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Welcome to my blog, a place to explore and learn about the experience of running a psychiatric practice. I post about things that I find useful to know or think about. So, enjoy, and let me know what you think.


Thursday, February 13, 2014

A Valentine's Day Tail

Mel Blanc

In his autobiography, That's not all Folks, Mel Blanc, who did the voice characterization for most of the Warner Bros. cartoon characters, most famously, Bugs Bunny, relates an amusing anecdote.
On January 24th, 1961, he was in a bad car accident. The surgeon told his family, "Mel has numerous internal injuries, compound fractures of both legs, a fractured arm, and a severe concussion. But we're most concerned about the pressure building around the brain."
His prognosis was not good.
He did pull through, but remained unconscious. Then on Valentine's Day, he spoke for the first time. "Noticing the image of Bugs Bunny on the wall-mounted television, [his doctor] thought to ask, 'How are you feeling today, Bugs Bunny?'"
Blanc replied, "Eh, just fine, Doc. How're you?"

I'm fascinated by the word, Doc. What I mean by that is I find it interesting to consider who calls who, "Doc".
For example, say I had a patient who was a Classics professor, maybe a scholar of Aeschylus (I'm completely making this up, BTW). It would be weird if he called me, "Doc", right?
But say my patient was an old-style cab driver, born and raised in Brooklyn. It wouldn't be so weird if he called me, "Doc".

What about people who are not my patients?

I first started to think about this a number of years ago, when I happened to get to my therapist's office before she did, one day. I waited in the lobby until she arrived, and as she came into the building, I heard the doorman say, "Hey, Doc!" I thought it sounded friendly and natural, and I simultaneously realized I would never call her, "Doc".
Then I started paying attention to it in the hospital. The nurses generally used the address, "Doctor".  It was the rest of the staff, janitorial, security, who, I discovered, use, "Doc". I think it's a way of being both respectful and collegial at the same time. After all, I have a lot more education and professional training than a typical security guard, but we still work in the same place. And let's face it, I couldn't do my job if the staff didn't do their jobs. It's as though "Doctor" would be too formal, would put too much distance between us, and my name would be too informal or disrespectful (plus they might not know my name), but "Doc" means we're equals, colleagues, but also not.
And of course, there's the medical tradition of being called, "Dr Jones" by your attending, on rounds, even when you're still a medical student. Or of calling your fellow residents, "Doctor so-and-so". I think this is done half as a sarcastic joke, and half to acknowledge, with some pride, that these are your colleagues, and you have a shared experience of all the rigors of medical school and residency. And more to the point, a shared identity, with some semblance of a shared perspective.
Because really, the Bugs Bunny story is about identity. Mel Blanc was obviously not Bugs Bunny. but he spent so many years creating Bugs Bunny, bringing him to life, as only he could, that the character became part of his identity, in the same way that being a doctor is part, but not all, of mine.
I mentioned recently that I wrote an article for the January issue of The Carlat Report entitled, An Ethical Perspective on the Affordable Care Act. I think I also mentioned that writing it was demoralizing, as I learned about all the problems involved in the ACA. But if I had to sum up the concern, I'd say it's that going forward, doctors may not be doctors anymore.
If you work in coordinated care and never get to see patients, if you are held to demonstrating "quality care" by using checklists rather than interviewing skills, if you are limited in your decisions about what kind and how much therapy a patient needs by insurance requirements, if you spend more time filling out forms than working with patients, then what has become of all the time, effort and money you put into becoming a doctor with some expertise in your field?
If you can be replaced by a nurse who had two days of training in depression management and behavioral strategies, or a piece of paper with checkboxes, or a bottle of pills, what will it mean to be a doctor? And who will I be then?

Happy Valentine's Day!

1 comment:

  1. You will be unemployed - exactly where the managed care cartel wants most psychiatrists to be. That will only happen if the government forbids physicians from opting out of government/ACO plans.

    You are describing how the system can be cheapened by removing quality (detailed assessment by a trained physician) and ethics (all care proceeds as a contract based on that personalized detailed assessment) to a model devoid of both. Unfortunately it is a model that our professional organization currently supports. Go figure.

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