Sunday, November 23, 2014


“Your doctor is a coat hanger”

What image strikes your mind’s eye? A coat hanger, right?

“Your doctor is a door knob”

What do you see?

Words have meaning. Each one represents a finality to evoke a thought, an idea, a recall a photo or a movie played out in the mind’s eye.

Now let us look at a commonly utilized word to describe a physician; “A provider.” What does the word “provider” conjure up inside your head?

Bland you say. Think again. Let me put a few descriptors so we can all see clearly the intent and purpose of the word. A provider can be someone who provides a service, provides a chair to sit on, provides cleaning services, plumbing services, analytical services, janitorial services, food service, in fact any kind of service available to humanity is delivered through a provider. In fact a robot is a provider too, providing some mechanical redundant service, the robotic assemblers in the auto industry are perfect examples of such descriptors. So now we get it, don’t we? What is in the elusive formlessness of words, but bewilderment! The gift and grace of time locked into the word “doctor” not only replenishes itself in the person- the doctor, but through him or her into the patient seeking help. Extract the essence and deploy the limpid vacuous expression and what is left, but nothingness, no desire, no respect, no toil. The new generation of doctors had better be careful lest what they envision the field of medicine as a 9-5 job with no responsibility actually comes true. Then the profession would have fatally spiraled into a rudderless “provider-ship.”

The doctor as a provider is nothing more than and nothing less than a set of services he or she provides. Angry as some might be and I am one of them, that is the lexical vector of the elites to take down the importance of physicians as doctors in the art of healing and medical care. So what! you say, it is only semantics!

Semantics? Think about it. If we dehumanize the doctor what does he become? Another robot, filled with the guideline software that regurgitates the output we have planned based on a set of course rules. The newly minted graduates from Medical Schools are schooled in the arbitrariness of archaic evidence. In fact some evidence is being “crafted” to denude the essence of the art of healing. The new “art” of medicine is to check the response from an digital monitor and based on the probability factor utilize the best diagnostic and cheapest tool to arrive at to fix a potential malady and then treat that malady with the cheapest medicine or intervention the digital 1 and 0s can output. Unfortunately for the current and future patients most of these guidelines are based on population based data that may have nothing to do with the individual patient. A cough may easily be interpreted as a “cold” given the assemblage of data from other physician electronic medical records that suggest that the “flu is going around!” And yet the diagnosis might be an onset of allergy, adverse drug effect, post nasal drip or even as vicious as cancer. The corruptness within the word is all!

The simple act of communicating and touching and evaluating through the reams of accumulated mental stores within the physician’s mind would provide a clue based on previous and ongoing human interactions about the potential illness. But, No, the guidelines are what they are and following them is the easiest way to lose the gift of a healer and substitute it with a robotic probability score.

I wrote about the guideline debacle that caused harm to a patient several years ago. Such harm exists in everyday life in medical care. We are so blinded by the seduction of this digital world that our conscious thought and reflexive acts are motivated by the false claim of technology as the wunderkind that will save humanity.

"Medicine is a science of uncertainty and an art of probability." _William Osler

and not

Medicine is an art of certainty and a science of probability.

Individual thought is a wonderful thing. There is purity in it in spite of bias. It follows the letters IMHO (In my humble opinion). For instance arguing against the need for a carotid sonogram in a frail 94 year old or a PET scan in a late stage cancer patient, the use of statin in a confused middle aged or arguing for the need of a biopsy of a neck mass, excision of a changed mole, vigilance as not “watchful waiting,” prescribing hormone therapy past the five year mark before it was fashionable and “study-proven,” are elements of critical thinking! These are the elements of medical care lost in the sea of claims and counterclaims serviced by guidelines and mandates pronounced by the experts who never see the light of day from their ivory towers.

So what is in a name? Everything!

There is meaning in the word doctor, a healer, an educator and a scholar. But a provider is one shifting resource from one place to another. Maybe now we get the gist of this subversive act to deplete the essence of being a doctor. Change the title, load up on guidelines and templates, eliminate individual thought, force the team concept to further suppress unique ideation, force feed the need for technological progress in medicine, interpose intermediaries like the EMRs, Insurers and other dictatorial governance, broadcast and vilify a few bad apples and destroy the nobility of the profession, you suddenly find the lost art and purity of desire diving deep into the sea of oblivion.

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