As we discuss further the problems of being a physician in these difficult times we have to consider the treatment by patients, administrators, insurance companies, government regulators and …oh yes the lawyers who are always looking for ways to sue you. Is it abusive?

What a profession where we are over regulated, forced to work long hours and forbidden to unionize and in which our professional organize often do not negotiate true effective change in our behalf.

Consider that a lot of times patients will be frustrated with waiting times or the time it takes to get a report/feedback on lab results etc.

First of all, I wish more patients understood about the fact that some appointments take an unexpected turn, and the patient or his/her complaints can require an excess of the time allotted in order for me to provide good quality health care! This is what leads to delays sometimes….

I also wish patients were more sensitive to the fact that we have lives outside the office! If it takes a week or so for you to get feedback on your results, its because they are not grossly pathological or and outside lab with there own problems, and a day only has so many hours……

I try to ignore the attitude and get them to join me in being caring- “Sorry we are running late- but another patient in our office today has had some bad news, I had to explain the bad prognosis of a tumor that the referring physician never told the patient/my job, unexpected troubles and it takes a while to help sort that out for them…I’m so glad we don’t have to worry about that with you”…. works most times.

As far as them caring if you have a life- don’t hold your breath. They are paying “enormous money” (Medicare) to be there to see you about the most important person in the entire world- themselves, with the world’s scariest test results awaiting… what could be more important than that? Most patients don’t realize the continual discounting of our services, sometimes only being paid pennies instead of dollars.

And there is a turn around time of about 24 hours for most lab tests and radiology evaluation and reads. Why the delay in contacting the patient? I have been frustrated with my own parents’ doctors also for this reason, but I understood more than most families.

I, like most of us care givers have spoiled my patients. They assume that they can be seen acutely the day they call, we give them their results usually the day they return, we get their scripts called, faxed or computer-sent the same day, they get the time they need at an appointment, and others know that so don’t complain when I run late. Some of them just show up at the office with the excuse that they know that the doctor would want to see me right away, yes and their primary care offices can’t see them for an appointment for weeks. Most of us take care of them even when they end up in the hospital.

The down side is, they want us to pick up the slack of other consultants’ offices, as well as their own primary care doctors and don’t want to wait 48 hours for a return call that many times doesn’t ever come, deal with forgotten appointments, no notification of test results etc.

Just the other day a patient was upset that I sent her to physical therapy but nothing got done. Authorization was sent to insurance. Insurance told patient that authorization was not required, which wasn’t true. Physical Therapy facility said we had to fax the request. We can’t just hand it over to the patient. So it is our entire fault. I wanted to tell the patient I did not go to med school to deal with this entire paperwork and insurance controlling the system. And truly, I do not really manage chronic back pain. I was trying to be nice. I didn’t tell her that, of course.

We just smile!

As I mentioned we physicians see abuse from multiple sides, the patients, the insurance companies, the hospital administrators, technology and of course the government as well as out true love…the lawyers. All who tell us how to practice our craft that we take almost a decade to train for and refine constantly.

As Kristin S. Held, M.D. stated we physicians devote our lives to serving others. We endure rites of passage, internships and residency training programs, known to a rare few, that is after medical school. We work undeterred for the good of each individual patient, together in trust, making many personal sacrifices by choice. I have had utmost respect for my colleagues, unified in the Oath of Hippocrates, equipped with hard-earned knowledge, skills, wisdom, and experience to do what was once unfathomable.

External philosophical and political forces are preying on our intrinsic, enduring calling to serve others. These forces intentionally manipulate, extort, and oppress us as a means to achieve fundamental transformation of the United States of America. These forces are succeeding, using predictable tactics including creating crises and dividing us, using us in opposition to each other. We are told that the quality of medicine we are providing is bad, that we are bad, and that government must fix our patients, our profession, and us.

We have been lied about, lied to, denigrated, and subjected to abusive measures resulting in a growing phenomenon that could rightly be called “battered physicians syndrome.” This syndrome is deadly for physicians, patients, the profession of medicine, and individual liberty. It is the physician’s responsibility to recognize and develop resistance to this syndrome.

Battered spouse syndrome is defined as “a pattern of signs and symptoms, such as fear and a perceived inability to escape, appearing in those who are physically and mentally abused over an extended period by a spouse or dominant individual.”

Battered physician syndrome could be defined similarly as “a pattern of signs and symptoms, such as fear and a perceived inability to escape, appearing in doctors who are physically and mentally abused over an extended period of time by demands and constraints of their profession or dominant individuals and groups seeking to malign and control them.”

Just as many spouses stay in the abusive marriage, will doctors stay in this abusive relationship? We must end this cycle before it ends us. We should apply to battered physicians the lessons learned from battered spouses.

Physicians must move beyond the stages of denial and guilt to those of enlightenment and responsibility. This abuse is happening. We must make a choice; we can stay forever trapped in this dysfunctional system, enabling and feeding it, or we can say “no more” and get out or change either the system or our own situation.

