Shootings are rare, but doctor abuse is common

September 17, 2010

I read with consternation about a doctor being shot at Hopkins by a gunman distraught about his mother who had undergone surgery for cancer treatment at that facility ("Fear strikes at Hopkins," Sept. 17). Apparently the gunman was upset about the care his mother received at Hopkins.

Although incidents where doctors are attacked with weapons are rare, "doctor abuse" by administrators and patients is not uncommon. Emergency room physicians are particularly exposed to this phenomenon. Patients seeking addictive drugs and pain pills, vagrants seeking shelter, hypochondriacs who are regular emergency room visitors, irate sick folks who expect immediate service and instant answers or cures and apprehensive relatives of accident, suicide or homicide victims crowd the emergency rooms of our inner city hospitals. Stressed patients don't see doctors as allies; rather as people to fight, manipulate or blame.

Doctors also face added pressure from administrators who, in the business model of medicine, see patients as customers who must be pleased or satisfied at all cost. In this model, complaints about patients who are violent, verbally or physically abusive in many instances are not addressed to the satisfaction of health care workers like doctors.

Even in doctor's offices irascible patients make scenes when they are not seen exactly at the appointed time. The same patients who insist on punctuality are frequently the ones who demand more time from their doctors, totally insensitive to the plight of patients waiting to see the doctor behind them. Many do not understand their insurance, that they owe co-pays in offices, that they have deductibles, that they have to meet their bills. The answer to legitimate bills can be verbal abuse and physical intimidation.

While the corporate model of medicine has taken off with flying colors, with well heeled administrators filling every crevice and corner of the health care industry, it does not seem to be working well for doctors. Patients still believe that doctors should be noble, live on bread and water and forgive what is owed to them. When such forgiveness is not readily forthcoming, because modern doctors have hugely burdensome overheads, then patients often accuse doctors of avarice and erupt in anger and retaliation.

American patients have undue expectations of what doctors can do for them. They imagine surgeries and medications can effect definitive and long lasting cures. Modern medicine is often not capable of rising to these exaggerated standards. A medical procedure or a therapeutic drug is only as good as the initial condition of the patient. Older patients, patients who are obese, who have heart, kidney or lung conditions, are not good surgical candidates. Patients who have not followed rules of prevention, who don't go for regular check ups and who appear for treatment with advanced diseases that have festered too long should not expect miracles. Modern doctors take chances when they operate on such patients.

Informed consent is obtained by doctors from patients and their relatives after explaining these unavoidable innate risks. But we now seem to be living in a country where death is no longer natural; instead it's a doctor's mistake.

The doctor patient relationship has been steadily eroded by the corporate model. Add to that the erosion of civility, humility and reason across America, and you have a combustible mixture. Doctors are at the cusp of the social and economic problems of this country. Medicine was never a "safe" profession, but now it is inordinately difficult and sometimes positively dangerous for the wellbeing of doctors at the center of the vortex called health care.

Usha Nellore, Bel Air

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