Physicians Are Talking; Join the Conversation!

Neil Chesanow

Disclosures

July 22, 2014

Can Doctors Speak Their Minds Without Getting Into Trouble?

When physicians express their opinions in examination rooms, committees, and the courts, they're expected to have a strong opinion and advocate forcefully on behalf of patients. But often, doctors who speak out have met with harsh retribution that has cost them their jobs and hospital privileges and permanently marred their reputations, as this article reported.

Many doctors described their own painful experiences with speaking out and declared that they would have been better off keeping mute, whereas other doctors said it's vital for doctors to speak out about whatever they think is wrong, no matter what the consequences.

"After I expressed a politically incorrect opinion," one doctor wrote, "I was quickly told that I did not know what disorganized thoughts were; that my competency was in question; and that after 10 years of working in the organization, I could be summarily dismissed with no recourse."

"I found this out the hard way in medical school," recalled another doctor. "I spoke truth to power, and all kinds of bogus, trumped-up charges were brought against me. I was badgered and harassed throughout my clinical years and was screwed over for top residency spots, despite performing mostly above average. My life will never be the same."

"After speaking out regarding the questionable practice at one hospital regarding 'mandatory' admitting of a percentage of patients from the ER, I was suddenly let go," another physician said. "The reason being that 'our hospital is taking a new direction with regard to physicians.'"

However, some doctors said it was important to speak up, no matter what the consequences.

"I have learned in my career that, yes, it is important to speak truth to power, but don't be surprised when power speaks back!" said one physician.

Said another, "Shame on ALL the people saying to keep quiet and ignore wrongdoing. YOU are the ones giving petty tyrants their power. YOU are the problem!"

"A large part of medicine's problems stem from physicians NOT speaking out. Think of it this way: If you don't speak up for what's right, wrong, or just plain lousy and unfair, who will?"

What Do You Think About Physician Compensation?

Are doctors earning too much or too little?

More than 24,000 physicians in 25 specialties responded to this year's Medscape Physician Compensation Report. Among the notable findings: 25% of physicians say they're not considering taking any new Medicare or Medicaid patients, and 6% of physicians operate cash-only practices, twice the number of two years ago. Very few of the more than 400 physicians commenting felt that physicians are fairly compensated.

An internist offered this perspective: "I have practiced general internal medicine for over 30 years. I net about $75/hour working 55-hour weeks, including weekend rounding and fielding urgent calls 24/7. I work hard to provide for my family. We are comfortable, but not dramatically successful compared with neighbors who are attorneys, accountants, retail store owners, and realtors, among other occupations."

"Once, while on a fellowship, I calculated how much I made per hour on average, and it was less than the janitor who cleaned out our unit," a pediatric specialist wrote. "Now I get paid more in total than my sister, who has a PhD in neurobiology. But she gets paid more per hours worked and has a much better lifestyle, with way more control of her life."

"I decided to do a three-year research fellowship after three years of internal medicine," a doctor recalled. "Little did I realize that at the end of the day, what matters is whether you can put food on the table for your family and pay the mountain of bills accumulated over the years in training. In short, the compensation in academia sucks."

And yet, one oncologist took an opposing view: "After 50 years in cancer medicine observing the quality of care witnessed firsthand by reviewing records of other physicians, as well as seeing how I, my family, and my friends were provided with medical care, I can say that most physicians do NOT deserve the salaries they receive," he wrote. "Medicine is a noble profession, but those allegedly practicing it now have made physician income a priority over patient outcomes."

The Pitfalls of Giving Free Advice to Family and Friends

When you're a physician, informal requests for information are part of the conversational landscape. Sometimes those requests are a quick and easy way to help someone out; at other times, they can escalate and become annoyances. In a worst-case scenario, they can present ethical landmines, and they can also get doctors in trouble.

Doctors recounted personal experiences with such requests. Some felt that physicians should always offer advice when asked; others said, "No way"!

"A friend of mine, an emergency specialist, was called by an attorney in the evening because his wife had a painful red eye," said one respondent. "My friend made a house call. He had no diagnostic equipment. He looked at her eye and said, 'I don't know what it is, but it looks bad. You should go to the ER right away.' The couple waited 24 hours to see an ophthalmologist. The diagnosis: acute angle-closure glaucoma, which resulted in permanent blindness. The couple sued my friend, and his malpractice company would not cover him because he had not made a chart. The couple lied, and my friend wound up paying a settlement out of pocket."

"I had a bad experience when a friend asked me to look at this small bump under the skin that I dismissed without even saying, 'Get it checked out if it gets bigger, though,'" a doctor admitted. "He ended up being diagnosed with non-Hodgkin lymphoma."

"A colleague suggested a good way to fend off questions," one doctor explained. "If asked to answer a true medical question or offer a diagnosis, you should say, 'You will first need to take all your clothes off so I can do an appropriate exam.'"

Some physicians disputed that viewpoint. "There is no harm in trying to help your immediate family in the time of need, especially emergent situations; however, the follow-through plan should still be that the family members are followed up by their own physicians," said one respondent.

"Has common sense really become such a rare thing?" another doctor asked. "The human bond is part of relationships; so is giving reasonable advice. Reasonable, common-sense advice will never be bad."

"There are risks involved," cautioned one physician. "But there are risks involved in taking care of every patient. Every patient contact is a potential lawsuit. A family member or friend is less likely to sue you. In my opinion, I do not have to be a physician if I cannot help my family and friends. I treat my parents too. If it's risky, let it be."

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