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Archive for December, 2012

Results of My Arbitration Hearing

Posted by MDViews on December 18, 2012

Some of you who are reading this are aware I formerly worked for Fairview Lakes in Wyoming, MN. I was there from 3/8/04 until 9/16/10 at which time I was told to resign or be fired by Vicki Stevens, head of human resources (HR) and Dr. Barry Bershow from corporate. I resigned realizing resignation was my only hope to ever work again. Dismissal for cause would have meant an investigation by the Minnesota Board of Medical Practice and a report to the National Practitioner Data Bank. In addition without any discussion, Dr. Bershow said my dismissal was because of my talk and a “few other things.” However, the “few other things” made me sound like I was not worthy to be a doctor. He said Fairview had concerns about my patient care, about my respect for diversity, about my ability to get along with others and about a refusal to follow guidelines recommended by Fairview.

When this happened, I had just a couple of weeks earlier, given a talk to the medical staff on medical ethics–the Oath of Hippocrates. When I asked Dr. Barry Bershow, the doctor who was dismissing me, if this was because of the talk, he said yes.

I had trouble finding a job. Only one place even gave me an interview, and then turned me down. I eventually joined the AALFA Family Clinic, a small pro-life clinic in White Bear Lake with three family doctors and one internal medicine doctor. They welcomed me with open arms. I’ve never worked in a clinic like this, one in which the doctors are kind, sincere and consistent. What you see in the exam room is who they are. They are not at all cynical. I’ve never heard them speak poorly of a patient–ever. As a lay person, you may not realize that doctors tend to be cynical types who may speak poorly of the patients when they think they are out of ear shot! I am so blessed to be at AALFA!

In any event, Fairview was contractually obligated to notify my patients of my new business address, phone number etc. in a letter. I sent them a letter in January 2011 asking them to do that and they did not respond. I sent it again in February 2011 by certified mail and they responded 5 weeks later, saying they had already done that. They had sent out a generic, “Dr. Anderson isn’t here, please schedule with our other doctors, etc.” the day after I left, but it had nothing to do with my contractual obligation as came out at trial. But they refused to send out an appropriate letter. Because of that, I decided to sue for a forced resignation. My contract specified any employment dispute had to be adjudicated by binding arbitration, so that’s what I asked for. My goal in suing was to hold Fairview accountable for violating my contract. I hoped to win a money award, not to enrich myself, but to get Fairview’s attention so that when another pro-life physician came along and took a moral stand, Fairview would think twice before dismissing him or her.

I learned several things because I sued. The first big surprise was their contention I was a bad doctor and that the talk was not the only reason I was dismissed! They had a list three pages single-spaced of my supposed sins, from doing to many hysterectomies to prescribing too many narcotics, to arguing too much in meetings, to not playing nice with some of the staff on the floors–and more.

At the trial, I was able to refute every charge they made quite effectively. Documents at trial proved I did fewer hysterectomies than my partner, Dr. Mericle, per hour worked in the clinic. That means I was just worked more hours than the rest which is why I did more surgery. The whole narcotic canard was based on rumor of the medical assistants. Dr. Mericle, my “dyad leader” didn’t even review a chart to see if that was true. I argued in meetings about the direction Fairview was taking to which their own witnesses admitted was the appropriate place to bring up disagreement. My yearly evaluations were always good. My re-credentialing for hospital privileges was never questioned. Their witness, the chief of staff, admitted he asked me to serve another term on the medical executive committee after he knew of all these charges against me because he viewed me a valuable member of the committee who made good contributions. Their witnesses tried to say my contract had been fundamentally changed by a reorganization Fairview went through in 2009, but then on cross exam also had to admit that my contract could not be changed except in writing by both parties and that it had never been changed. They brought up some conflict I had with another doctor, a head nurse and the clinic manager from years earlier like it just happened yesterday, events that had been long resolved.

