Doctor = Most miserable profession

[BarakzaiAbdali]

@BarakzaiAbdali your thoughts.

How Being a Doctor Became the Most Miserable Profession



9 of 10 doctors discourage others from joining the profession, and 300 physicians commit suicide every year. When did it get this bad?





By the end of this year, it’s estimated that 300 physicians will commit suicide. While depression amongst physicians is not new—a few years back, it was named the second-most suicidal occupation—the level of sheer unhappiness amongst physicians is on the rise.


Simply put, being a doctor has become a miserable and humiliating undertaking. Indeed, many doctors feel that America has declared war on physicians—and both physicians and patients are the losers.
Not surprisingly, many doctors want out. Medical students opt for high-paying specialties so they can retire as quickly as possible. Physician MBA programs—that promise doctors a way into management—are flourishing. The website known as the Drop-Out-Club—which hooks doctors up with jobs at hedge funds and venture capital firms—has a solid following. In fact, physicians are so bummed out that 9 out of 10 doctors would discourage anyone from entering the profession.
It’s hard for anyone outside the profession to understand just how rotten the job has become—and what bad news that is for America’s health care system. Perhaps that’s why author Malcolm Gladwell recently implied that to fix the healthcare crisis, the public needs to understand what it’s like to be a physician. Imagine, for things to get better for patients, they need to empathize with physicians—that’s a tall order in our noxious and decidedly un-empathetic times.
After all, the public sees ophthalmologists and radiologists making out like bandits and wonder why they should feel anything but scorn for such doctors—especially when Americans haven’t gotten a raise in decades. But being a primary care physician is not like being, say, a plastic surgeon—a profession that garners both respect and retirement savings. Given that primary care doctors do the work that no one else is willing to do, being a primary care physician is more like being a janitor—but without the social status or union protections.
Unfortunately, things are only getting worse for most doctors, especially those who still accept health insurance. Just processing the insurance forms costs $58 for every patient encounter, according to Dr. Stephen Schimpff, an internist and former CEO of University of Maryland Medical Center who is writing a book about the crisis in primary care. To make ends meet, physicians have had to increase the number of patients they see. The end result is that the average face-to-face clinic visit lasts about 12 minutes.
Neither patients nor doctors are happy about that. What worries many doctors, however, is that the Affordable Care Act has codified this broken system into law. While forcing everyone to buy health insurance, ACA might have mandated a uniform or streamlined claims procedure that would have gone a long way to improving access to care. As Malcolm Gladwell noted, “You don’t train someone for all of those years in [medicine]… and then have them run a claims processing operation for insurance companies.”

To make ends meet, physicians have had to increase the number of patients they see. The end result is that the average face-to-face clinic visit lasts about 12 minutes.

In fact, difficulty dealing with insurers has caused many physicians to close their practices and become employees. But for patients, seeing an employed doctor doesn’t give them more time with the doctor—since employed physicians also have high patient loads. “A panel size of 2,000 to 2,500 patients is too many,” says Dr. Schimpff. That’s the number of patients primary care doctors typically are forced to carry—and that means seeing 24 or more patients a day, and often these patients have 10 or more medical problems. As any seasoned physician knows, this is do-able, but it’s certainly not optimal.
Most patients have experienced the rushed clinic visit—and that’s where the breakdown in good medical care starts. “Doctors who are in a rush, don’t have the time to listen,” says Dr. Schimpff. “Often, patients get referred to specialists when the problem can be solved in the office visit.” It’s true that specialist referrals are on the rise, but the time crunch also causes doctors to rely on guidelines instead of personally tailoring medical care. Unfortunately, mindlessly following guidelines can result in bad outcomes.
Yet physicians have to go along, constantly trying to improve their “productivity” and patient satisfaction scores—or risk losing their jobs. Industry leaders are fixated on patient satisfaction, despite the fact that high scores are correlated with worse outcomes and higher costs. Indeed, trying to please whatever patient comes along destroys the integrity of our work. It’s a fact that doctors acquiesce to patient demands—for narcotics, X-rays, doctor’s notes—despite what survey advocates claim. And now that Medicare payments will be tied to patient satisfaction—this problem will get worse. Doctors need to have the ability to say no. If not, when patients go to see the doctor, they won’t actually have a physician—they’ll have a hostage.
But the primary care doctor doesn’t have the political power to say no to anything—so the “to-do” list continues to lengthen. A stunning and unmanageable number of forms—often illegible—show up daily on a physician’s desk needing to be signed. Reams of lab results, refill requests, emails, and callbacks pop up continually on the computer screen. Calls to plead with insurance companies are peppered throughout the day. Every decision carries with it an implied threat of malpractice litigation. Failing to attend to these things brings prompt disciplining or patient complaint. And mercilessly, all of these tasks have to be done on the exhausted doctor’s personal time.
Almost comically, the response of medical leadership—their solution— is to call for more physician testing. In fact, the American Board of Internal Medicine (ABIM)—in its own act of hostage-taking—has decided that in addition to being tested every ten years, doctors must comply with new, costly, "two year milestones." For many physicians, if they don't comply be the end of this month, the ABIM will advertise the doctor's "lack of compliance" on their website.

