Saturday, August 7, 2010

On medical blogging

I read so many blogs from doctors, the psychiatry ones like to discuss how psychiatry has been reduced to simply writing prescriptions. It is old news. Most psychiatrists did not go into psych to write scripts all day to see patients every ten minutes. Generally speaking most start out with the ideal of wanting to understand and help their fellow human being. Old news.
Then their are the usual blogs about bashing the pharmaceutical industry, nothing new, usual stuff, politically correct. Meds are bad, pharmaceutical companies sinister etc etc. Lots of bad doctors pandering to the drug companies. People love these blogs, safe politically correct targets to bash.
There seems to be more physicians blogging than ever before, but they may reflect more the fact that there are more people blogging than ever. Some are a bit more pithy than others, some walk a political line, hoping to stay ahead of things with electronic media preserving their place in the cosmos, as the current physician-patient relationship, the therapeutic alliance, what medicine was created on since the beginning of human-kind, continues to erode. It erodes because of economics and politics.
I hate it when some of these blogs stay on the right side of the line, stopping short of speaking what is really on their mind. You can feel it and smell it. They don't always speak with candor, they may be honest, but they don't say what people don't want to hear, because nobody would read them. Fortunately for the blogger it is a world where most people are on the outside looking in, so most would not know if they are candid or not.
The blogger feels good because they are honest, but generally there is a pervasive fear and a general need for self-preservation, that behooves the medical blogger to stop short of telling the whole story.
Some actually open up about their human side of things, but one must be very careful with that. It is a very ultra thin line as we still hold the medical profession in some sort of bizarre precarious inflated esteem.
We want and assume our doctors to be smart and flawless and the greatest healers, but we know and expect them to be money-grubbing, selfish crooks, who don't care about their patient. We almost expect it, and the system reinforces our negative perceptions.  We look and wait for any clue to reinforce it. Is it any wonder the most prolific medical bloggers stay on the safe side? What option to physicians have?
I always assumed that the physician was the primo patient advocate, but nowadays we must be wise consumers who bring people to advocate for the patient against the physician. Who truly made the system adversarial? FDR? LBJ? Managed Care? HMO's? the AMA?
Perhaps I idealize the past, maybe the system was always adversarial, maybe the old physician-patient alliance was always challenged and precarious. I have to admit though since I have been working for 17 or 18 years now, it seems that their is less and less opportunity to take care of your patient and much more paperwork, defensive work, fighting with insurance companies and so many things in the way of letting you care for your patient. That part I can see. The doctor is just not free to practice medicine anymore. Yet on some level in the end, we still want our doctor to be the best and do everything right.

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Talking about the book with the Lake Superior wind....... a calm day