One phrase they all said was this: Dr. Anderson was just not a good fit for Fairview. They based that on my arguing in meetings and e-mails against the path Fairview was taking. I argued against “cookbook” medicine in which a doctor is graded on how well he or she follows a protocol of medical rules with each patient. I explained it fundamentally changed the doctor patient relationship to make the doctor beholding to the protocol in order to get paid more instead of deciding what would be best for that particular patient in that particular setting. I argued against the lack of privacy with the electronic medical record (EMR). I argued against the poor communication with the EMR because the doctor’s notes were generated by templates that were generally ignored and I argued against the “bill-padding” that resulted from higher codes which the EMR easily generated which fraudulently increased income for the doctor and corporation. (I didn’t use the templates–I dictated with voice-recognition software. As a result, I billed honestly, my notes were easy to read and communicated well. Just practicing good medicine meant I was meeting the standards they set with rare exception.)

At trial, my attorney asked their witnesses about this arguing in meetings against the protocols and then would ask their witness if they checked to see if I had met the measures or used the protocols in the hospital in general. No one had checked. They just assumed since I didn’t want to follow a cookbook that I couldn’t possibly be practicing good medicine when the truth was most were easy to meet and I met them. Then my attorney would ask if the witness had known I was meeting the protocols, would that have mattered in their determination of my performance. They had to answer yes, of course.

The 800lb gorilla in the middle of the room the entire trial was my talk. They contended I was disrespectful of diversity. I contended my talk informed them of the need to truly understand the diversity of various religions and cultures, including the culture of conservative Christians. In addition, my talk illustrated how the Oath of Hippocrates was pro-life, how the Oath insisted medicine was a moral activity, how a belief in God was required by the Oath–all that and more. Each witness Fairview presented was asked if my dismissal had anything to do with my pro-life stand or my religious views. All said ‘no’. I don’t believe that for a minute. I met no pro-life conservatives in leadership in my 7 years there. Dr. Mericle charged me in her document and testified at trial that my pro-life views caused me to not counsel OB patients on the availability of genetic testing (False. But I did tell my patients the purpose behind the testing.) and caused me not to put in IUD’s under the false notion that the IUD caused abortion. (The IUD does cause early abortion by preventing implantation of the already formed embryo.) Those were two of the reasons I was fired. Vicki Stevens recorded notes of the phone conversation the 4 of them had at noon on the day they dismissed me. One phrase no one would claim which was part of that four-way conversation was that Dr. Anderson had “very right wing extreme radical viewpoints.” (This is just tongue-in-cheek conjecture on my part here, but I think that means I was a pro-life Republican. I’m just guessing.)

On and on it went with their witnesses actually helping my case more than their case. It was something to behold. By the time the trial ended, I felt completely vindicated.

Most importantly, I learned that my liberal, politically-left-leaning radical feminist pro-abortion partner, Dr. Mericle, was the one who started this whispering campaign behind my back about 6 months before I was dismissed. During that time, she developed this list of how terrible I was as a doctor, this list I knew nothing of until I filed suit. Also, she admitted at trial that she was the one who made the final decision that I should be fired, she and the clinic manager, Wendy Young. Also, the one who actually dismissed me, Dr. Bershow, had taken her word on everything and had not done any independent investigation at all into my performance as a doctor. Also, he and Vicki Stevens would have not fired me, but tried to discipline me, a course Dr. Mericle and Wendy Young rejected.

Dr. Mericle and her husband also owned the Nesting Grounds restaurant and coffee shop in Wyoming. They placed it for sale two months before my dismissal.

The trial boiled down to one question and one question only and that was this: Did I voluntarily resign or was I forced to resign? I contended that Fairview lied in presenting me with those two options of resign or be fired because they had no justification to dismiss me. Since they had no justification to dismiss me, I made my decision based on their lie, not on the truth of the situation. Therefore, I was forced to resign knowing that a dismissal for cause would end my medical career. They contend that my resignation was voluntary and that I had no standing to even bring the lawsuit.

The judge agreed with me and I won the case on its merits. The judge’s words were a joy to behold. He agreed with me completely. Fairview did violate my contract. They had no justification to fire me. All the charges they supposedly had against me were refuted at trial. My talk was clearly my own opinion, not Fairview’s opinion and did not warrant discipline or dismissal. The meeting at which I “voluntarily resigned” was based on subterfuge (Dr. Mericle lied to me to bring me over to the clinic). The judge concluded that since Fairview had no justification to fire me, they gave me a false choice of resign or be fired. I was forced to resign.