In an era when nurse practitioners and physician assistants have shown that they can provide excellent primary care, it’s nonsensical to raise the barriers for physicians to participate. In an era when you can call up guidelines on your smartphone, demanding more physician testing is a ludicrous and self-serving response.
It is tone deaf. It is punitive. It is wrong. And practicing doctors can’t do a damn thing about it. No wonder doctors are suicidal. No wonder young doctors want nothing to do with primary care.
But what is a bit of a wonder is how things got this bad.

Certainly, the relentlessly negative press coverage of physicians sets the tone. “There’s a media narrative that blames physicians for things the doctor has no control over,” says Kevin Pho, MD, an internist with a popular blog where physicians often vent their frustrations. Indeed, in the popular press recently doctors have been held responsible for everything from the wheelchair-unfriendly furniture to lab fees for pap smears.
The meme is that doctors are getting away with something and need constant training, watching and regulating. With this in mind, it’s almost a reflex for policy makers to pile on the regulations. Regulating the physician is an easy sell because it is a fantasy—a Freudian fever dream—the wish to diminish, punish and control a disappointing parent, give him a report card, and tell him to wash his hands.
To be sure many people with good intentions are working toward solving the healthcare crisis. But the answers they’ve come up with are driving up costs and driving out doctors. Maybe it’s too much to ask for empathy, and maybe physician lives don’t matter to most people.
But for America’s health to be safeguarded, the wellbeing of America’s caretakers is going to have to start mattering to someone.

http://www.thedailybeast.com/article...rofession.html

I think Bannu Mazdigar is correct about needing to examine nuances.
The article writer is Daniela Drake. Here is some key information to know about her:

"Daniela Drake, M.D., attended Wellesley College and received an MBA from Stanford University. She, along with Elizabeth Ford, authored the book “Smart Girls Marry Money.” A former McKinsey consultant, she is now a full-time primary care physician. Drake married (for love) and has reaped the consequences. The views expressed are her own."
http://blogs.reuters.com/great-debat...daniela-drake/
She offers us some unique insights and has a catharsis about the general feelings of the challenges facing primary care practitioners. Her career pathway is interesting in that she used to be a consultant in the financial industry and moved back into primary care.

Her own career pathway illustrates a crucial point - somewhere along the way she decided that her MBA either was not cutting it or she desired to get back in touch with her clinical skills set. The key point here is that she was able to quickly move from the financial sector and fall back on her MD. This would be unimaginable in most other careers - she basically proves the case in point that the MD gave her a leg up in her consultancy and allowed her some "strategic depth" (no pun intended, lol) to fall back into should her high fly life in the business sector not work out.
Regarding some of the more dramatic references in her piece - lets go to the next professions on the suicidal list in 2011. Finance workers, vets, and dentists are right behind physicians. Medscape physicians also make sure to remind readers about the skill of interpolating data:

http://www.medscape.com/viewarticle/805151
"For some of these professions, high suicide rates were explained by easy occupational access to a method of suicide."

