Featured in NEJM Journal Watch: Cynicism in Medicine — Physician’s First Watch

Medical News |
April 30, 2014

Featured in NEJM Journal Watch: Cynicism in Medicine

By the NEJM Journal Watch Editors

When a group of residents were recently asked whether they were more or less cynical now than at the start of their residency, many expressed increased cynicism toward the healthcare system — but not toward patients. Akhil Narang poses the same question to readers, adding: "If you're more cynical, why and how much of this was a result of modifiable factors in your training program?"

Reader Comments (5)

J ROSS HESTER Other Healthcare Professional, Internal Medicine, Edcom Associates Holistic Health

During my fifteen years as a Physician Assistant in Internal Medicine and Gastroenterology-Hepatology, I came to feel more like a Greeter at the Elephant Graveyard, than a clinician dispensing the "miracles of modern medicine" that my patients now demanded after years of self-neglect or self-abuse.

Joyce Finlay NP Other Healthcare Professional, Obstetrics/Gynecology, scripps clinic

Just knowing that Press Ganey surveys are being used to evaluate and award health care providers is enough to make anyone cynical

CAROL VASSAR Physician, Internal Medicine, private practice, Vermont

increased cynicism due to the revelation of how little mammography is likely to help women, the staggeringly increased costs of medication, the FDA agreeing to the monopoly for colchicine, the price of insulin, the cost of glucose test strips, the cost of colonoscopies, the presentation of clinical practice guidelines as evidence based when they are largely consensus. The closing of the loop giving the pharmaceutical industry control over the practice of Medicine. The loop consists of clinical medical research, providing the evidence for clinical practice guidelines, elements of which are used to gauge performance and determine payment for practicing physicians. Most clinical medical research is funded by and controlled by the pharmaceutical industry. So the "evidence" used to develop clinical practice guidelines is provided/controled by the industry. The committees which write the guidelines are generally composed of physicians more than 50% of whom have relied on pharmaceutical industry for funding. Because guidelines are supposed to be evidence based, Medicare has used elements of the guidelines as fairly uncontested clinical measures to be used to judge physician practices, and determine physician reimbursement.
Add to this deplorable situation the fact that most physicians are now employed rather than independent, and you have near perfect control by the industry, for the industry.
How could we not be cynical.

Michael Gamble Other, Other, Law firm

Medical billing and lack of effort to coordinate with healthcare insurer. Or, intentional not filing claim with major medical when injured party presents-- obvious purpose is to collect unreduced bills directly from automobile liability carrier or med-pay provider.

RJ Cavanagh Physician, Psychiatry, public health

Cynicism might arise not significantly in relationship to deficits in training but more so in response to social, financial and environmental influences upon practice. Poverty is being indirectly thrust upon practitioners, not upon politicians, as if we had the ability to correct it, as it emerges daily within patients who self-neglect, abuse drugs, delay care and hope for medical analysis & correction.

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