The judge awarded me a money amount less than my request. He contended my writing in WORLD magazine and in my church newsletter made me undesirable as a doctor and, as a result, no one would want to hire me. I was responsible for what I written, therefore Fairview was not. Also, he said I didn’t try hard enough to find similar employment.

Although his logic escapes me, I remain vindicated. The amount Fairview will pay will be noticed. And, through the providence of God, I found probably one of the only practices which would hire me–AALFA–a solidly pro-life clinic populated with doctors all of whom have a moral compass. God bless them all! A day doesn’t pass without me thanking God for this wonderful clinic where patients–all patients of every religious persuasion, even conservative pro-life Christian patients and devout Catholic patients–are treated with respect and dignity.

So that is what happened with my departure from Fairview. I am so thankful for all the prayers people have lifted to God on my behalf. I know I never could have survived the whole affair without them. It’s not easy to listen to former colleagues say bad things about you, but God sustained me. My family, God bless them all, supported me through this as well as they could.

My hope and stay through this entire event has be Habakkuk 3:17,18. It says,

“Though the fig tree should not blossom, nor fruit be on the vines, the produce of the olive fail and the fields yield no food, the flock be cut off from the fold and there be no herd in the stalls, yet I will rejoice in the Lord; I will take joy in the God of my salvation. Habakkuk 3:17,18 (ESV)

I know that God works out everything for good for those who love Him and are called according to his purpose. But I also understand quite well that God’s good for me may not be my concept of God’s good for me. From a human perspective, I would expect “good for me” to be finding a wonderful job with little effort after my dismissal from Fairview, that I would soon have a satisfying, growing practice, that if I sued, I would win and win a large money award with little emotional strain or trauma.

But that’s not necessarily how God works. He could have decided I find work in rural South Dakota in the middle of nowhere, that I move away from my children and grandchildren, that I sue and lose totally to Fairview, or that I never find work again as an OB/GYN doctor and live the rest of my life in poverty. That could have been God’s “good” for me. Who can know the mind of God and who can be His adviser?

As a student of Christian history, the stories of great Christians helped me so much during this time.

I think of William Tyndale, a brilliant scholar who translated the scriptures (much of them anyway) from the original Greek and Hebrew into English. The king of England put a price on his head for doing that and he fled to France, where he was eventually betrayed by a close friend, spent two years in an unheated prison and was then burned at the stake as a heretic. The king of France did have some mercy on him, however, allowing him to be killed with one blow to the head prior to being burned at the stake. Shortly thereafter, the king of England allowed Tyndale’s translation. It was all casual politics for the king of England for which William Tyndale gave his life.

Adonirom Judson lost three wives in Burma, nearly lost his faith and then eventually became ill himself and died somewhere in the middle of the Indian Ocean, the only Christian on the boat–no family, no friends–and was dumped in the sea.

The stories go on and on of followers of Christ who died or suffered horribly with no recognition, no compensation. But living to bring glory to the King of Kings is enough. And death is only the beginning of glory. And that also is enough. It was enough for saints of old. I prayed then and pray now that it will be enough for me. Knowing that whatever happens, I will someday gaze on the face of God and rejoice for eternity in His presence means God is good, all the time, God is good. I know I deserve nothing but His wrath, but because of His great gift of Christ’s sacrifice on the cross, I can live for Him now and I will, one day, experience heaven and worship Him forever, experience constant and complete joy, all for the temporary trial in this life.

My poor little problem seemed minor when compared to the suffering of these heroes of old!

So the Fairview chapter of my life is now closed. I’ve had two huge regrets about leaving Fairview like I did.

First, I left all my former patients with no word as to why I left or where I went. Even now, Fairview won’t tell my former patients when they call the Fairview OB/GYN clinic where I now practice. I saw two former patients just last week who had called the OB/GYN clinic at Fairview and were told Fairview could not/would not tell anyone where I was. That is despite testimony at trial that Fairview has been sharing my practice location with my former patients who called since April of 2011!

Second, I had no chance to say goodbye to so many people who worked there, friends whom I held dear. So many nurses, techs, anesthetists and others were such good friends. It came out in trial that, had I tried to walk back on the Fairview Lakes campus, security was at the ready to hammer-lock me and throw me off the premises (slight exaggeration). They were to be called to escort me off the premises if I showed up. As far as I know, that order has never been rescinded.