That boils down to the fact that its easy these professionals to get ahold of some fatal doses of propofol, fentanyl, and midazolam and slip themselves away into "that gentle night"

Another important question is whether suicidality has any relationship with specific speciality. In the past some authors indicated psychiatrists were more likely to commit suicide.

My suspicion and sympathy with Dr. Drake is that her primary care practice may be busy enough yet suffering from the financial smackdowns of decreased compensation for visits and tests she orders.
She is absolutely correct that the primary care physician faces threats on numerous levels - from NPs, PAs, and others who are playing doctor to locals but I would caution that patients would have to feel comfortable getting care from a group of practitioners who failed a watered down version of a certification exam based on the clinically oriented exam all MDs have to pass to practice:

"Last fall, the National Board of Medical Examiners began offering the voluntary DNP test, based in part on Step 3 of the U.S. Medical Licensing Examination. Step 3 is the final stage in the physician testing series. In January, the Council for the Advancement of Comprehensive Care -- a nonprofit nursing group that contracted with the NBME to develop the exam -- announced the results of the first DNP certification test, with 50% of candidates receiving passing scores."
http://www.amednews.com/article/2009...n/306089978/1/
compare that with first time MD pass rates which is 97% - so if you prefer your final decision care from an NP or a PA - then so be it, but do not blame them when you get c. diff. from over prescription of antibiotics. Buyer beware.

What I can say is that she has every right to complain regarding the current atmosphere primary care providers face. She is correct about
1) The business model being imposed on PMDs to reach a reasonable break even and profit point
2) The cumbersome hits that being beholden to multiple parties (government, business, insurance, law system) takes on you
3) The thankless job of dealing with so many patients who will ignore your advice or not gain the benefit of an accurate assessment due to the limited interaction time available.

On the other hand, I would say that her thoughts, based on who she is and what she talks about is more applicable to primary care doctors then to the other specialties.

She mentions something about radiologists and opthalmologists making off like bandits. What she is alluding to is that other specialties are doing just fine - seeing as many patients as she is, with fewer of those pesky medicaid and medicare forms - with a better happiness index. The reason for this is that compensation packages are still pretty good for most of these people who often can hone in on an organ system specific to their training in a 15 min visit.

So now the kicker - lets get into the nitty gritty and away from Dr. Drake's catharsis. Here is a nice discussion on WebMD:

http://www.webmd.com/balance/news/20...est-healthiest

"The least happy doctors are a three-way tie between neurologists, gastroenterologists, and internal medicine doctors. They rated their happiness at 3.88 -- hardly unhappy, but trailing the pack."
and

"That's still pretty happy. Why? A clue comes from doctors' financial report card: 61% of those in practice say they have adequate or more than adequate savings for their stage of life, while only 7% say they are in unmanageable debt. And it isn't all about money. More than 4 out of 5 doctors say they are religious, and more than 40% actively practice or attend religious services."

So all in all, I would say that Dr. Drake has published an important opinion piece. We have to take into account that

1) Her initial profession was in the business world where she likely lived the relatively easy life of a consultant (relative to a primary care doctor)
2) For some reason she returned to primary care medicine and does accurately discuss some of the challenges facing primary care medicine
3) The other specialties are not so glum and are doing pretty well for themselves.

I would end by saying that when you look at the test scores and distributions of who goes into primary care vs the specialties she bemoans (radiology and optho for instance) - some of this is self inflicted.
Primary Care Professionals can be some of the brightest and down to earth people, but by the USMLE test scores and competitiveness of residency, they rank at the bottom. The joke is that the the USMLE 1 determines whether you do dermatology or primary care alluding to the fact that low test scorers end up in the latter profession.

