LETTERS TO THE EDITOR: LET US STOP DOCTOR BASHING; DOCTORS ARE PEOPLE, TOO

Dear Editor:

Exuberant President Clinton in his State of the Union address stressed health care reform as his foremost priority. Health care in United States is at a cross roads. Rated as the best in the world, it is costing too much and is still not accessible to a large portion of its population.

The American physician, like anywhere in the world, is the main provider of health care. When someone gets sick, he or she goes to his or her doctor. The doctor is the one who examines the patient, orders the tests, makes the diagnosis, writes the prescriptions, or admits the patient to the hospital and takes the responsibility of further care. The physician acts as the liaison between the patient and the health care providers and the institutions. If the sick person gets well, the doctor receives compliments, and if the patient develops complications, the doctor is the one who takes the blame.

So invariably, whenever the present health care crisis is brought about, all fingers including those of the government, public and of course the news media point to the inimitable health care provider, the physician. I wonder how many of those pointing fingers pause for a minute to reflect before they blame the doctors?

Physicians are a breed apart. They chose a difficult life. Their hardships start when they are young: putting in excessive number of hours of study and hard work in school to get grades good enough to be accepted to a good college; spending four years in college taking courses heavy in math, physics, chemistry and biology and maintaining a 3.5 average or better; spending four more years of grinding study in medical school with the 3rd and 4th years in clinical training 80 to 100 hours a week; spending another 3-10 years in postgraduate training depending on the speciality chosen; living virtually day and night in the hospital during all these years, maybe $100,000 in debt after medical school.

Earning an M.D. degree and the speciality training is only the beginning. An average physician works 60 to 70 regular hours a week at the hospital, office or in surgery. In addition, family physicians work nights and weekends in the emergency room. After 24 grueling hours of work in the emergency room, they have to go back to their offices to see their scheduled patients! Most doctors have to attend emergencies at odd hours during the nights or weekends irrespective of rain, snow or sleet or their own personal health. When home, the phone never stops ringing. The doctor has to answer the nurses from the hospital, patients worried about their problems or the anxious relatives trying to find out what kind of surgery their loved one is going to have. Doctors do this at the expense of their personal and family life. Most of them miss the PTA meetings or their own child's ball game to attend a sick patient.

The profession not only imposes killing hours, but also continuous tension: one way or another doctors deal all the time with crisis -- with accidents, diseases, cancer, disaster, the imminence of death. However tired, or whatever physical or mental state, whatever time of the day or night, the next decision a doctor makes could mean life and death to the patient.

This highly strenuous profession is made worse with the malpractice crisis. An extremely litigious-minded public expects perfect outcome and guaranteed results. If a child is born with birth defects, or a patient bleeds after surgery or has less than perfect result, invariably, it is the doctor's fault and grounds for malpractice.

There is the exhaustion of feeling that we live in a malevolent universe, and that every patient that walks through the doctor's office doors could be a potential enemy. In addition to what they learnt in medical school, they have to practice defensive medicine, which accounts for 20 to 25 percent of health care costs.

Since the government is slowly taking over medical care, the poorly publicized and dark side of medical care -- trying to comply with regulations -- is becoming the biggest headache for all physicians. The Physician Review Organizations (PROs) and other regulatory boards are hitting doctors with denial letters, quality issues and sanctions and the practicing doctor has to spend countless hours answering these array of letters which are totally unproductive and not related to patient care. Sometimes they have to take special courses and attend seminars to learn how to satisfy these bureaucrats!

Very few people realize that doctors are not robots, but human beings that have emotions and vibrate in harmony with human interactions. Despite being taught to maintain clinical distance from patients, physicians often get emotionally involved: like some patients, dislike others, feel angry when the patient fails to follow instructions, frustration if the patient is not getting better with the treatment, sadness when a patient dies. Very few doctors are hard-hearted enough not to feel depressed to hold a patient's hand, look into his eyes and say he has cancer. Most of them feel extremely dejected to face the anxious family and tell them that the patient had a heart attack on the operating table and could not be saved. Physicians face pain, agony, depression and, of course, death, which very often makes them feel emotionally drained.

Escalating health care costs unfortunately tarnish the doctor's image with greed, selfish motives and insensitivity for the patient's pain and suffering. It is a false notion. One has to be in the physician's shoes to understand their way of life. Let us stop doctor "bashing" and try to sympathize with him or her. Let us try to be compassionate if he is late to his office attending an emergency, or ask her if she is feeling well if she looks blue or depressed. After all, doctors are people too.

S.D. MADDURI, M.D.

Poplar Bluff