In this post, I’ve been careful to write what is accurate, true and documented in depositions, trial testimony under oath or the judge’s ruling. (Except the part about the Nesting Grounds. That information I found on the internet and make no conclusions about it.) I’ve no interest in harming my former employer as most of the people I worked with at Fairview were wonderful hardworking people delightfully committed to patient care.

Posted in Uncategorized | 23 Comments »

I Won My Case

Posted by MDViews on December 17, 2012

I won my employment case against my former employer. Good news. Details to follow at a later time.

Posted in Doctoring | Leave a Comment »

What I’ve Learned After 30 Years of OB/GYN

Posted by MDViews on December 17, 2012

My first day of practice after I finished my OB/GYN residency at Iowa was July 19, 1982. That seems like a lifetime ago, probably because it is.

I thought I might share some thoughts on this thirty year journey I’ve been blessed to have. You may enjoy the read. (Or, you may not if you are included in my list of things that have gotten worse in the last 30 years!)

First, some things have not changed a bit.

1) The patient encounter. It is still a conversation, an exam, an investigation, a diagnosis and a plan. The most important part without a doubt is the conversation. With the conversation comes listening. Without listening, I never really get to the bottom of any patient’s problem. I’ve read that a doctor interrupts a patient after an average of 17 seconds during an encounter. Whew! Shame on us doctors!

2) Fear. All patients have some element of fear and uncertainty in the back of their minds when they see me. No one comes to the doctor 100% sure all the news will be good. That applies to every visit, whether a routine annual exam or a routine OB check up or a problem of a more serious nature. Is my baby OK? Do I have cancer? Will I bleed to death? Why do I always have pain? All doctor visits entail some anxiety for a patient.

3) Trust. Trust is the glue holding together the doctor-patient relationship. Without trust–trust in myself that I am up to the challenge of the patient encounter or trust the patient has in me that I am capable of helping her–the whole thing falls apart. I have to know–not just “think” or not just “hope,” but actually know–that I have the mental capacity, the ability, the knowledge, the skills and the desire to help my patient in a real way. If I don’t have trust in my skills as a doctor, I’m lying to her if I imply I can help. If my patient has doubts I could be a good doctor for her, if she doesn’t really trust me to help her, if she thinks me disinterested, incompetent, distracted, casual, insensitive or somehow not totally committed to her well-being, my chances of helping her decrease significantly. Patients, I think, can sense a doctor’s competence.

4) Care. Caring is the “product” or “service” I offer to my patients. I’ve learned I can’t hide it if I care and I can’t hide it if I don’t care. The signals may be subtle, but are unmistakable to patients. I’m far from perfect and have had occasions in which I’ve been fatigued, or rushed, or distracted by some outside event or just ill myself and have provided less than ideal care to my patients and have seen them move on to other doctors. Fortunately, I’ve not seen a lot of that through these years and have seen it more with patients leaving other doctors to come to me, but I’m guilty as well of not caring as much as I should have more times than I like to think. Patients have an ability to sense caring I’ve come to realize.

Some things have changed profoundly in the last thirty years for the better and all have to do with better technology which has improved patient care.

1) Ultrasound. When I started, real-time ultrasound was new and I was lucky if I could tell what part of the baby was coming first. Ultrasound now gives me such clear and accurate pictures, I only infrequently miss abnormalities as a pregnancy progress. Also, ultrasound for gynecology was worthless when I started. Now, it is indispensable at diagnosing gynecologic problems.

2) CT and MRI scans. CT scans were just invented when I started. MRI was only a dream. Now, I can order a scan and view the insides of any part of the body with unbelievable accuracy. Both are totally valuable and indispensable now.

3) Fetal monitoring. Monitoring the baby in labor was somewhat new when I first started OB, but is now commonplace and allows me to tell how the baby is doing in labor. There have been published studies that say listening with a stethoscope is just as good as a fetal monitor. Don’t believe it because it’s just not true. Fetal monitoring is worth it’s weight in gold, in my judgment.