[Admin Khan]

I think Bannu Mazdigar is correct about needing to examine nuances.
The article writer is Daniela Drake. Here is some key information to know about her:

"Daniela Drake, M.D., attended Wellesley College and received an MBA from Stanford University. She, along with Elizabeth Ford, authored the book “Smart Girls Marry Money.” A former McKinsey consultant, she is now a full-time primary care physician. Drake married (for love) and has reaped the consequences. The views expressed are her own."
http://blogs.reuters.com/great-debat...daniela-drake/
She offers us some unique insights and has a catharsis about the general feelings of the challenges facing primary care practitioners. Her career pathway is interesting in that she used to be a consultant in the financial industry and moved back into primary care.

Her own career pathway illustrates a crucial point - somewhere along the way she decided that her MBA either was not cutting it or she desired to get back in touch with her clinical skills set. The key point here is that she was able to quickly move from the financial sector and fall back on her MD. This would be unimaginable in most other careers - she basically proves the case in point that the MD gave her a leg up in her consultancy and allowed her some "strategic depth" (no pun intended, lol) to fall back into should her high fly life in the business sector not work out.
Regarding some of the more dramatic references in her piece - lets go to the next professions on the suicidal list in 2011. Finance workers, vets, and dentists are right behind physicians. Medscape physicians also make sure to remind readers about the skill of interpolating data:

http://www.medscape.com/viewarticle/805151
"For some of these professions, high suicide rates were explained by easy occupational access to a method of suicide."

That boils down to the fact that its easy these professionals to get ahold of some fatal doses of propofol, fentanyl, and midazolam and slip themselves away into "that gentle night"

Another important question is whether suicidality has any relationship with specific speciality. In the past some authors indicated psychiatrists were more likely to commit suicide.

My suspicion and sympathy with Dr. Drake is that her primary care practice may be busy enough yet suffering from the financial smackdowns of decreased compensation for visits and tests she orders.
She is absolutely correct that the primary care physician faces threats on numerous levels - from NPs, PAs, and others who are playing doctor to locals but I would caution that patients would have to feel comfortable getting care from a group of practitioners who failed a watered down version of a certification exam based on the clinically oriented exam all MDs have to pass to practice:

"Last fall, the National Board of Medical Examiners began offering the voluntary DNP test, based in part on Step 3 of the U.S. Medical Licensing Examination. Step 3 is the final stage in the physician testing series. In January, the Council for the Advancement of Comprehensive Care -- a nonprofit nursing group that contracted with the NBME to develop the exam -- announced the results of the first DNP certification test, with 50% of candidates receiving passing scores."
http://www.amednews.com/article/2009...n/306089978/1/
compare that with first time MD pass rates which is 97% - so if you prefer your final decision care from an NP or a PA - then so be it, but do not blame them when you get c. diff. from over prescription of antibiotics. Buyer beware.

What I can say is that she has every right to complain regarding the current atmosphere primary care providers face. She is correct about
1) The business model being imposed on PMDs to reach a reasonable break even and profit point
2) The cumbersome hits that being beholden to multiple parties (government, business, insurance, law system) takes on you
3) The thankless job of dealing with so many patients who will ignore your advice or not gain the benefit of an accurate assessment due to the limited interaction time available.

On the other hand, I would say that her thoughts, based on who she is and what she talks about is more applicable to primary care doctors then to the other specialties.

She mentions something about radiologists and opthalmologists making off like bandits. What she is alluding to is that other specialties are doing just fine - seeing as many patients as she is, with fewer of those pesky medicaid and medicare forms - with a better happiness index. The reason for this is that compensation packages are still pretty good for most of these people who often can hone in on an organ system specific to their training in a 15 min visit.

So now the kicker - lets get into the nitty gritty and away from Dr. Drake's catharsis. Here is a nice discussion on WebMD:

http://www.webmd.com/balance/news/20...est-healthiest

"The least happy doctors are a three-way tie between neurologists, gastroenterologists, and internal medicine doctors. They rated their happiness at 3.88 -- hardly unhappy, but trailing the pack."
and

"That's still pretty happy. Why? A clue comes from doctors' financial report card: 61% of those in practice say they have adequate or more than adequate savings for their stage of life, while only 7% say they are in unmanageable debt. And it isn't all about money. More than 4 out of 5 doctors say they are religious, and more than 40% actively practice or attend religious services."

