. Hollywood’s favourite villain is the businessman.
It is now morally acceptable to attack anyone who seems better off than each of us. Aristocrats do not fight back.
The Star presents doctors as ersatz aristocrats and gives tomatoes for the ersatz peasantry to throw, insulting both groups in the process.
Is doctor bashing about doctors or about societal envy in general? Do we like to hate anyone who is smarter, prettier, or more successful than ourselves?
Maybe the Toronto Star and tabloids simply sell ‘guilty pleasures’. By definition, a guilty pleasure is doing what we know we should not.
If more than a guilty pleasure, more people would condemn it. If society found doctor bashing truly heinous, the public would protest. They would boycott the Star.
Responding to Nonsense
Throughout history wisdom writers have wrestled with what to say to fools and tabloids. Sages often sound confused and confusing.
Even King Solomon seems to contradict himself:
Answer not a fool according to his folly, lest thou be like unto him.
Answer a fool according to his folly, lest he be wise in his own conceit.
In the end, the anti-business, anti-profit Star is a business trying to maximize profit. “If it bleeds, it leads.”
Bad news sells.
Bad news about successful people sells more.
I doubt the Star cares enough about doctors to attack them. It cares first about making money.
Am I naive? Is it Pollyannaish to think society, for the most part, still appreciates doctors?
Just because the Toronto Star has chosen to anchor its failing business on bashing doctors does not mean that the public hates us.
It is a sad comment on society. But it is not hate.
PS. The picture is of the ‘Ancient Booer” from the movie Princess Bride.
Thanks for including she-who-booed Princess Buttercup – I love that movie on several levels. Its funny how the dread pirate Roberts is actually the good guy and the handsome prince is the villain. I think the hatred of doctors is not universal. I have yet to meet an American who was disrespectful of doctors. Same for Germans. I don’t hear Brits complaining about fat cat doctors. The trouble in Canada is that Doctors are thought of as free and worth every penny you don’t pay them. The only way Doctors earn respect in this country is to save a patient, then the perception is they were just doing their jobs. What we need is to increase our tangible value and that is only accomplished by saving everybody or by charging fees to set our value into numbers.
I just recently had a sense of worth affirmed when on my way back from Mexico I jumped into action when a young boy fell and suffered a head laceration. I calmly intervened identifying myself as a doctor and quickly assessed the pt (no closed head injury, just a scalp lac that was full thickness and needed a suture) and then dealt with his hysterically wailing mother and the other 8 members of his family. Long story short, I staunched the bleeding with pressure of a bunch of fast food napkins. By the time the airport med “team” came (one medic with a pathetic kit and nothing to suture with) I had informed the gate crew that the boy needed sutures before getting on the plane. I gave instructions for the medic to do a double pad and circumferential bandage. He left with the boy and the now calmer mother. I then made my way to the bathroom to wash the blood on my hands. Many people thanked me and gave me a look of respect, one guy offered to buy me chocolates! In their eyes I was the heroic doctor even if what I did was pretty minimal to my eyes. They valued me because they saw what I did. The Airline offered to comp my ticket!
Ernest, great comments…
“…Doctors are thought of as free and worth every penny you don’t pay them.” Well said!
GREAT story about your work in Mexico. Well done! I’m sure the patient and all the family really appreciated your help. Although anyone could have applied pressure, very few could have identified pupil asymmetry or subtle signs on increased intracranial pressure. Thanks for stepping up…and for sharing the story! Excellent.
No one can escape the economic axiom: We value what we pay for. Free means not very valued.
Thanks again for reading and sharing a comment!
Cheers
Shawn,
I think the term “guilty pleasure” is absolutely the wrong term to use in this circumstance. A guilty pleasure is maybe a self indulgent, maybe somewhat sinful pleasure that one partakes in. Kind of like having extra dessert or buying that special something that you really shouldn’t or maybe can’t really afford. It implies “pleasure” and as such is a somewhat positive experience. If it hurts anyone, it’s usually yourself (extra calories, cost, etc).
Guilty pleasures don’t usually hurt other people. What paper’s publish can be slanderous, invade privacy or otherwise be negative to individuals that are the objects of these reports. What 100 doctors bill OHIP as gross billings need to be weighed against disclosure of public payments – individually vs in aggregate, disclosure of fees in general (the SOB is online – you can see what the fees are that MD’s can bill the government), and be considered fair in that other similar fees are also disclosed in the same way.