4) Medicines. Several come to mind. One is Zofran for nausea and vomiting of pregnancy. What a godsend for women. I rarely have to hospitalize a woman for nausea and vomiting early in pregnancy any more. Acid reducers for heartburn late in pregnancy have also greatly increased a woman’s comfort during pregnancy. SSRI’s (Prozac, Celexa, etc.) have totally changed the face of depression in women. Those with disabling, depressive PMS and those with post partum depression get relief and can function. What a blessing! Antiviral meds for recurrent herpes have helped many women. None was available when I first started.

5) New surgeries. The first would be operative laparoscopy. With that minimally invasive technique, I can treat endometriosis, adhesions, ovarian cysts, pelvic pain and infertility. Endometrial ablation, a procedure to destroy the uterine lining to stop bleeding done as an outpatient without hysterectomy, is another.

Some things in medicine were unsatisfactory 30 years ago and remain unsatisfactory today, and others have taken a turn for the worse in the last thirty years much to my dismay.

1) Lawyers. Believe it or not, the medical malpractice crisis is not new and a doctor’s fear of being sued is not new. When I chose OB/GYN as my specialty, the biggest hurdle I had to overcome in my mind was the high risk of lawsuits in OB/GYN. And that was 1976. Medical malpractice continues to be the bane of all OB/GYN doctors. Any baby born less than perfect can result in a lawsuit. No chart is perfect, so there is always something an opposing expert can or will say to blame the attending physician for any problems the baby may have, because any and every labor a mom experiences which results in the birth of a less than perfect baby is scrutinized and can result in a lawsuit. One of the unintended consequences of this sue-happy society is the rising cesarean section rate. When I started residency, the C/S rate at my hospital was about 5-7%. Now, the nationwide average is above 30%. Politicians and researchers say they don’t know how much of this increased rate they can attribute to lawsuits. Well, I do. About 99%.

2) Institutional and corporate physician employment. Private practice was the norm when I started out. Few doctors worked for large health care companies, government entities or universities. Even then, most of those physicians in academic medicine were in it for the right reasons–teach and do research. However, now, private practice, especially in Minnesota, is dying out. More and more doctors work for the large Fairview, Allina and HealthPartners of the world. They work for less money, but usually have only a 4 day work week and share call with a plethora of other physicians. In Minnesota, an on-call doctor never speaks to a patient after hours. All patients have to call a “nurse-call line” where they are told to go to the ER, stay home or go to OB. The ER or OB then contacts the doctor after the patient has been evaluated. Also, most doctors who work for the large companies do not take patient calls during the day as well. They go to the nurse-call line.

This change of institutional and corporate physician employment profoundly affects how physicians and patients interact. In such a system, physicians tend not to view themselves as one patient’s doctor. They lack loyalty to any particular patient. I’m generalizing here as there are exceptions. But, by and large, loyalty lacks significant influence over physician behavior. Therefore, the doctor/patient relationship is superficial. A superficial relationship hinders the trust and confidence a patient should have with their doctor. As I said above, patients can tell if you care and if you don’t care. If you are unavailable 3 days out of 7 and won’t take a phone call on the other four days of the week, what does that tell a patient about caring?

Also, the doctor is beholding to the corporation and must do whatever the corporation says. Corporate folks, however, are not generally medical. They sway with the wind of corporate style and change, the process du jour to improve productivity. Patients get called customers, physicians get called providers and hospitals take on strange-sounding names. Processes get copied from the auto industry (the Toyota way) or the airline industry, as if screwing bolts on a bumper or going through a pre-flight checklist somehow compares to the vagaries of a treatment plan for breast cancer.

The word to sum it up best in my mind would be de-personalized care. But if medicine is anything–anything at all–it is personal and it is private and it is a relationship. Trying to shoe horn medicine–this very complicated, private, personal, unique, caring relationship–into the one-size-fits-all corporate/institutional model results in a medicine best for the hospital, the bean counter, the coder, the administrator, the government rule-maker, the bureaucrat and the lawyers, but for the patient? Not so good. The patient is left to deal with a rushed, often surly doctor who is under the gun to produce (move patients in and out–see as many as possible in a short period of time) and follow the cookbook du jour (protocols are always changing and always getting more detailed and difficult to follow) in order to maximize income from those in control. At some big medical corporations, doctors pay is based on how well he or she follows the latest medical protocol cookbooks. The doctor becomes a puppet on a string, jerking here and there with the latest corporate or government fad or protocol leaving his or her best medical judgment at the exam room door.

