Battles Between Physicians and the Loss of Credibility

There are several ongoing battles between different groups of physicians. We no longer talk about that professional solidarity, so often accused of being responsible for physicians tolerating colleagues who were impaired or of poor quality. Even the AMA has fragmented over the interests of specialists and generalists and has been busy wooing back ACP, AAFP and AAP members.

I got dumped on by an ER doc yesterday and I find it hard to believe. A man went to the emergency room with the complaint of several months of abdominal pain and a lump near the mid- line that he noticed only when lying down. I know it's not an impressive complaint and it has no business being in the emergency room. I know he was probably illegal (I noticed the hospital's tell-tale 111111111 SSN in the forms I was faxed) and he didn't speak English.

But I speak Spanish and got a straight history from a man who didn't know enough to lie about it. The ER was empty, so it wasn't busy enough to have the excuse needed to go into triage mode. The doc diagnosed a hernia, but the patient said he never dropped his pants for the necessary groin exam. In fact, when I go the ER note, it indicates he never found a lump, mass or hernia on the abdominal wall either. There was no indication of an inguinal exam.

So why did the ER physician send the patient to a surgeon? At least the surgeon had the sense to refer him to a county agency who in turn referred him to me. The surgeon later thanked me for at least taking the time to steer the patient in the right direction. I'll be seeing him in follow-up after a couple of weeks of anti-inflammatories for an abdominal muscle strain.

I did mention he was probably an illegal worker. That means manual work, remember? Muscle pains are still the most common complaint amongst manual laborers.

OK, so the ER doc was sloppy and probably had good reason for frustration. Then I hear about hospitalists complain about ER docs that don't complete a work-up before admission. Well, I thought the ER docs were supposed to ensure accurate disposition, not necessarily accurate diagnosis. So let's defend the ER docs at this point. The ER docs were hired to keep things moving and handle trauma and acute life-threatening medical emergencies. Hospitalists were hired to handle the flow between an admission decision and discharge.

Specialists complain about primary care docs not sending them sufficient information on consultations (mea culpa on occasion, but I usually keep it brief and accurate) and I never get any information back from the cardiologist, who went ahead and changed all my patients' meds and now she's confused.

Physician solidarity is a thing of the past and maybe, it's "good riddance."

There was a time that physicians' interests were considered an important component of the health care system. Now, we're just another cog in the wheel, and apparently, not a very important one at that. Maybe the reason is we don't respect each other and our skills any more. After all, no matter what the specialty we are all physicians. I can stand shoulder to shoulder with any physician in this country in talent, skill and acumen. But I have come to expect to be denigrated by my specialists for my choice of job, specialty and location.

If we could set aside the obvious differences in our personal and financial interests and focus on the patients and greater societal needs, maybe our opinion would count more than it does now. Maybe we would have credibility when we say we know what's wrong with the health care system.