Minor deities?

An anonymous commenter below notes:

It's interesting; there is a repeated strong undercurrent of resentment of physicians in these comments and in a lot of healthcare blogs I read.

I had already been thinking about this topic. I am reminded in some ways about how people feel about legislators. "I love my legislator, but I hate Congress." I sometimes see a similar attitude about doctors. "I love my primary care doctor, but I hate doctors in general." What's going on here?

Joke #1: What does MD stand for? Answer: Minor deity.
Joke #2: Why can't a nun be a good nurse? Answer: Because she has been taught to serve only one God.

Jokes often reflect societal stereotypes, and doctor jokes are no exception. Why do so many doctor jokes make this kind of reference? Well, in part, it is because doctors make the kind of life and death decisions that are closely related to people's view of a divine power. Doctors can quite literally bring us back from death. We admire that, but unlike our attitude towards divinity in the theological context, we also resent it.

Joke #3: A man dies and goes to heaven and is patiently waiting in line at the Pearly Gates with other recent arrivals. A man in a white coat impatiently pushes his way through to the front of the line. "Who's that?" asks the new arrival of an angel standing by. The angel replies, "Oh, that's just God. He thinks he's a doctor."

People also believe that doctors often have poor interpersonal skills, don't want to be bothered with spending time with patients, and are arrogant and impatient. This belief is compounded when the insurance reimbursement environment puts pressure on doctors to deliver service in a rushed manner. The patients attribute the brusque behavior to the MDs themselves.

Joke #4: The first Jewish president is elected and is on the podium about to be sworn in. His mother nudges the person next to her and says, "You see the man up there with his hand raised? His brother is a doctor."

And yet, almost every parent would love to see a son or daughter become a doctor. It is as highly valued a career as one could imagine, and it brings great pride to the family.

All of this suggests a tremendous ambivalence about the profession and those in it. It's really not that surprising. It is inherent in any position of power and influence and prominence and perceived wealth. We admire our political, commercial, and sports heroes but also are quick to call them bums and crooks when they don't meet the standards we have set for them. We should expect some of that reaction in the highly personal field of medicine, especially since our interaction with a doctor is likely to occur when we are most vulnerable.

When I new to health care and was being interviewed to be Administrative Dean of Harvard Medical School in 1998, I asked Dean Joseph Martin a question that reflected my own ambivalence at that time, and the resentment noted by the anonymous commenter: "Do doctors still care?" He assured me that the new crop of medical students at HMS each year was as idealistic and caring as ever, and that the people I would meet at HMS and the hospitals in Boston were likewise extremely dedicated. I have absolutely found that to be the case.

No doubt we will continue to tell doctor jokes, but I hope we can also acknowledge that the men and women who have trained for this profession and who practice it are as well intentioned as we could ever want. Sure, there will be personality quirks and occasional bad behavior, as there will be in any group of people, but there is also a level of dedication and commitment that is extraordinary.

The anonymous commenter goes further, though, and says:

And yet when I read posts in Sermo (the physicians' only website), there is a strong undercurrent of discouragement and even despair with the profession they have chosen. No one is happy on any side.

I see this, too. Much of this stems from the reimbursement environment, in which doctors feel that their professional judgments are overridden by faceless bureaucrats in insurance companies and at Medicare, or by (ahem!) ignorant hospital administrators. They fear malpractice suits, too. So they practice defensive medicine, knowing certain tests and approaches are not warranted, but feeling pressured to inoculate themselves against patient complaints and lawsuits.

And truthfully, they (particularly the older ones) may have been trained in medical school and afterwards in ways that do not reflect the social, political, and financial environment in which they practice. They have been rewarded during their professional advancement for attributes that may not be helpful for coping with the current environment. And, finally, they face an ever more knowledgeable and (perhaps entitled) public that is not so willing to be forgiving of mistakes or tolerant of ambiguity in diagnoses and treatments.

I do not pretend to have an answer to this set of problems. I would like to think that society will value doctors commensurate with their dedication, skills, experience, ability, and commitment to our well being. But this will take movement and good intentions and also understanding, empathy, and forgiveness on both sides of the relationship.