So all in all, I would say that Dr. Drake has published an important opinion piece. We have to take into account that

1) Her initial profession was in the business world where she likely lived the relatively easy life of a consultant (relative to a primary care doctor)
2) For some reason she returned to primary care medicine and does accurately discuss some of the challenges facing primary care medicine
3) The other specialties are not so glum and are doing pretty well for themselves.

I would end by saying that when you look at the test scores and distributions of who goes into primary care vs the specialties she bemoans (radiology and optho for instance) - some of this is self inflicted.
Primary Care Professionals can be some of the brightest and down to earth people, but by the USMLE test scores and competitiveness of residency, they rank at the bottom. The joke is that the the USMLE 1 determines whether you do dermatology or primary care alluding to the fact that low test scorers end up in the latter profession.

Can you join those other specialties right out of medical school, or does that require more education? Can you perhaps explain the process of medical school for folks who are interested. 4 year undergrad + med school + (x) == to what specialty, etc. I found this article on the front page of reddit, and as per reddit, each post on the front page is viewed by 500,000 to 1 million people, so your response might be appreciated by many.

Thanks for your insight graana.

[BarakzaiAbdali]

I wonder what our pf scholar/doctor barakzai thinks about this article.

Wrora,

Refer to my above post. Dr. Drake has some valid viewpoints but I think they are reflected by her own career trajectory from a non practicing physician in the business world (using her MBA) suddenly thrown into the realm of real bedside clinical practice and care.

I would say her view reflects some of what primary care practitioners face but the important caveats are to avoid comparing her viewpoints with that of a primary care doctor who entered his or her field from the get go and adapted with the changing system.

As a specialist I would say that some of what she deals with as a full spectrum care nonspecialist (primary care physician) are mitigated by honing your practice in on the organ system and disease states you like to study the most (i.e. specializing).

Her usual patient looks like this:

67 year old morbidly obese female with knee pain, back pain, anemia, diabetes, hypertension, probable coronary artery disease who comes in with

back pain, shortness of breath, weight gain, uncontrolled blood sugar, uncontrolled blood pressure etc.

What does a physician do here? Which problem does he focus in on? How does he differentiate what is most important (the patients weight being the underlying issue of all the others) from focusing in on a side issue (back pain) that the patient thinks is most important.

My usual day looks like this:

A patient comes in short of breath and feels his heart racing - I get an EKG and I see an abnormal rhythm, and I immediately start to treat the patient based on what else I know about them.

[randolph85]

Wrora,

Refer to my above post. Dr. Drake has some valid viewpoints but I think they are reflected by her own career trajectory from a non practicing physician in the business world (using her MBA) suddenly thrown into the realm of real bedside clinical practice and care.

I would say her view reflects some of what primary care practitioners face but the important caveats are to avoid comparing her viewpoints with that of a primary care doctor who entered his or her field from the get go and adapted with the changing system.

As a specialist I would say that some of what she deals with as a full spectrum care nonspecialist (primary care physician) are mitigated by honing your practice in on the organ system and disease states you like to study the most (i.e. specializing).

Her usual patient looks like this:

67 year old morbidly obese female with knee pain, back pain, anemia, diabetes, hypertension, probable coronary artery disease who comes in with

back pain, shortness of breath, weight gain, uncontrolled blood sugar, uncontrolled blood pressure etc.

What does a physician do here? Which problem does he focus in on? How does he differentiate what is most important (the patients weight being the underlying issue of all the others) from focusing in on a side issue (back pain) that the patient thinks is most important.

My usual day looks like this:

A patient comes in short of breath and feels his heart racing - I get an EKG and I see an abnormal rhythm, and I immediately start to treat the patient based on what else I know about them.

thanks for the response.

what is your specialization?

i am not stranger to hospitals and doctors due to my type 1 diabetes and other related problems. a few years ago, i became a fatty due to bad habbits and was close to 230 pounds, before this i was always skinny. good news is that a year and a half ago i lost all the weight through a low calorie diet (500 less than my average cal intake daily = 1 pound loss a week) but i was surprised at how clueless some of the doctors i talked to were. i was hearing nonsense about low fat diets, low carb, and "bro science" of the sort, none of which mentioned calories. calories which i cut before to lose fat and now increase to gain muscle, easy science i can calculate and see results either way.

do you have experience with doctors who give advice when they have no business giving such junk advice?

luckily today i have a good indian doctor who seems to know his stuff and that i trust.