It is not easy. We will have to forge new paths and start over from scratch, but we can do it right this time for the good of our patients, our profession, our nation, and our souls.

Like most physicians, I’ve experienced Battered Physician Syndrome. When Obamacare/ the Affordable Care Act passed I also felt betrayed by our professional organizations, especially the AMA. Image paying huge yearly dues and constantly losing the battle.  They were part of the problem.  No one was going to save me.  So I dropped those organizations, did the best I could to cut the overhead of my insurance-based practice and kept working.

It is interesting that about 5 years ago my internist made the monumental decision to opt out of Medicare.  The increasing rules, regulations and penalties were eating him and his practice needing to borrow from banks to pay his employees salaries.  He just couldn’t take it anymore.  He had dropped all insurance contracts and started a direct primary care practice – the first in our area. He felt bad for his patients who wanted him to continue to take their insurance, but he just couldn’t do it anymore. It was terrifying, but failure was not an option. He felt bad for his Medicare patients but he wasn’t willing to go to jail for anyone.  He began a concierge practice, charged a yearly fee, only saw about 25-30% of the patients that he cared for before, but was able to take control of his practice and his life.

He did something pretty radical.   He told me that honestly it is one of the best things he had ever done.

The best way to avoid being “battered” by administrators or others is not to tolerate it any of it from the onset. The Easy Rider Salute be mandated as part of the curriculum in medical school, but it is not because so many of the teaching faculty are basically complicit and may feel “battered” themselves.

Actually the abusive behavior starts in medical school or more importantly in our internship and residency. We are told that we have to be strong, put up with the long hours, threats, and mental and sometimes physical abuse. It has gotten better, but not much. Now we hold their hands and off they go into the real world where the abuse continues.

All patients generally care about is themselves when it comes to medical care and their pocketbooks. There are no disincentives for them not to call you, page you. If you start charging for each 15 minutes block, like attorneys do. There would be a lot less calls, pages, etc. When it is free, why not call the doc. Remember, the patients don’t actually pay for the services….it is those darn insurance companies. The politicians who write the laws allow consumers (patients included) to have more rights than doctors in general. That is reality. What can you do about it? Sigh…nothing.

When I started out in private practice, I took over for a doc that was always in the surgeon lounge for at least 30 minutes after his office hours began. I asked him about this and he told me to always make the patient wait so they think you are very important. We work hard to keep waiting times to a minimum. Then in the middle of the afternoon the EMR techie pinheads show up and expect us to stop everything so they can show us a new trick or how to build a new “macro” or a new fix for why their software doesn’t work. When I tell them I have no time, they tell our manager that I have a poor attitude.

As long as someone else (e.g., any third party/ insurance companies or he government) is paying the bills, they get to call the shots, which is to bad for many physicians and especially their patients. The younger physicians who are saddled with educational debt are far more vulnerable to abuse than those of us who have been around the block a few decades and are able to function independently.

There is also an evident lack of cognition here of what “opting out” of an abusive relationship means just as in a real setting of domestic violence.

It could not be further from the non-risk of trying going payor/insurance-free knowing that you can always sign up again if it doesn’t work out or as a physician becoming more prosperous by converting to a concierge practice.

This post is about empowering the physician to leave an abusive professional relationship or fix it. Many physicians feel trapped in the current system and are beat down and exhausted. Each physician is a unique individual with unique circumstances. One size does not fit all and it is important for each physician to know his or her options.

It is important for each physician to know they have the freedom to choose.

We are forced to do things that demean and degrade us. We have lost our title of doctor or physician. We are a means to everyone else’s end. It is abusive. Our innate caring natures have been manipulated for everyone else. And many of us feel trapped. We kill ourselves, literally and figuratively.

To those of you who have been victims of physical and psychological abuse, I am truly sorry. However, your colleagues are crying out for help here, there and everywhere. I don’t really want to read about another physician suicide. How about you?

In the mean while, we ARE being degraded, and we need to recognize it and start doing something about it.

I have never been physically abused as a physician, but on some occasions I have seen nurses and other physician residents and interns physically abused, all of whom I have stepped in and rescued more than once even when I was threatened with dismissal.

Also been treated like the TV repairman (please, I mean no offense to TV repairmen),I feel that I want to be treated as a professional colleague not as a tradesman. I have tried as a specialist to take control and yes at a decrease in my income, but a healthier lifestyle. My surgical practice is fun except for the ever-increasing bureaucratic red tape from meaningful use to being certified as a patient centered medical home.

They, the offending parties, can take away everything, but our minds and hearts they cannot steal. Our skills, knowledge, experience, and code of ethics they cannot take away. They do not possess what they peddle to our patients. We must opt out of government-run medicine or modify the system to benefit the care givers as well as the patients. It is time to take responsibility. It’s our choice. Make it for your own as well as the health of yourselves and…..your patients. Take time for family, get a hobby, volunteer in the community and learn to balance your life and its stresses, challenges and joys.

Have you experienced Battered Physician Syndrome?  What did you do and what are you doing about it?