Sword of Damocles

Greek literature contains the account of Damocles and Dionysius.  Damocles was a courtier who coveted the luxury, influence and power of King Dionysius.  Damocles begged Dionysius to allow him to experience what it was like to be the King.  Dionysius consented and traded places with Damocles.  Damocles gleefully stepped up and sat down in the throne.  He began enjoying all of the privileges of being king.  As Damocles gazes around at his luxurious surroundings, he looked up and suddenly his mouth went dry and all of the pleasure he had been enjoying drained away.  The source of his sudden change of mood was that he saw directly over his head, a large sword was hanging suspended by a single hair.

There are lots of people who are envious of doctors.  Doctors are perceived to have lots of money, status and power.  There is no argument that doctors are paid more than the average individual.  In most communities, doctors are given respect solely on the basis of their profession.  People entrust their lives and thoughts to doctors in ways they would never trust anyone else.

There is no question that physicians are privileged to be able to earn their living in a field that is intellectually stimulating, pays well and allows one to be a tremendous help to lots of people.  At the same time, there is a huge Sword of Damocles hanging over physicians.

The job of being a doctor has always been stressful.  Knowing that the evaluations and decisions you make regarding a patient can have a tremendous impact on that individual is a very heavy burden.  That burden has not gone away, but now is added the burden of fear of being sued or running afoul of the endless regulations.    Imagine what it is like to be a physician knowing that every single interaction with a patient has the potential to result in a law suit or cause you to violate some regulation.  No  matter how conscientious you are, you will be sued at some point during your career.  You are going to be audited and have to defend your actions before some regulatory body.

Today physicians are literally being hunted.  Lawyers advertise, trying to stir people up to sue their doctors.  The government now has whole departments spending millions of dollars, devoted to finding “fraud” being committed by doctors and hospitals.  The average person thinks fraud means the health entity is trying to get paid for services they did not perform.  The government’s definition of fraud is providing a service without doing the paperwork properly or not following all of their endless rules, which are designed to not pay for the services being provided.  They do not have to have probable cause to investigate you.  They just show up, collect records and try to find evidence you have committed “fraud.”

Even if a physician does not experience the major events of being sued or running into regulatory difficulty; just the daily practice of medicine is a struggle.  There is the unending paperwork, the constantly changing and ever more complex rules.  There are patients, who are understandably frustrated with how difficult it is becoming for them to obtain medical care, and they frequently take that frustration out on the doctor or their staff.

Over the last number of years, I have been saying that I still love being a physician, but being a doctor in the United States has become a nightmare.  I can think of nothing I would rather do than work with people to solve their problems.  Unfortunately, the providing of medical care, in the United States, has become very overshadowed by many other factors.  These other factors are having a tremendously negative impact on physicians.  Whenever, I am with a group of physicians, I am struck by the overwhelming amount of gloom that permeates their thinking.  This is how one observer puts it:   “Physicians, almost universally, are caring people.  They’re programmed personality-wise to please others and try as hard as they can to be perfect.  I‘ve seen what happens to physicians when they’ve delivered care out of the goodness of their hearts only to have it turned around in some way and become somebody’s lawsuit.”

You cannot put a human being under the relentless pressure that physicians in the United States are under today and not have serious adverse consequences.  Some of the results patients see are cold and irritable physicians.  Practices become very rigid, unwilling to help patients outside of strict and costly guidelines.  The physicians themselves have much turmoil in their personal life as a result of the stress of practicing medicine.  Male physicians have twice the suicide rate of the general population and female physicians have a rate up to seven times the general population.

The result that has the greatest impact on patients is the early retirement of physicians.  For most physicians, being a doctor is part of what makes them tick.  As a result, in years gone by most physicians practiced until they could physically no longer do it.  That is no longer the case.  Now most physicians are retiring from clinical practice as soon as they can afford to do so.  The result is a major loss of the most experienced clinicians, who are at the peak of their profession.  Today 50% of physicians are over the age of 50.  Imagine the impact on skilled physician availability to patients as these physicians retire at a very high rate, because they are no longer willing to endure the stresses being imposed by an ever more oppressive health care system.

Unfortunately, these pressures on physicians are going to continue to mount and that will have a negative impact on the patients for  whom they care.