Should PCPs Begin Packing Heat?

DrRich | September 29th, 2010 - 9:54 am

This is a delicate topic, and even DrRich (who has displayed on these pages a willingness to risk alienating Progressives, Conservatives, President Obama’s minions, fat people, editors of prestigious medical journals, global warming enthusiasts, babies, bunnies, and even his beloved fellow cardiologists) is hesitant to bring it up.

But events force DrRich to throw caution to the wind, and issue a warning, and a plea, to those among the broad community of physicians for whom he has the most respect – the PCPs. The event to which DrRich refers, of course, is the recent, tragic gunning-down of a physician at Johns Hopkins University Hospital by a disgruntled patient (or rather, by the clearly disgruntled son of a possibly disgruntled patient).

This is DrRich’s warning: the recent shooting at Johns Hopkins may indicate that the long-predicted (predicted by DrRich, at least) bloodbath of American PCPs may now be at hand. And this is his plea (and here is where even the usually audacious DrRich must admit to a slight bit of trepidation): PCPs, for your own good, for the survival of primary care medicine, and therefore for the success of Obamacare, you must now prepare to defend yourselves.

Yes, dear readers, it is time for American PCPs to begin packing heat.

DrRich well understands that many of his readers at this moment doubtless think he has, at long last, lost it; that his finely-honed (and amply-demonstrated) abilities in logical discourse have finally taken their leave, that he has, sadly, gone ’round the bend. DrRich forgives you for this reaction.

After all, the doctor who was shot (whose identity has not been disclosed, but who is apparently expected to recover fully), works at Johns Hopkins, one of the premier medical institutions in the world. And therefore, while its leaders undoubtedly give the requisite lip service to the importance of primary care medicine, Johns Hopkins likely does not have very many actual PCPs frequenting its premises. So (DrRich’s clever readers correctly surmise), it seems very unlikely that the shooting victim was a PCP; and for him to find a lesson for PCPs in this unfortunate incident is obviously too ridiculous for words.

DrRich does not take such criticism personally. He realizes that those of you who doubt him in this case are not being mean-spirited, but merely misinformed. DrRich accepts the fact that most of you do not scour the relevant scientific literature with as much care as he does. And so, he does not expect you to be aware of the recent work of one David Fishbain, Professor of Psychiatry and Behavioral Sciences at the University of Miami, who published a study in NewScientist Magazine which indicates that up to 1 in 20 patients would like to kill their primary care physicians.

Professor Fishbain learned this interesting tidbit in a survey he conducted among 800 patients undergoing physical rehabilitation or suffering significant pain.

Those PCPs who are reading this startling news, and who, by virtue of the fact that they are still working as PCPs, have have most likely honed their skills of denial to a high art form, are doubtless consoling themselves at this very moment with this observation: “Sure they want to kill me. But as they’re disabled, their chances of success seem low.”

So chew on this. In a control group of patients who were not suffering from pain or disability, Fishbain reported that “only” 1 in 50 admitted to having murderous tendencies toward their PCPs.

Any way you cut it, the math is not pretty: the typical PCP with a patient load of 3,000 souls can assume that at least 60 of these individuals (up to 150, if he/she treats a lot of patients with pain or disability) would not only like to see them dead, but would be pleased to be the instrument of their demise. Worse, even these statistics are surely unreasonably cheerful, as they rely on the likelihood that everyone who wants to see their doctor lying lifeless in a pool of blood are comfortable admitting this fact to medical researchers doing written surveys.

In any case, whatever the specialty might be of the physician who was shot at Johns Hopkins, it is the PCPs who are at the highest risk. And now that the shooting has actually begun, DrRich does not think PCPs should take much comfort in the possiblity that the first casualty may not have been one of them.

Why are patients murderously angry with their PCPs? Let us count the ways.

DrRich has expended much space and effort on this blog describing how PCPs have been maneuvered into covertly rationing healthcare at the bedside. Patients who go to their guideline-compliant, non-fraudulent PCPs these days will find themselves limited to 7.5 to 12.5 minutes of actual face time, most of which their doctor will spend sitting at a keyboard, staring at an LCD screen, desperately attempting to make the appropriate clicks on the most favorable little boxes next to a government-sanctioned Pay For Performance checklist. There will be little or no time for whatever pressing issues may be on the patient’s own (non-government-approved) agenda.

The patient, who has waited weeks for this opportunity, will be asked to wait weeks more for another appointment to discuss those other things – or will be directed to an emergency room.

But the greatest sin of all is that, to assuage their guilt and to make such behaviors seem less than reprehensible, physicians have allowed their professional organizations to formally adopt a new code of medical ethics, one which charges physicians with the task of achieving a just distribution of healthcare resources – namely, with covert healthcare rationing at the bedside. This new ethical obligation officially drives a stake into the heart of the classic doctor-patient relationship, and is an abject admission that the practice of medicine no longer constitutes a real profession.

Patients may not know the niceties of this New Age medical ethics – they may not be able to articulate the reasons they feel abandoned in their hour of need – but they certainly perceive its effects on their lives. Their anger is not unjustified.

The fallout for the medical profession from all these developments has landed disproportionately on the PCP. For most patients, their PCP is the face of the medical profession, and it is in the PCP’s office where they most often experience the changes.

