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created the stimulus for our immediate interest in this topic. It
was a 2-full-page story in the March 17, 2019, issue of the Boston
Sunday Globe, headlined "Bullied To Death" and makes riveting
reading. It indicates that stories of medical bullying abound, and
that "if you search 'bullying in residency' you'll get thousands of
hits." We only read a sampling, including stories showing that
bullying by senior residents or attendings, and running the gamut
from verbal threats, intimidation, "over-monitoring of patient
care," and public humiliation, can adversely affect the quality of
care provided by the victim, cause students to drop out of the
profession, and make them physically or emotionally ill. Worst of
all, the article mentions that suicide is estimated to be the second
leading cause of death among medical students, after cancer, as
opposed to the leading cause of death in the general population for
that age group (of 25 to 40 years old), namely, car accidents and
other trauma, with the somewhat obvious inuendo.

fees, that is not allowed and indeed could lead to serious legal
ramifications. The upshot is that the government has more and
more been treating these erstwhile professionals as if they were in
fact employees of a public utility or a de facto National Health

The article notes that suicide data for young doctors are
difficult to specify, especially as many possible suicide deaths
are not reported as such. However, it does note that the annual
suicide rate for American physicians is twice that of the general
population, and leaves one wondering whether the pressures on
physicians, both from within and without the profession, are
contributing causes.

Again, other significant results of this bureaucratic power grab
find weary doctors continually worrying about junk lawsuits,
lawyers trolling TV ads looking for clients to sue doctors and
hospitals, and lawyers working to bring back an atavistic "change
of venue" system. That, in addition to interfacing more with
the computer in the examining room than in fact taking the
patient's medical history and doing the physical exam as he/she
was taught to do in medical school. And, he is required to use
inadequately designed electronic health records which often as not
have difficulty interfacing with the systems used by their hospitals,
nursing homes or specialty consultants. It even goes further, in that
the doctors may be penalized for failing to meet federal computer
usage requirements, and can be held liable for HIPAA breaches
if an outside "hacker" gets into the system and steals the patient's
privileged data.

Several years ago, we began to see numerous articles concerning
the declining state of morale among practicing physicians. This
seemed to be occurring for a variety of reasons. We all pretty much
agreed that many of the pressures of practicing clinical (especially
private) medicine were being imposed upon us from external
sources and, as one physician mentioned to us, "Medicine isn't fun
Ask any experienced physician these days and you get similar
responses from a majority of them, presumably because the
factors contributing to physician burnout are pretty obvious to
them. Some of the most obvious triggers include overarching
governmental regulations which have created a milieu paralleling
(and perhaps even responsible for) the rise of onerous burdens
of documentation, measurement, administrative responsibilities
and legal liabilities imposed on doctors by 3rd party payers and
health care organizations. It clearly has reached the point where
the historic profession of Medicine has been de-professionalized
and in turn "industrialized," and sometimes even criminalized.
The profession no longer controls itself, its educational system, its
standards of quality or the indications or regimens for the medical
care given to its patients.
Physicians have to spend undue time trying to contact the
patients' insurance providers, arguing with non-medical decision
makers, and taking the blame from the patients when approvals
are not received for medically indicated treatments. For certain
economic reasons, they are considered to be "small businessmen/
women" and are regulated that way. But when it comes to a small
business trying to recoup the related costs by charging additional

Since the government now in fact controls much of the
profession, including what may be prescribed, when and for how
much, how many days a patient will be allowed to receive that
care as an inpatient or in certain long term care facilities, denying
payments retroactively as well as for re-admissions within so many
days of discharge, etc., etc., we have by definition a socialist
system, wherein the government controls the facilities, industries,
means, manner, mode of distribution of, and payment system
for, medical goods and services (reference any reasonably standard
dictionary or history book for discussion of government control of
land, labor, and capital).

It is no wonder, then, that so many physicians continue to
look into cutting back their practices, selling out, or even taking
early retirement. Recent reports show that about half of physicians
experience burnout at some time or other, and by 2018 that had
reached to 78% in at least one study.
The US DHHS has predicted a shortage of up to 90,000
physicians by the year 2025, and it doesn't take a rocket scientist
to see that our all-knowing goverrnment interference in this once
proud and self-regulating profession is at least partially responsible
for that trend. One has to recall former President Reagan's
prophetic comment that the "Government is not the solution to
our problem - Government is the problem!"
Dr. Maher is a retired physician, former County Health
Director, has taught at three different Medical Schools,
and is a long-time member of CCHD's Board of Directors.

SPRING 2019 | CHESTER COUNT Y Medicine 27


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