6 Terrifying Reasons Why Doctors Sometimes Lose It
Doctors are people, too. Sometimes that means they make mistakes. Sometimes that means you need to cut them a little slack after a hard day. Sometimes that means they just go plain ol' nuts: They attack Uber drivers, become serial killers, and sexually assault women. Y'know, like a bunch of nuts. Pure fringe cases? Maybe. But then why are physicians also twice as likely to kill themselves? What's actually going on here? Cracked sat down with our favorite neurosurgeon, Daniel, and tried to find a polite way to ask: "What's your guys' damage, anyway?"
The Screening Process Is Hilariously Light
Becoming a neurosurgeon is a 15-year process, from undergrad to residency training. Imagine investing that much time only to find out you vigorously suck at your job. It happens, and if you subscribe to the "10,000 hours" theory, it kind of makes sense. Within the government-mandated work-hour restrictions, a new surgeon will only spend about 5,000 to 6,000 hours training over a seven-year period. Mastery is not attainable, so we shoot for competency.
That starts with the screening process. Every medical student finds out their residency on the same day. We call it match day, for obvious reasons (because of how many disappointed students turn to arson). Some specialties aren't very competitive, but neurosurgery sure is. Most years, there are about 170 slots for neurosurgery residents, nationwide. There are four or five hundred applicants. We determine who gets in based on interviews, since we can't actually have them perform brain surgery before they technically know how to do that, fun as it might be.
Yes, shockingly, selecting a surgeon based on an academic transcript and 15-minute interview is a fallible process. The best we can do is look for glaring red flags, and at least once a year we blackball someone who is clearly crazy. One year, there was a set of identical twins. They each spent the whole interview slamming the other. That is the reddest flag, and neither became neurosurgeons.
Some students try to increase their chances by doing an away-rotation at the hospital of their desired residency. They'll basically spend a month at our hospital trying to impress everybody, usually closing out with a lecture. One year a kid clicked open the wrong folder right before his lecture started and accidentally showed his porn preferences to the audience. We're talking hardcore anal. If he'd been a proctologist, that might have been forgivable...
Here's how Match Day works: On the hiring team, we interview candidates and submit our hiring preferences, and then a mysterious computer algorithm sorts through both those and the applicants' preferences, and jobs get assigned. Both the program and the applicant are then legally obliged to offer and accept the job. You may have noticed there's no time allotted there for a psychological profile, an evaluation of how they will fit into a team, or how they will respond to pressure.
One of my fellow surgery interns scored in the 99th percentile of every standardized test he took. On paper, he was the best surgeon you could possibly imagine. You'd expect him to match to Harvard. Everyone was excited when he matched to our program, because it looked like we might be getting a genius. But the first time we had a patient dying in the trauma bay, he cried for his mommy. I'm being literal, not figurative. He actually cried out for his mom while the rest of us rushed to save a patient.
We wound up firing him three years into his five-year residency. I hope he's out there in some lab curing cancer right now, but I really hope he's not in some ER dealing with actual injured people.
You Have To Literally (And Routinely) Kill To Get Fired
Once the wrong person makes it into a specialty, it's hard to get rid of them. Firing a resident was commonplace in the bygone days of god-like chairmen. Now, firing a resident is difficult, painful, and opens up their program up to lawsuits, because once you've spent a quarter of a million bucks on school, you'll probably fight for your career.
But firing a doctor doesn't just mean the doctor might sue you. Think about all your patients once they learn they were worked on by someone you now deem incompetent to practice medicine. Plus there just aren't many doctors; if we have two residents and fire one of them, there goes half our manpower for the year. Neurosurgery programs aren't like Subway; we can't just put up a "Help Wanted" sign and slap the "Brain Artist" label on the very next applicant.
Add all that together, and you wind up with hospitals that'll do anything not to fire a doctor for incompetence. How crazy can that get? I'll let Dallas, Texas answer that question: Back in 2013, one of their neurosurgeons was convicted of crippling four people and killing two more. He did such an aggressively terrible job on dozens more patients that he was charged with aggravated assault. We're talking cutting bone where there was no conceivable reason to, and (according to one bizarre email he sent) intentionally causing paralysis, chronic pain, and even death. Although other doctors complained to the hospital during his campaign of carnage, it took a lawsuit to remove him. And that surgeon trained in very reputable programs. We're talking about a doctor with credentials; not someone who bought a phony degree from Barbados University.
We had a pretty bad surgeon (though not at the horror-movie level) in our city, too. I wound up dealing with him tangentially, when one of his patients came to me for a second opinion. She'd had spine surgery, which included screws in certain parts of her bones to hold them together. She thought her surgery had gone well, because she had a copy of her X-rays after the fact -- and they did look great. But I decided to get another set of X-rays done, just to double-check. And when I got the second set back, it became clear that the X-rays she'd shown me were not her X-rays. He'd done as good a job fixing her spine as that roll of duct tape did in fixing your old Camry's engine block. All I could say was, "Hey look, this is what your X-rays show now. I have no idea how you got those other X-rays but here's what you have to do about it now."
He ended up getting run out of every hospital in town, but it was never a "firing." It was always a "mutual parting." He never lost medical privileges. He eventually moved out of state. While our town rid ourselves of the problem, some other state inherited it. That's not great.
Doctors Spend More Time Charting Than They Do Treating Patients
It's estimated that there are 10 administrators for every doctor in the United States. Add in greedy insurance companies, a revolving door of CEOs, and the always-fun teams of lawyers -- a lot of doctors feel bogged down by the wet mattress of bureaucracy they lug on their backs. It's not just idle whining -- doctors spend two hours "charting" for every one hour we spend treating patients.