Docs invoice the government for insured services. Do other contracted workers who provide invoices for the government to pay, have their gross invoice numbers disclosed. How about the top 100 plumbers, electricians or security guards. I don’t see a similar standard being followed for everyone.
And why focus on the top 100. Obviously to be sensational. Obviously to try to invoke shaming of those MDs. Obviously to sell papers. Ya.. and obviously to facilitate full public disclosure – inconceivable!
Thanks for taking the bait on this, Rob!
I was hoping that someone would say, “Hold on a second!” I intentionally tried to take the tack that people are generally good willed and only fall prey to voyeurism like any other temptation. But you called me on it. Excellent. Some people are NOT just tempted to titillation. Some are genuinely maleficent. The issue is how many?
If the Star appeals to a silent majority who hates doctors, we have a big problem. It should inform the public relations strategies of all medical associations. If the Star only tempts and titillates, then we need a different strategy altogether.
Again, thanks so much for posting such a thoughtful comment!
Cheers
Selective self indulgent victimhood might be a reason to be a bit harsh with the first to the trough last leave guild from the 1800s. Are you really crying victim?
Thanks Colin.
You make it sound like doctors always get everything they want from ‘the trough’ and are never left out? After cuts every year since 2012, your comments comes across as uninformed and insensitive to patients and doctors alike.
Having said that, if you are referring to the medical monopoly created by medical licensing, I’d love to engage in a discussion! It’s a completely new topic and more appropriate for a separate thread, but I appreciate you raising the issue nonetheless.
Best regards,
Shawn
As always Shawn, so insightful.
I feel physicians, and other frontline healthcare providers, need to more open with the public about our challenges providing responsible care we can feel good about, including our challenges with healthcare management/leadership.
I am part of a Coalition that includes former and current frontline healthcare providers and others interested in public Addictions and Mental Health care in Alberta, the Alberta Mental Health Advocacy Coalition (AMHAC).
We are concerned that problematic relations between health management/leadership and frontline care providers undermine quality of care, patient safety, and responsible stewardship of public resources.
We currently have an Advocacy project underway where we have shared information with some members of the public about some challenges frontline care providers have faced with dysfunctional healthcare management/leadership and the lack of accountable response from current system. We have also shared a moving testimonial from a patient (anonymously of course) of impact on her due to dysfunctional healthcare management.
Generally receiving very positive response.
Many members of the public are truly shocked that physicians have no proper means with clout to redress dysfunctional management or conflicts between front-line clinicians and healthcare management/leadership. At least not a physician who is not one of many physicians in a large organization, or not oneself a physician in a politically powerful position in the larger system.
This is some of the information we are sharing with the public.
We also share some examples of problems encountered and lack of accountable response from current system.
“It matters little if patients find frontline healthcare provider(s) whose integrity and judgement they trust, if those healthcare provider(s) work within organization(s) where leaders undermine frontline healthcare provider(s).”
“Without the support and resources of a larger healthcare organization/healthcare system, individual care providers are not able to provide adequate care to particularly sick, high-risk, and or complex patients.”
“The intent of the Alberta Health Professions Act (HPA) is undermined if critical decision-making regarding quality of care and patient safety is subject to unilateral decision-making by healthcare managers/leaders who are not held to same level of accountability as the regulated Health Professionals.”
Some of our main proposed solutions are:
Proposed Solutions
• Effective conflict resolution process between frontline healthcare providers, healthcare management, Union representative (if Union members involved) with Patient Advocate(s) present, and binding arbitration.
• Consequences for healthcare managers/leaders involved in ‘ambush management’- lack of any or adequate notice to front-line workers of critical changes affecting ability to meet their care responsibilities. Frontline care providers need to be included in decisions and determinations of timelines.
• Additional measures to safeguard health professionals who speak about concerns and or advocate.
Although we are based in Alberta, we suspect other provinces may face similar challenges. Thus, we have shared our Advocacy information with Linda Duncan NDP MP and Don Davies, NDP MP, Vice-Chair and Member Federal Standing Committee on Health.
We have asked the Alberta Medical Association (AMA) to place consideration of supporting this Advocacy effort on the agenda of their fall meeting. We have also reached out to Alberta Psychiatry Association (APA) asking them to support this Advocacy.
We have felt it is important to proceed with Advocacy effort without waiting for official support of AMA and APA, as have heard unofficially that Alberta provincial government is specifically addressing Addictions and Mental Health in Legislature this fall/winter, so we feel there is some time urgency.
If interested in further information or would consider supporting this Advocacy effort, please contact me at tammy_hugie@yahoo.ca.
