June, 2015

Bland On The Run

By Michael J. Katin, MD

As if we needed anything else to think about: on May 28, Charles Krauthammer, MD, further disrupted our daily lives by reminding us of the increasing burden under which we work and that, in fact, there is an alternative....dropping out.

Although the thought of not having to go to work every day is a happy one, the idea of thousands of disillusioned physicians suddenly swarming the countryside is somewhat unnerving. Even worse, the thought of 4,000 recently liberated radiation oncologists running amok is downright terrifying.

Dr. Krauthammer (Harvard, 1975) expressed in his Washington Post column of May 28 that more and more physicians will be quitting medicine because of bureaucratic burdens and particularly because of the evil of electronic health records. He described that the $27 billion spent on EHR resulted in "money squandered, patients neglected, good doctors demoralized" -- definitely one of the more discouraging triads in medicine.

It's certainly true that the practice of medicine now involves far more time in meetings, documentation, and addressing guidelines than it did 20 years ago. Dr. Krauthammer is probably correct that, with this onslaught of extra unpaid work, many physicians will decide to hang it up rather than continue. These factors could also be used as an excuse to leave when other factors may also be involvepl. For example, how many physicians may be overcome with compassion fatigue: an entity that is rarely discussed but which can take a major toll on one's health and mental status?

Compassion fatigue has now earned its own organization (CFAP, not a respiratory concept) and it is becoming acceptable to admit that one has cared too much for one's own good. . It would probably not be a good idea to take the Professional Quality of Life Scale (PROQOLS) Version 5 test at this point if one intends to stay in practice. A recent article in the Journal of the American Medical Association addressed that flight crew members involved in accidents or near-accidents are never put right back into their same environment, whereas in the medical field, after stressful and sometimes fatal outcomes, we are expected to carry on as if nothing unusual has happened. In fact, although Captain Chesley Sullenberger III, who, along with Brian Williams, NBC News, landed US Airways Flight 1549 in the Hudson River in 2009, returned to piloting after a reasonable delay, he flew for only one more year before retiring.

The question then remains as to what activities to pursue if no longer working in the practice of medicine. Certain physicians might want to indulge totally in recreational activities --maybe not much different than they had spent half their time doing during practice -- but others might be seeking a new profession. There is certainly precedent in history of persons leaving one field and attaining success in another. Dolph Lundgren had earned degrees in chemical engineering before he gave it up to become a martial arts champion, male model, bouncer, and, eventually, movie star Marcel Duchamp gave up painting by 1913, created highly controversial "sculpture" including "Fountain," voted the century most influential modern art work of all time, and then became a chess master. It's unclear why anyone would give up the legal profession to go into another field, but there are attorneys who moved on to other careers, such as literature (John Grisham ), music (Andrea Bocelli ), sports journalism (Howard Cosell ), and even politics. Physicians have not seemed to be as successful at following up with successful careers, with a few exceptions. Dr. Mehmet Cengiz Oz is spending less and less time in medical practice and is becoming a human infomercial. Most successful of all, however, are Bashar al-Assad (University of Damascus, 1988), an ophthalmologist, who is now a tyrannical despot, and Taryn Rose (UCLA, also 1988), who completed training in orthopedic surgery but who is now is achieving success as a shoe designer.

Unfortunately, most of us will not have the good fortune to achieve our dream jobs to become dictators or darlings of the fashion industry, or both, but that doesn't mean we should stop trying to find a new field that is satisfying and rewarding.

That then brings us to the proper post-medical occupation for most radiation oncologists, who are accustomed to multitasking, have a background in chemistry and physics, are used to interacting with demanding referring physicians and patients, and who have needed to cultivate attention to detail. I already have my application to fill out.

Emanuel Countdown: The Emanuel Countdown will be suspended for several months, to be replaced by a tribute to each of the 37 persons currently seeking the position of President of the United States. The Emanuel Countdown will resume after the nominees of both parties have been selected. The clock, however, will still be running.

Rand Paul (to the tune of Wild Thing )

Rand Paul
You'll make our debt small
You'll make medical marijuana legal -- groovy
Rand Paul
Put Up a big wall
Around the whole USA
Rand Paul
I think I'll support you
But I gotta know for sure
Tell me I can keep all my guns
And make the NSA begone
Rand Paul
You'll make our taxes fall
And regulations go away
Rand Paul
I think I'll vote for you
But I gotta know for sure
Keep our government limited
And make sure our vision isn't
Rand Paul
You'll make us stand tall
Rand Paul