3) The electronic medical record (EMR). I’ve written on the problems with the EMR before here, so I won’t re-write the whole post. Care is even more de-personalized. If you’ve been to the office of a doctor who spent the whole visit looking at the computer screen and typing, you probably know what I mean. Privacy becomes a sad joke. Errors are perpetuated in the chart. Your visit notes become polluted with extraneous, irrelevant information and your doctor can commit coding fraud and you will never be the wiser, all because of the EMR. Thanks, EMR.

4) Nursing. The nursing profession (and I use that term with hesitation) was hijacked by the master degree and PhD degree nurses (nurses who no longer do actual patient care) who decided that nursing’s primary role from centuries ago was inadequate, demeaning and needed to be changed. What was/is nursing’s primary role? To carry out the orders of the doctor. (You probably didn’t know that, I’m guessing.) The doctor listens to the patient, examines, tests, reaches a diagnosis and develops a plan to treat the illness. This plan, at least in the hospital setting, is carried out by the nurse.

However, with the 1960’s and 70’s came the feminist movement. Since most doctors at that time were male and most nurses were female, you can see how this situation rankled those in feminist power. So, nursing developed their own “nursing diagnosis,” things like “potential for pain” for a patient who has had a surgery or “potential for a fall” for a very elderly, frail patient. How demeaning for nurses. Along with these nursing diagnosis came pages and pages of burdensome charting, charting which was read by no one except supervisor nurses. I know as a doctor, I could care less what a nursing diagnosis was, but I cared deeply to know how my patient was doing based on the nurses care and judgment. Her (or his) assessment of my patient’s status was critical to my decision-making.

A professional nurse who knew her job and cared about her patient could tell me in a short paragraph my patient’s status, whether or not she was getting better or worse, what new problems had developed, what old problems were resolving. Such information was critical to good patient care.

When I started in medicine, nurses routinely rounded with the doctor (me) and so would be able to fill me in on any problems the patient had, listen to the conversation between me and my patient, understand my exam and then understand where I wanted to go from there with new orders or a new plan. Communication occurred and misunderstandings were few.

In the 1980’s as nurses became more and more burdened with charting no one read, they had less and less time to round with me. The nursing higher-ups demanded this charting and placed a low value on rounding with the doctor. I guess they viewed rounding with the doctor a demeaning experience–you know, a woman subservient to a man, that sort of thing. They totally missed the picture of what was best for the patient.

Also, nursing unions removed from this noble profession the word “profession”. I hesitate to call nursing a profession any longer as so many nurses now have a union “them-against-us,” “we’re the good guys, they’re the bad guys,” “I’m only doing what my contract requires,” attitude. When you hear of unions threatening to go on strike, they always get the ear of the local papers who have always been in favor of the unions, it seems and against administration and doctors. So the interviews always come out favorable to the nurses and the nurses always say they are threatening to strike for the good of “our patients.” What a sad joke. They strike for money. When their shift is over, they care little about “their patient”. However, I still encounter nurses who are true professionals and who are in medicine for the right reasons. That number is less than 50% now in my judgment, but I’m still refreshed and pleased to find nurses doing real nursing and really caring.

So now, in 2012, I would say a nurse accompanies me on rounds less than 5% of the time, and that 5% is mostly by accident. She (or he) happened to be in the patient’s room when I made rounds. Instead, if I want to talk to my patient’s nurse, I’ll have to have him or her paged and wait. To get report from a nurse is like pulling teeth. Then, the nurse will sometime be upset at being inconvenienced by my call and request for information. How sad! I wonder how many patient realize that I have so much trouble getting important information about their condition from their nurse! I’m sure they think we work together as a team.

The last change in nursing I’ve seen, a change that could have some positives to it, but is really 80 to 90% negative, is the nursing dependence on protocols and the authority given nursing to directly countermand the decisions of the doctor.