PCP’s, of course, are no happier with this new reality than are their patients. The loss of their professional integrity and their ability to act as autonomous advocates for their patients has (far more than the steady ratcheting down of their pay) made primary care medicine an exquisitely unattractive proposition, both to current practitioners and to potential future PCPs.

Unfortunately, any notion that this damage to primary care medicine can be readily reversed is sadly mistaken. It would be a great mistake, for instance, to place the blame for all this on Obamacare. While Obamacare will indeed utterly rely on PCPs to do the dirty work of covert rationing, the basis for such reliance was established long ago by the medical profession itself, which voluntarily adopted their New Age ethics several years before anyone had ever heard of Barack Obama or his healthcare reforms.

So it should be no wonder that patients are pissed. And since that which is pissing them off is not going away anytime soon, and indeed is about to become greatly accelerated, PCPs must be alert to the likelihood that the lethal ideations entertained by a small but not insignificant proportion of American patients may soon find an outlet beyond mere daydreaming. The Johns Hopkins shooting ought to be a wake-up call to all doctors – but especially to the American PCP.

And so, as a public service, DrRich reluctantly suggests that perhaps it is time for PCPs to prepare to defend themselves in one of the few ways they have left to do so.

PCPs may have lost everything else, but to this point, at least, they still have the second amendment to rely on.

10 Responses to “Should PCPs Begin Packing Heat?”

  1. NotYourAverageJoe says:

    While good of you to illustrate the growing tension, it would have been more helpful, and a good deal more difficult, to elaborate (or perhaps simply re-emphasize) solutions which do not further militarize the doctor-patient relationship.

    • DrRich says:

      NYAJ,

      I have done so, and many times. The solutions I have offered pertain to taking whatever steps are necessary to re-instate the classic doctor-patient relationship. There are three avenues I have suggested for doing this. 1) Lobby physician organizations (or take over the leadership – by peaceful means, of course) to reverse the formal change these organizations have promulgated in medical ethics; 2) ignore New Age medical ethics altogether and make your own primary obligation the individual patient (unfortunately, the only way to do this, perhaps, is to drop out of the “system” altogether and establish a direct-pay practice model); and 3) black market healthcare. I have discussed all three of these in some detail in the past. This current post is addressed to physicians who find all three of these alternatives unattractive, and who had best, therefore, learn to defend themselves. It is not me saying this – it is the scientific data.

      Sorry.

      Rich

  2. Epoetker says:

    I suppose redirecting the rage to the local medical regulatory agency is misguided and unpracticable then? Haven’t heard of too many shootings at those places. A suicidal parson is a tragedy. A homicidal person, particularly an unclearly homicidal person, is an opportunity. Assuming you could isolate and unify the strain of people willing to go homicidal, would they be willing to hit, say, the main offices of WellPoint? Medicare? The IRS?

    Simply responding to angry patients with armed doctors is silly. Anger of the murderous variety must be directed and controlled for it to be of any use. And if doctors don’t effectively direct it, I’m sure certain official and unofficial ‘patient advocates’ will be happy to do the job, though they may have some different and unfortunately softer targets in mind.

    • DrRich says:

      Epoetker,

      Redirecting violent patients toward the regulators is certainly an interesting idea, but you mistake my purpose. Being not a fighter but a lover, I am actually trying to avoid violence altogether.

      That is, I do not encourage (or even envision) a series of shoot-outs (Old West-style) in doctors’ offices across America. Certainly not. Rather, I envision doctors offices everywhere posting signs saying, “Notice: Dr. Jones and his entire staff have concealed carry permits. Proceed with caution.” And perhaps, instead of decorating the office with attractive displays from drug companies, a poster or two from Smith & Wesson might serve a more useful purpose.

      I believe such friendly warnings might serve as a great deterrence to any violent intentions of one’s ever-growing collection of disgruntled patients.

      Rich

  3. Paul Sisk says:

    I guess I will die in the service of my brother. I get what you are saying and I am well aware of violence in healthcare. Thanks for the warning.

  4. tired dog says:

    Anyone, anywhere who has a need for self preservation tools should pack…just remember, when you’ve got just seconds the cops are minutes away.

  5. Pat H. says:

    I believe the physician that was the gun shot victim was a neurosurgeon.

    Naturally, as an operating room nurse by profession, I understand fully the drive towards physician shootings, I myself have felt those urges. I’ve always successfully resisted them, but one never knows when failure might occur.

  6. Six says:

    That is a fascinating post. As a retired police officer and firearms instructor, as well as a crime prevention specialist, I can find no fault in your logic.

    In fact, if you’re a PCP or other Doctor who is of the same mind, come on out to my place in Utah for some BBQ and quality trigger time. Ammo’s on you, adult beverages on me.

    • DrRich says:

      Six,

      Thanks for the invite. Next time I’m in the area I’ll look you up. One question: Do I actually have to hit something, when we’re out shooting, to get any BBQ? Or is the meat supply not dependent on my marksmanship?

      Rich

  7. Six says:

    BBQ regardless of scores but low shooter is relegated to clean up duties. Hey, I’ll take any excuse to cook meat with fire.

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