[Karachi]

it depends, I think if you have your own small clinic as a family doctor, then it is good. I have few cousins who have their own clinics, they probably make over $200,000 a year and only work like 4-5 hours a day. They seem pretty happy. Of course I am talking about here in Canada, not sure about other countries

Even in UAE/Saudi Arabia Doctors trained from the West make a lot of money and get so many benefits

The reason neurologists, gastroenterologists, and internal medicine doctors might be unhappy is because in these fields, it is usually very difficult to diagnose and treat patients, doctors may spend years treating one individual and this can be really frustrating.

[BarakzaiAbdali]

thanks for the response.

what is your specialization?

i am not stranger to hospitals and doctors due to my type 1 diabetes and other related problems. a few years ago, i became a fatty due to bad habbits and was close to 230 pounds, before this i was always skinny. good news is that a year and a half ago i lost all the weight through a low calorie diet (500 less than my average cal intake daily = 1 pound loss a week) but i was surprised at how clueless some of the doctors i talked to were. i was hearing nonsense about low fat diets, low carb, and "bro science" of the sort, none of which mentioned calories. calories which i cut before to lose fat and now increase to gain muscle, easy science i can calculate and see results either way.

do you have experience with doctors who give advice when they have no business giving such junk advice?

luckily today i have a good indian doctor who seems to know his stuff and that i trust.

Your post troubles me - opened up some fresh wounds - my child, a 2 year old was just recently diagnosed with diabetes mellitus type 1. Hence, the hiatus.

It was a shock at first, but thank God I was well trained in residency to manage her (though it was difficult to translate the adult science into the child - hence my greater respect for pediatricians now). If nothing else medicine teaches you to compartmentalize your own emotions and rise to the occasion.

I was astounded because DM1 is more common amongst Caucasians and not seen amongst Afghans. But my conclusion on this after some thought is that these children probably die young in the village with most assuming they died from some unknown illness.

I am a heart specialist - a cardiologist with an emphasis on heart transplant and end stage heart failure.

Regarding your question about the dieting, this is an artifact of our training.

What has happened is that the body of knowledge and role of a physician has changed tremendously, even in training.

It used to be that physicians had time to draw their own blood, even run their own lab tests - but now hospital systems absorb hundreds of admissions daily, with residents and fellows being an important component of that team. The emphasis now falls on quickly diagnosing the ailment and coming up with a treatment plan.

On average in the hospital setting on a day to day basis I might see 30 some patients.

Dieticians are now an essential component of the medical care team, and they design the carbs and protein components to everything from tube feeds to a diabetic diet.

What I could recommend is that you get a good ACADEMIC endocrinologist. That means you get plugged into care at your local major university where they have a fellow and attending joint clinic. Often, these endocrinology teams have adjunctive components are some endocrine folks are more aware of these sub component diet trends etc.

Kidney and liver specialists also deal somewhat with the diet issues since protein loads affect their patient's disease states.

Anyone else in your family with DM1?

[randolph85]

Your post troubles me - opened up some fresh wounds - my child, a 2 year old was just recently diagnosed with diabetes mellitus type 1. Hence, the hiatus.

It was a shock at first, but thank God I was well trained in residency to manage her (though it was difficult to translate the adult science into the child - hence my greater respect for pediatricians now). If nothing else medicine teaches you to compartmentalize your own emotions and rise to the occasion.

I was astounded because DM1 is more common amongst Caucasians and not seen amongst Afghans. But my conclusion on this after some thought is that these children probably die young in the village with most assuming they died from some unknown illness.

I am a heart specialist - a cardiologist with an emphasis on heart transplant and end stage heart failure.