We now have protocols–medical cookbooks–for almost everything. In general, they’re good. They keep me from forgetting something important. However, because all patients are unique, they don’t all fit the protocol. So sometimes, I have to write orders that don’t match the protocol. Oh dear. To nursing, these protocols are carved in granite. Add to that the explicit permission nurses are given to ignore a doctor’s order with which they disagree and you have recipe for trouble.

One can get a diploma RN degree with 30 months of school after high school and be employed as a hospital nurse. I spent 12 years after high school getting my college degree, then my MD degree and then OB/GYN residency training. Yet I’ve had happen again and again failure of nursing to follow my plan for patient care because they couldn’t understand why I wanted to do what I wanted to do, even when I spent much time explaining my rationale. If the staff nurse disagrees with my order, he or she goes to the charge nurse. The charge nurse goes to the head nurse on the floor or OB or surgery. Next, I’m called into an office to be told they won’t be following my plan since it doesn’t follow the protocol. My next step is to appeal to the head doctor of the department. If I can get the head of the department to agree with me, it’s possible my plan may be carried out, but even that is iffy. Sometimes, nursing insists on discussions at committees and changes in protocols processes which can take months. If I push hard to have my plan followed, I’m viewed as a troublemaker and a problem physician.

So the noble, honorable profession of nursing has, in my mind, gone downhill, led by feminists jealous of the role of a doctor, feminists who burdened nurses with menial tasks and cumbersome charting of questionable value, unions out to garner more money for nurses which changed nursing from a profession to a job and protocol/institutional/government influence on nursing which caused nurses to quit thinking and follow a medical cookbook at all costs.

5) Lastly, I have to mention–how do I say this–uncoupling of doctors from the tenants of the Oath of Hippocrates.

I’m not sure how much influence the Oath of Hippocrates had prior to my entry into medicine in 1974, but I think it was substantial. I base that opinion on the doctor’s attitudes I witnessed in my early medical training.

In 1973, when Roe v. Wade became the law of the land with one sweep of the Supreme Court’s pen, most (70 or 80%) of doctors eschewed abortion. Genetic testing did not exist. Ultrasound did not detect prenatal abnormalities. Doctors were trying to save babies, not kill them. Within two years, however, a sea change of opinion occurred and a majority of doctors became pro-choice. Why? Pressure from the liberal woman’s movement. If a doctor was not pro-choice, they were viewed as women-hating, misogynistic, backward, stupid troglodytes and were marginalized in the doctor’s lounges and medical meetings across the country. It’s a testimony to the weakness of the pro-life commitment doctors held prior to Roe. Apparently, the medical profession’s pre-Roe pro-life commitment was (metaphor alert) a mile wide and an inch deep. Not much there. The doctors folded like a cheap suit.

But the Oath is not just pro-life, but pro-God, pro-morality, pro-privacy, pro-honesty, pro-only-work-for-the-good-of-the-patient. I’ve written about the Oath in much more detail here so you can get my detailed analysis of the Oath and why I think it should still be followed.

This uncoupling contributes to the current decline of medicine today. If doctor’s followed the Oath, medical records would not touch the internet without a patient’s consent. Billing would be honest. Life would be honored. Greed would be less. There would be no death panels. The phrase, “cost-effective care,” would disappear from the lexicon. All patients would be treated with equal dignity, respect and the best medical judgment a physician could muster. All patients would feel safe in a doctor’s care. Protocols would be just gentle guidelines as reminders for good patient care, not inflexible rules with harsh consequences trumping a doctor’s best judgment. Doctors would have a concept of their “profession” instead of viewing doctoring as a 9 to 5 job four days a week, a don’t-bother-me-unless-I’m-on-call and where’s-my-paycheck attitude.

So those are my thoughts on medicine from then to now. I know for myself, I’ve finally grown up medically, I think. I relate to George W. Bush who so famously said, “When I was young and dumb, I was young and dumb.” That’s me. I did many things I now deeply regret as a Christian, a husband, a father and a doctor. I’m totally convinced of my depravity.

I take my medical calling with all the seriousness I can muster. I embrace medicine with both hands–the good and the bad–recognizing that it’s my duty and my privilege. I more fully recognize the unique role God has given me and the responsibility that goes with it. I more humbly thank God for this “job”, this calling, having suffered through a period of unemployment. I pray I can be effective as a Christian physician until my health fails or God calls me home.

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