Tammy Hugie, MD, Psychiatry
Director of Advocacy, Alberta Mental Health Advocacy Coalition (AMHAC)
Great note, Tammy!
It’s impossible to respond to all the great comments you made. I know readers will digest it all….comments are the most popular part of a post. So thanks again for taking time to read and share!
Cheers
There are only two causes for hatred …fear and envy…the Red Star does its best to whip up both sentiments in regard to the medical profession…of course the attempt of ideological purificating self flagellation of some members of the profession confirms the public’s sense that the profession is possessed by evil spirits the moment that they graduate…of course, our purified SJWarrior colleagues have perfected the ritual where they joyfully join in the flagellation of their impure colleagues.
Andris,
Your comments stand out as always pithy and full of provocative content. Thanks again for posting. Let’s see if others join in with your charge. Courageous!
Cheers
Shawn,
Well written! I comment to challenge from a different perspective and to add to the conversation, not take away from your excellent blog.
My thesis, “I wonder if excessive eloquences are in fact a malady where moral goals are not well established.”
We see this problem in our colleagues, healthcare politicians, and US presidents. There is always the litmus test of authenticity in the way we live our lives, which is curiously often ignored.
Persons living beyond their means, without proper accountability, or speak vociferously against tradition must be regarded sceptically. Not because of the fact all of us have been there. No, nor because change is necessarily bad, but because all of us have agendas, and many of those agendas are hidden, even to our conscious selves.
Maybe it is not the pejorative “hate, envy or entertainment” that drives our nemesis but rather old fashion pride? Maybe group-think interferes with a resolution of this problem where we are tossed and turned about like ocean herring, you know, that defensive posturing when focused on “us” versus “them?”
It seems that those who are frustrated attending the clinic daily are being tortured by unethical decision-making dilemmas like “volume versus quality”, or “selling out to drug company” incentives, or daily dealing with “support staff and colleagues” who are also morally challenged by their own prideful choices.
Perhaps physician leadership vision should emphasize and empower individual choices to improve our lot. Empower exit strategies to private enterprize, rather than shame doctors “for not practising medicine”. Support extra billing where the government has not at least kept up with inflation or has made cuts. Someone has to pay for bad behaviour.
Another question to consider, what happens if we are betrayed by those who have been elected to represent us? Do they still represent us? Is a father who constantly invalidates his child, damaging their sense of worth and safety – does that still make him a father to be followed? Maybe MD leadership should facilitate an answer to this question, “Are we bound to an oath to a traitorous system?”
Wow. Tough questions, Barry. Thanks so much for posting them.
I agree, we can only scratch the surface once we start trying to plumb the depths of human motivation. As Kant said, From the crooked timber of humanity no straight thing has ever been made.
Adam Smith, especially in this Theory of Moral Sentiments, discussed your theme at length. We cannot ignore it. If we have the courage to face what you raise, then we must admit that our current system does not build any safety nets for this issue. Choice and competition seem to be the best (and only, to my mind) way to deal with the issues you raise. But choice is anathema to the central-control, first dollar coverage, Medicare-before-patient-care crowd.
Thanks again for posting such a thoughtful comment. I know readers will enjoy it.
Cheers
Dear Doctors:
A note from the other side of the desk.
Perhaps I’m an outlier, but I’m head over heels appreciative of every doctor who has treated me here over the years, and I thank them at every meeting. I sincerely hope that your patients express their appreciation to you. Maybe it’s because I was born and raised in the States and only immigrated to Canada when I was 39. About 15 years after arriving, I had an operation and remember telling my family and friends in the States how I felt that I had been treated like royalty by all involved, from clerk/receptionists to lab techs and nurses and doctors. I vividly remember sitting with my parents as my dad explained to my mom that she had so many more days of rehab available on their HMO coverage before they would need to spend down their assets enough to qualify for Medicaid. Mom thoughtfully died before that happened. I compare that to two friends up here who died of brain cancer, and rather than talk about money, we talked about them and life and death.
If we patients are frustrated, it’s because we feel that Gummint™️ has bollixed things up so as to create wait times that certainly seem excessive, but we equally certainly don’t blame the doctors for that situation.
Very Best Regards, and Thank You, Doctors!
Tony
P.S. If anyone should be the object of envy, it should be geeks like me: No one, most of whose IT duties could be done by a passably clever twelve year old, should command the salaries that we do. 🙂
Tony,
Thank you. Thank you. Thank you!
Very sorry to hear that you needed an operation, but it is so refreshing to hear your story and kind words. I can’t thank you enough.
Grateful,
s