There's an adage that hospitals drill into us: "The only thing that matters is what's listed in the chart." And yes, documentation is a necessary part of medicine. You want the nurse to know you removed a lightbulb from that guy's ass, because that info will save her a ton of time when he gets another bright idea. But most of the paperwork we do is for the benefit of insurance companies and lawyers, not patients.
One night, I got called to a "code" -- a term meaning a patient is coming down with a severe case of death -- so I ran to the room and saw the patient's team of nurses furiously typing on computers outside of the patient's room. They were resuscitating the chart more than the person.
That's how ingrained the thinking is -- that the most important thing is charting, not directly caring for the patient. I scolded them, we took care of the problem, and the patient ended up fine. I got written up for yelling. Thank god! More writing!
And if you don't have time for all your charting during the work day, well, you'll just have to spend hours working for free after your shift ends. There's a reason physician burnout is on the rise: only 41 percent of doctors are "happy" with their work-life balance. Do you want a burnt-out doctor?
Malpractice Is Actually Pretty Crazy
Doctors are at personal risk for malpractice charges, and it's not always just. One man cut off his hand because he believed it was possessed by the devil; he refused to let surgeons reattach it, then sued the hospital for not overriding his decision. A woman won nearly a million dollars in her suit against a doctor, claiming that a routine test robbed her of her psychic powers.
That case was later overturned on appeal; neither of those people got money out of the hospital. But the mere fact that these suits happen has a huge impact on doctors. See, malpractice law varies a lot state by state. Indiana happens to be one of the best ones for physicians. Compare it to Illinois: When I was in med school, there were 27 counties in Illinois that did not have an OB-GYN. Every single one in Indiana did, and that was because of malpractice laws.
Currently, Illinois has no cap on how much you can sue for in cases of malpractice. From 2004 to 2014, malpractice suits cost state hospitals over $180 million. Some of those suits were legitimate payouts for legitimate screw-ups, but the lack of a cap means even the legitimate cases can get blown out of proportion by lawyers eager for a big payday.
An example: When I was a resident, a guy came into the free clinic with chronic back pain. I told him we could fix his leg pain, but not his back pain. That was the extent of the care I gave. He was operated on, did well, and continued to have his chronic back pain. Finally someone else operated on him for that, but it didn't help. He sued, and said we didn't do enough to keep his back from falling apart. The case didn't go anywhere, because we'd done nothing wrong, but the legal process took four years. Every time I applied for admitting privileges to a new hospital, they'd ask if I had litigation pending, and because of that -- just that little involvement -- I had to say yes.
That feeling of always being under siege has a negative impact. When scientists bothered to ask doctors why they're so damned unhappy, fear of malpractice suits was the number-two reason, after dealing with insurance companies and their precious charting.
My malpractice insurance is about $30,000. That lets me perform cranial surgery in Indiana. In Chicago, I think it's in the $300-400,000 range. When I was new to medicine, there were certain parts of Illinois where no neurosurgeons actually had hospital privileges to perform cranial surgery. Patients would have to be flown to St. Louis, and there are people who died on that six-hour flight because no neurosurgeon wanted to pay the malpractice insurance to work in Illinois. Illinois is still one of the most expensive states to doctor in, because of its malpractice laws. And that means Illinoisans get fewer doctors.
There Just Plain Aren't Enough Doctors
Over the last few years, the number of active physicians has declined, while the number of old-ass people in need of doctorin' keeps right on rising. That leaves the rest of us under a lot of pressure. We have to fit more patients into less time, so we can spend that saved time charting, of course. This leads to cutting corners, and the extremely dubious ethics of operating on multiple people at once.
Remember that doctor United Airlines drop-kicked right off a flight? I can't speak to him as a professional (he sounds pretty shady), but his claim that he couldn't afford to miss appointments with his patients is pretty darn legitimate. If I was forced to delay a flight by a day, that could mean 25 people who need to reschedule after waiting three months just to talk with me. It's even worse if I have surgery that day. There is no more expensive real estate in any city than an operating room. It's about $6k an hour. Even San Francisco looks sane in comparison.
There Are About To Be Even Fewer Doctors
As a pediatric neurosurgeon, I rarely get called in to deliver good news. I may have to tell a parent about their child's horrible injury, or devastating brain tumor. And then there are the days I run across the worst of humanity: I've seen people torture their elderly parents to keep getting disability checks. I've seen a mom inject her own feces into her child to try to keep him sick (Munchausen syndrome by proxy). I don't know how you stay chipper after that.
Medical students experience less depression than their peers. Before their internships, only 3.9% of medical students suffer from depression. And yet one year after their internship, that number jumps to 25.7%. The stifling bureaucracy, crazy liability, and crap work-life balance quickly leads to burnout. Although doctors becoming killers, abusers, rapists, and raging drug addicts are outlier cases, physician suicide is nothing short of an epidemic.
The suicide rate of male physicians is three times that of the general population. For women in medicine, the risk is four to five times higher than their non-physician peers. This is an important issue to me, because I've personally been touched by a friend in medicine ending his own life. This guy was successful, tall, and good looking, with three beautiful kids. He was known throughout the country in his field, got what seemed like a promotion, and ... something must not have worked out. He killed himself. None of us will ever know why. But I bet most doctors have a similar story.
And all that suicide, all that depression, all those early retirements? They mean America is looking at a projected shortfall of up to 90,000 doctors by 2025.
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Note: this article has been edited to correct commentary on a study about depression among medical students, and medical interns.