Monday, September 8, 2014

Are We Emasculating Our Physicians?

On the face of it, the phone call was relatively innocent.  A family member was confused about the test I scheduled.  Apparently the lab refused to draw the blood.  When I inquired why, I was informed that the patient hadn't been fasting.  I calmly explained to the daughter that fasting was not necessary.  Recent studies had shown little effect on lipid panel results and I was using the glycosylated hemoglobin to asses diabetes.  The daughter, however, said the lab technician was steadfast.  They wouldn't draw the blood unless my order specifically stated: no fasting necessary.  Furthermore, the lab refused to call me directly, I had to hear this all secondhand from the family.

Not a moment later, a fax was returned to my office,  Although I had filled out the durable medical equipment form correctly, medicare wouldn't accept it.  Apparently I had typed instead of hand written the date.

My hospice patient wasn't doing so great either.  Actively dying in the nursing home, I had written a prescription for morphine hours ago.  Unfortunately the pharmacy wouldn't fill my order.  Although I had specified the numeric version of the quantity on the script, I hadn't also spelled it out.  The pharmacist on the phone was less than apologetic.  Government regulation!

There is no question that physicians should not be above the regular pains and hassles of any professional workforce.  I accept that governments regulate industry and sometimes one has to deal with nonsensical rules from time to time.  But the recent systemic demoralization of this highly skilled and trained group of individuals is having untoward effects.

Facing arduous and difficult decisions while being distracted by an ever-growing mound of minutia molded by technocrats and enforced by unskilled labor is nothing less than emasculating.  It is no wonder why the modern day physician is becoming ever more distant and emotionally as well as physically unavailable.

If we truly want to build a high value, high quality version of our healthcare system, we need our physician workforce to feel a strong sense of internal motivation and pride in their work product.

We can't do this if we keep cutting them off at the legs.


Anonymous said...

Dr. Grumet,

I greatly appreciate your responding to my concerns about your post on Facebook today. It appears that I was not successful in posting the comment I wrote earlier in the day so I will rewrite it here.

The word, "emasculate" has both a connotation and denotation related to removing masculinity. The Merriam Webster definition follows:


: to make (a man) feel less masculine : to deprive (a man) of his male strength, role, etc.

: to make (something) weaker or less effective"

The word, "masculine" is almost entirely present in the word, "emasculate". As I mentioned earlier today, I was offended by your use of this word in your post as it associates power and competence with masculinity.

I understand it was not your intention to refer to gender. I am a psychologist, a mother, and a woman. My impression of you is that you are a smart, sensitive, and competent physician with a very big heart. I am sincere in my belief that you are an excellent physician.

But your use of this word is offensive and detracts from the very good points you are making about the challenges in medicine, especially primary care. I have a very competent female internist, whom I just saw today for my annual physical. I have a very competent female medical oncologist, who I see for my breast cancer follow up care. I have a very competent female psychologist, who I see for the aftermath of cancer. And I have wonderful male physicians as well.

This is longer than my original comment but I ask you to think about your word choice especially, the word you chose.


Elizabeth MacKenzie, Ph.D.

jimbo26 said...

v. t. 1. To deprive of virile or procreative power; to castrate power; to castrate; to geld.
In this case , it is to take away the power of the physician by the admin system .
In this case the word is correct .

meredyth kezar said...

Good article but I too think emasculate is a poor choice of a word