Regarding your question about the dieting, this is an artifact of our training.

What has happened is that the body of knowledge and role of a physician has changed tremendously, even in training.

It used to be that physicians had time to draw their own blood, even run their own lab tests - but now hospital systems absorb hundreds of admissions daily, with residents and fellows being an important component of that team. The emphasis now falls on quickly diagnosing the ailment and coming up with a treatment plan.

On average in the hospital setting on a day to day basis I might see 30 some patients.

Dieticians are now an essential component of the medical care team, and they design the carbs and protein components to everything from tube feeds to a diabetic diet.

What I could recommend is that you get a good ACADEMIC endocrinologist. That means you get plugged into care at your local major university where they have a fellow and attending joint clinic. Often, these endocrinology teams have adjunctive components are some endocrine folks are more aware of these sub component diet trends etc.

Kidney and liver specialists also deal somewhat with the diet issues since protein loads affect their patient's disease states.

Anyone else in your family with DM1?

i am sorry about your daughter but Alhamdulilah she has a father like you to take care of business.

its interesting that you mention children dying in the villages of afghanistan or even in the cities without so much as a medical explanation. that is because there is no one in my family present or known past who had/have type 1 diabetes. being that its said its a genetic disease and there must be some family link, i am assuming that there must of been family members way back who died prematurely of the condition and society being what it was didn't investigate the matter further.

[BarakzaiAbdali]

i am sorry about your daughter but Alhamdulilah she has a father like you to take care of business.

its interesting that you mention children dying in the villages of afghanistan or even in the cities without so much as a medical explanation. that is because there is no one in my family present or known past who had/have type 1 diabetes. being that its said its a genetic disease and there must be some family link, i am assuming that there must of been family members way back who died prematurely of the condition and society being what it was didn't investigate the matter further.

That is what I assume as well. There are some unknowns regarding DM1 for now - there appears to be some urban exposure connection at least in the US where certain locations have higher incidence.

How old were you when you were diagnosed?

I think some folks at Mayo Clinic are developing the closed loop pump - which may make life a lot easier on DM1 (and insulin dep DM2) patients.

[BarakzaiAbdali]

In Indo-Afg-Pak, everyone wants to become a doctor, which is not a healthy trend. There should long have been diversification of the labor market in terms of demand for skills and jobs, which of course also depends on the overall shape of economy and level of human development achieved by these countries.

I believe what the developing countries need is more engineers and graduates and specialists of pure and applied sciences.

I would posit that this is a consequence of our being members of that vibrant family known as the animal kingdom.... the bee finds the flower, the ant seeks out the crumb and so on and so forth.

The immigrant experience plays a major role in this push. I refer you to the biography of the nobel laureate Roald Hoffman of organic chemistry fame:

http://science.howstuffworks.com/dictionary/famous-scientists/chemists/roald-hoffmann-info.htm

"Roald Hoffmann entered Columbia University in New York City in 1955. He planned to study medicine and become a doctor."

When I read his autobio years ago, he talked about the fact that the new jewish immigrant population urged their children into medicine for some of the same reasons these immigrant groups push their kids into it. He talked about how his mother and father tried to force him along this way and that many of his bright colleagues ended up in Columbia medicine for the aforementioned reason. He decided to be a maverick.

Immigrants are acutely aware of instability back home and my assumption is that besides wealth generation, their secondary focus falls on being somewhat risk averse and finding constancy.

In this way, this wave of Hindu and Muslim as well as Chinese immigrants were often gifted engineers from their homelands. They did what the jews did and sought constancy in a profession with some respect.

What they found in their gatherings were that they had to chase jobs from city to city and might have a nice job one year and be subject to economic woes by being laid off the next. They recognized that physicians, while not making a super salary immediately were rarely if ever unemployed and could easily transfer into a new profession within medicine if challenged in their own field.

Eventually as the immigrant jews got a footing, their risk taking became more common and circumstances forced them to branch out and diversify. My guess is that the same phenomena will happen with the other immigrant populations with due time.

