The Real Medical Education

September 17, 2019

Before you can practice medicine, you must complete 4 years of undergraduate work, 4 years of medical school and 3-5 years of residency.  Upon successful completion of your prescribed training program, you are a highly trained and, hopefully, skilled DOCTOR OF MEDICINE.

You are ready to setup practice and see patients. You are ready to diagnose and treat a vast array of illnesses.  You have read the most up-to-date journals and practice evidence-based medicine. Really?

While you may think your education has prepared for life and death decisions, it has not.  Realistically, once you start seeing patients, your real training begins. You’ve been taught by a system to prepare you for the routine, everyday patient with textbook perfect complaints and treatments.  

In simple everyday terms, you have been trained to put square pegs in square holes and round pegs in round holes and you’ve gotten quite proficient at your task.  Then, one day, you’re given triangular pegs.  What do you do?

Having practiced medicine close to 40 years, I can attest to the fact that all patients are different and many cannot be successfully diagnosed and treated using the most up-to-date rule books. What do you do?  My answer is easy.  You customize your treatment protocols to fit the individual patient’s needs and wishes. Sometimes, it takes months or even years to find the right treatment regimen for your patient.  Sometimes, if you listen closely to what your patient tells you (and you choose to believe your patient) deciding what to do is a slam dunk!

Why am I writing about this today?  My patients are actively searching for new docs as I am no longer in practice.  Some of the new docs will review the patient’s history, his old charts and his treatment regimen and, despite the fact that the treatment does not stand up to present day standards, will choose to continue it because it works!  It has safely worked for 20 years and survived the test of time.

Other docs will choose to stand by the latest treatment protocols, decide that Dr Segal did not know what he was doing, and change the patient’s treatment plan simply because they don’t understand how it was developed.  Reading 20 years of chart notes just isn’t possible.  For the physician, it’s easier to simply start from scratch.  For the patient, it is not so simple.  Sometimes, it’s like squeezing a square peg into a round hole.

What can you do to make the transition of care easier on you and your new physician?

The solution may be as simple as making a phone call.  While I no longer have access to your chart, I can answer many of your new physician’s questions if he/she will call me.  My number is 847-846-2131and I will be happy to help in your transition of care to a new doc.  Feel free to share this post with your new physician as well.

The solution may not be simple.  It may take several attempts to find a new physician who fits your need.  Trust your gut.  If you don’t feel comfortable with your new physician, move on.

I am truly sorry that I’m no longer here to take care of your needs.  I want to thank all of you for your calls, cards and prayers.

The following article was published on April 27, 2011 and is even more pertinent today then it was then.

No, I haven’t lost it.  Today’s article is all about fitting a round peg into a square whole.  My profession is changing.  “Payers,” those entities that have taken on the responsibility for paying for and ultimately providing healthcare for my patients, want statistics.  They collect data on every visit, every medication ordered and filled, every test ordered and done (or not done).  If you are afraid of what Google and Apple are doing with your geographic data, you should be more afraid of “payers.”  The government, in the guise of Medicare, is the worst.

Protocols, for medical care, are being actively built and implemented on a daily basis.  When the President says that the electronic exchange of medical information will save money, he means it.  Information (data) is being harvested from every patient encounter.  That information is used to create evidence on what the least costly and, therefore, most effective treatment protocols are.  I am forced to follow these protocols every day.

Today, my patient needed a stat CT scan of her lungs to assure she did not have a pulmonary embolism.  Her insurer’s protocol required prior authorization (article 4/15/11) for this potentially lifesaving test.  Failure to follow her insurer’s protocol would result in thousands of out-of-pocket dollars expense to my patient.  Delay in care could result in her life.  What to do? 

Protocols don’t take into effect an individual’s needs; they make an individual fit within the protocol’s needs.  Protocols are in the best interest of the “payer”, not the provider and his patient.  In “Normal,” published 2/28/11, I wrote that I had never met a “normal” or “average” patient.  I see individuals and they come in all sizes and shapes.  Protocols are devised to care for that fictitious, average, normal individual.

In “Are We There Yet?” (4/14/11), I wrote about a fictitious New York city in the year 2020.  There, everyone lived by protocol, from what they ate to when they died, protocol controlled everything.  We aren’t there yet, but I think we are on our way.  Certainly, from a medical point of view, we are being pushed to sacrifice the personal aspects of care for the sake of cost control.

How do you fit a square peg in a round hole?  Try using a hammer, chisel or saw.  I’m afraid that the new world of medicine is going to be uncomfortable for most patients and downright painful for many.

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