How to be an Authentic Doctor #18: You Have to Care

Dave 3

“…for the secret of the care of the patient is in caring for the patient.” – Francis W. Peabody to Harvard students on October 21, 1925

Caring about your patient seems intuitive, right? You would think that all doctors display this human trait but I am not so sure. There it is. I am throwing it out there. Who wouldn’t care about an ill person sitting right in front of them needing their help?  Well, there are doctors like this and there are reasons for their lack of caring.  For one, doctors can get what is called “compassion fatigue” and they can’t seem to feel anything inside anymore. As per past entries in this series, there is no one really to talk to about this problem due to the risk of being reported to the board of medicine and so those doctors keep grinding until they snap out of it, quit or kill themselves. The medical profession is the culprit and it has beaten the life out of these good doctors. If this is you, then you know what I am talking about. Please get help.

Then there are the others. The ones that just don’t seem to care. No, not the ones who hold it inside because they are so thick skinned.  No, I am talking about the ones who never thought they had to care or don’t have the innate ability to care.  These people exist.  I once had a medical colleague who had this. He seemed soulless to me.  He would call in sick any time. He would cancel his week of patients at the last minute to paint his house then find out it was going to rain. Then he would put himself back in the schedule (after all those patients have been moved to the next week) and do nothing in the office but twiddle his thumbs because his appointment slots were empty. Come Friday he would cancel the next week of patients because the weather was going to better for painting his house and move all those patients.  This happened for any project he was doing at home.   There were so many other examples of this in the couple of years I worked for him that I knew it was something pathologic about him. In my opinion, unfortunately, there are a small percentage of doctors who are like this.  These are the ones who run pill mills, do unethical procedures, are shoddy practitioners and are legitimately sanctioned by the board.   These docs do need to move on.

Here is the problem, however. This job, in this healthcare climate, can make us all feel like we don’t care. We may feel we have compassion fatigue. Even worse, we may feel we don’t have the innate ability to care anymore like my ex-colleague. The positive spin to all of this is that you can fix the first problem. And if really you had the second problem, you would never be reading this in the first place. There is hope for you but that hope is dimming. With all the bogus metrics, quality indicators, suspect patient satisfaction scores and loss of control to administrators, you will teeter on the edge of not caring any more. I can guarantee that.  Don’t give up.  Instead, break free of the addiction to sucking at the teat of the government, the insurance companies and the hospitals and will you be a better doctor. You will be able to care for the patient again.


Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected]

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3 Responses

  1. SteveofCaley says:

    The 1927 JAMA article from Francis Peabody should be read, read and read again. Peabody was speaking out as part of the Humanist movement in medicine that opposed Flexner’s technocratic movement that came to dominate medicine.
    Peabody’s article may have held off the Technocratic movement for sixty years or so. But it prevailed. The Technocrats believe that the patient is a set of condition tensors, and medicine is simply analysis of the condition tensors to minimize the dimensionality of the condition space, which can be called diagnosis; and the intervention to minimize the length of the illness vector.
    If that sounds like absolute gibberish, it is but it isn’t. That’s what the soulless see the practice of medicine to be. But it is something that can be completely automated; it is a process that needs no physician, simply an overdeveloped adding machine with an attitude, an EMR, a medical algorithm.
    Like any tyrannical movement, resistance IS futile, and you WILL be assimilated:
    “As per past entries in this series, there is no one really to talk to about this problem due to the risk of being reported to the board of medicine and so those doctors keep grinding until they snap out of it, quit or kill themselves. The medical profession is the culprit and beat life out of these good doctors. If this is you then you know what I am talking about. Please get help.”
    The technocratic model has been accelerating over the last two decades, and is now going full-throttle. Does it make sense, does it work? The answer is simple – is medicine better now than it was twenty years ago?
    The formula in America now is: Obedience + patience = success. That formula does not heal the sick, although we are embarking on a senseless adventure to pretend that it will.
    All I can say is, cling to humanity. We ARE something other than an algorithm, and we shall remain so, no matter what Machine Medicine pretends that it can accomplish. But it means going against the prevailing tide. Embrace humanity; it is a rare commodity these days.

    • Doug Farrago says:

      Great points! Thank you.

    • Pat says:

      And the Technocrats found government force to be the perfect vehicle for their good works. Great reply Steve, you perfectly described the logical destination of modern medicine.

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