Basically what will happen is that Pashtun Hoffman's will break apart from the rest as resources and a firm footing occur in the rest of the families.

[BarakzaiAbdali]

Admin is correct about one important thing though -
The Indo Pak and Afghan perception is derived from a local experience. How this happens is that a bunch of these guys get together and see a trend, or what they think is a trend. Often, these physicians are private practice folks and are making a pretty penny. Some of them earn respect in religious circles because they provide a constant source of funding for the masjid.

What the observers see is the physician on their down time. They don't see the years of painstaking training, the amount of forcibly learned savvy it takes to learn that human touch allowing the physician patient bond to flourish (i.e. my patients are people not dollar signs), the trainee time away from the family, etc.

They dont see the patience of having to learn under a hirarchy where the attending is like a high priest whose every order is to be executed. They do not recognize the sabr required to patiently explain a concept to 4 family members for an hour while their loved one is dying in a critical care unit. They dont see the sweat and the energy needed to execute a 3 hour radial artery access case in a patient with tons of bypass grafts and horrible disease.

I think Afghans, Chinese, Pakistanis, and Indians are very capable of excellent care but they need to get exposure and see the life of a young trainee and understand what they are getting into.

Yes, attending life is a lot better since you give the orders and have more time to do things, but the road there is lined with sweat and tears.

My colleague cardiac fellows and I that trained together spent more time together than we did with our respective families. We bonded in important ways and found life long friendships... we vented to each other about unnecessary testing and the cost of care, etc etc; when one of us was getting slammed with work we knew to be there for our colleague and function as a unit.

This is the life that these kids must know they are pursuing. They should spend a week with a first year medical or surgical intern on a difficult rotation and see that side of it that their parents dont see. Otherwise, I have so much confidence in our people that I urge them on in whatever aspect of medicine they seek to train in.

[کیش]

being a doctor is good for Muslims as oppose to the finance field is that in the latter the only way to get a job is through networking. and the networking events all have wine, and if you dont drink you will be look down upon and will be deemed untrustworthy, antisocial and introverted.

i don't care or judge, but all the Muslims i know who work in investment banks drink with their co-workers.

[randolph85]

That is what I assume as well. There are some unknowns regarding DM1 for now - there appears to be some urban exposure connection at least in the US where certain locations have higher incidence.

How old were you when you were diagnosed?

I think some folks at Mayo Clinic are developing the closed loop pump - which may make life a lot easier on DM1 (and insulin dep DM2) patients.

i was 18 when i was diagnosed, almost 11 years now. i am not holding my breath for a cure because that is not happening any time soon, but yeah these new pumps with advanced algorithms that detect blood sugar levels in real time is something to look forward to.

[BarakzaiAbdali]

i was 18 when i was diagnosed, almost 11 years now. i am not holding my breath for a cure because that is not happening any time soon, but yeah these new pumps with advanced algorithms that detect blood sugar levels in real time is something to look forward to.

Randolph if you are not on a statin, you should consider having your physician start you on one. Its one of the few medications we have potentially for primary prevention for protecting those coronary and brain arteries.

This would be more so the case if you have immediate family members with heart disease.

Irrespective of that diabetes is a risk factor.

[BarakzaiAbdali]

being a doctor is good for Muslims as oppose to the finance field is that in the latter the only way to get a job is through networking. and the networking events all have wine, and if you dont drink you will be look down upon and will be deemed untrustworthy, antisocial and introverted.

i don't care or judge, but all the Muslims i know who work in investment banks drink with their co-workers.

I agree with this. Besides in your training period, or if you stay in academia, you are for the most part your own boss.

[کیش]

Randolph if you are not on a statin, you should consider having your physician start you on one. Its one of the few medications we have potentially for primary prevention for protecting those coronary and brain arteries.

This would be more so the case if you have immediate family members with heart disease.

Irrespective of that diabetes is a risk factor.

aren't statins, like crestor, zocor, and provachol used, for lipid metabolism?

Would Metformin or enalapril/lisinopril and/or Glucovance be good for treating type 1