Unusual topics in medicine :Physician Ego and the patient suffering
Posted Apr 23 2010 11:03am
Ego can be a great motivator and destroyer as well. It has the potential not only to damage the self but also the people in the near domain .This has been proven in all walks of life. Medical practice is no different . In fact ,it can have the more devastating effect as the victims are often the poor patients.
The medical ego can be individualistic, departmental, institutional, etc.
Often in the dormant form , can raise to gargantuan levels when stimulated or challenged. In its mildest form it occurs every day in the office practice. A physician often thinks he is always right and fails to get a second opinion even in difficult cases . Some where along the medical curriculum , doctors have to be taught that , what we know is only a fraction of what we are supposed to know , and the importance of self auditing. This never happens in most medical schools.
Individual Physician ego
This exist in several forms . Ego with fellow colleagues is the most common type . Failure to accept a error in diagnosis is the most frequent form injured physician ego. There are many instances doctors carry on with the wrong diagnosis tag (On their patients) even after some authentic documentation is available against it. This especially happens when the correct diagnosis is made by a junior colleague . Eg : “I still think it is a pheochromocytoma let us do the scans again” Same tests are repeated . In the intervening period involves treatment delay and financial costs for the patient. It is obvious , such an ego in emergency rooms can be disastrous .
Few doctors have a habit of asking for fresh set of investigations even if the patient has recent records of his illness . This is because many feel interpreting investigations ordered by other doctors is an inferior job .(Of course , financial incentives for repeating the tests could also be a motivation )
Ego with paramedics and fellows
This is also quiet common. Doctors expect their orders to be carried out at any cost. They take it very seriously , if a nurse or a junior doctor behaves independently . This is understandable as it raises the fundamental question who the boss is ? ! But , the problem here is, even a smart move in the interest of patient is not always relished the physicians . (Because it is perceived as an insult to the consultant ) . You can’t act smarter than me !
We know the major responsibility of caring a patient lies with staff nurses and junior doctors .(It is a universal medical rule the consultant will be remote from the patient care unless of course it is needed).If the specialist exerts an academic ego on them , there is every chance for the patient to suffer as even vital interventions could be delayed.
(Eg : Sir , I withheld the beta blocker in this patient as he had a bradycardia ! I thought it is better to remove the urinary catheter as the patient was struggling with it etc and etc )
I have observed , even some of the shrewd directives from the residents and junior doctors have elicited big hue and cry from some of the renowned physicians of our region.While many recognise the good work done by the junior colleagues , still their ego does not allow to appreciate and complement them . This is not a good sign for the medical professional .
Specialty ego and departmental ego
This is new phenomenon . Traditional ego was between surgeons and physicians. Now , with medicine growing leaps and bound there is probably a medical and surgical specialty for every human organ . This helps the physicians , to shrug of the collective responsibility . It has become a dangerous trend in many institutions.
God created human body as a single entity . Specialists share their organs , convert a human body into a commodity (Has to make a living out of it ) As the medical science is branching out at a phenomenal rate it becomes a difficult task for them to come to the rescue of the patient when they need a collective intervention . Further , conflicts of interest and ego clashes take a front stage.
Even in an academically and ethically superior medical center it is a herculean task to arrange for . . .example
An ENT surgeon and neuro surgeon to operate a nasal tumor together.
A hybrid procedure of PTCA and CABG (Could be very useful in many situations) can not be practiced that easily .
The issue here is not simply logistic .It goes beyond that . . .
(Why should I sweat for some one else’s fame ?)
It has a peculiar issue .The admitting physician is vested with supreme powers – he becomes the sole caretaker for the given patient .Though it fixes responsibility , it has a potential risk , as this patient automatically becomes untouchable for other consultants . There are centers in which even intra departmental consultations are lacking .I know at least a handful of cardiologists who do not talk with each other even at times of crises in cath lab. This is more prevalent in fully commercial institutions .
In this regard group practice with fixed financial remuneration may be a lesser breeding ground for ego clashes.
Another form egoism may be financial discrimination , which is seen in some of the big corporate hospitals . There are instances some doctors and institutions shy away poor or relatively poor patients .There are institutions which feel allowing entry to less sophisticated public inside their premises is detrimental to their reputation and ambiance.
Ego issues with patients.
Generally doctors show great respect for their patients. Information sharing is the major issue. What to tell and what not to, can some times reach really difficult proposition. Does the patient have a right to criticize the treatment ? Whether you like it or not some patients do it .
Few suffer from a worst form of physician ego , that is directed against their own patient. Doctors are rarely comfortable when patient ask probing questions.This is acceptable in few instances. The root of the problem is doctors rarely accept their ignorance .
There are many instances where a consultant refuses to see his own patient once he gets a second opinion from another doctor . It need to be realised this is actually the fundamental right of the patient he is executing .No need to get offended .
Why this ego ?
It is the part of normal human psyche. There is no reason to believe doctors are different . But the following could be unique factors .
A subconsciously feel of the demi god status conferred by the patients .
Failure to have an open mind approach .
This translates into fixed ideas about a patient and his illness.
This is especially common in countries where , single doctor or a family of doctors run nursing homes .
The other substrates for ego growth among physicians are
Popularity in the society
Negative ego : A feel of inferiority also creeps in for many physicians who find to hard to acquire the above .And this can have a serious effect on the patients .It is shocking to note many of the academically incompetent have a strong dose of ego .This is most dangerous for the society. A deadly combination of incompetence and arrogance
What is to be done ?
Containing the physician egoism could be more important for doctors than attending to sophisticated CMEs and conferences and workshops .
Counseling is required for many .
Behavioral science with the specific tips for self-regulation is to be included in the basic undergraduate medical curriculum
Courage to tell the truth to their patients to be imbibed.
Hippocrates said some 2000 years ago the fundamental quality of a doctor is to accept his limitations and ignorance .Every action of his or her, should aim only at removing the suffering of the patient .
Now we are in the era where , market force have literally hijacked the medical filed . A medical degree can be bought in a weekend university shopping (At least in India it is possible ! ) .
In this scenario if our students grow with one more wise ie “hyped up ego” one can imagine where our profession is heading for !
We need to initiate a debate on the issue . And there need to be a movement to cleanse the contaminated profession. It should be in the league of nuclear treaty , war on terror or the global environmental protection.