Just When I Thought I Was Out…They Pull Me Back In

Over the past few days there has been a lot of attention on me.  I am not really fazed.  It’s not like I haven’t been in trouble before.  Heck, Cigna once tried to put pressure on my hospital to get me fired. These things come and go.  What I put out there, however, is NOT for shock sake to get myself attention.  I really truly am bothered by the direction our healthcare system has taken and what the organizations that were supposed to represent us have done about it.  I think this is summarized in this really nice article written about the AAFP and me here.

I wanted to let things cool down but then I go ahead and read this article in the AAFP called Being a Family Physician Requires ‘Courageous’ Commitment.

To be honest, it’s not my fault because the title got me sucked in. Pure AAFP clickbait. Unfortunately, I read the whole thing and now I am unable to eat.  A little vomit actually came up.

Here are the highlights:

  • The author, Greg LeRoy MD, on the board of directors of the AAFP,  talks about seeing your own blind spots and having commitment (what the author calls aroha).
  • He talks about going back to your medical school application personal statement where most people wrote how they wanted to make a difference in other’s lives.
  • “Unlike any other medical specialty, the intellectual bedrock of family medicine is the concept of establishing aroha with the patient’s entire family and the population health dynamic in which they exist.”
  • “We see excitement in the eyes of our residents and students who attend the AAFP’s National Conference of Family Medicine Residents and Medical Students. Each year, attendance grows as word spreads about the wealth of career- and life-enhancing opportunities available at this event.”
  • “The excitement that once brightly shined within your spirit continues to be fueled by aroha. Do not allow it to prematurely be extinguished by the darkness of professional burnout. Instead refocus it to illuminate your own professional blind spots and to reveal grander opportunities for the future.”

And this is why I can’t stop poking fun at them.  This guy thinks we family doctors in the trenches don’t have commitment? We spent over a decade of our lives in training and gave away our youth for this profession!  That excitement he sees in medical students’ and residents’ eyes is being extinguished by a system that the AAFP supported the whole way.

Do not let it prematurely be “extinguished by the darkness of professional burnout”?  Now he is giving guilt to those docs suffering on the front lines in medicine who have to grind through AAFP supported metrics, codes, etc.  Dr. LeRoy, these docs are just trying to survive.  Your “aroha” speech is not going to save them.  Only change will.  You should have mentioned DPC because that is what you are really talking about.

Now the AAFP is all about burnout.  Hey, AAFP, you had $61 million dollars in net profit (assets) in your last reported tax statement.  How about putting on your burnout conferences for free?  Yeah, I didn’t think so. But instead you can just have your people keep following this blog and to “watch” me.  That’s right, Shawn, I saw that you signed up.  I hope you enjoy my stuff.

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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] 

  6 comments for “Just When I Thought I Was Out…They Pull Me Back In

  1. Mamadoc
    January 17, 2018 at 9:12 pm

    Just another crock. And it would be “brightly shone,” not “brightly shined.” And what in thunder is a ‘personal statement’ on a medical school application? All I remember is they gave us an MMPI.

  2. Pat
    January 15, 2018 at 11:08 pm

    Yet another pretentious doc, spraying his own (perceived) self-importance around, using guilt to push assimilation. As a patient, I would not want to see this jerk as my physician, nor any who would buy his socially conscious garbage.

  3. SP
    January 15, 2018 at 1:28 pm

    Go, Doug, Go! Get Them!
    See How they Run. They can’t hide.
    Burnout IS their fault….

    Thought, I’d contribute a Haiku to summarize your story. Be the knight in shining armor!

  4. Steve O'
    January 15, 2018 at 1:00 pm

    In the essay, LeRoy co-opts the Maori word “AROHA.” I think he means “AROMA” especially its synonyms. “…malodor, stench, reek, and stink are used specifically to describe unpleasant odor.” (From Wikipedia, the Book of My People.)
    Edward Te Rangihiwinui (Hiwi) Tauroa CMG . The abbreviation means “Companion Of The Most Distinguished Order of Saint Michael and Saint George,” to which he was nominated in 1994.
    This Edward fellow is not a barefoot apostle. I think it is presumptuous to appropriate this Maori word in the service of vulgar American propaganda, no matter whether Sir Edward (Hiwi) would approve.
    I find it condescending and presumptuous to use foreign words, with implications that they have mystical alien meanings, when there are good and solid English nouns which convey meaning without the atmosphere of jargon and woo.
    Gary LeRoy considers and refutes the principle of “Aroha” in his essay on Being a Family Physician. The principle is nearly universal. The term seems to mean loyalty and acceptance in a small social sphere. There is no healthy group of human beings across the globe which does not cherish this social element among family and friends.
    Gary then warns of the lethality of AROHA. “The burnout we experience in primary care is in part due to the enduring flame burning within us that seeks constant verification that we are making a difference.” That is a breathtaking sentence, a true skater’s leap of bullshit adeptly performed.
    People do not burn out in primary care from AROHA. They burn out from being constantly f*cked over, treated like machines, treated like sub-humans. No doubt the Maori people of New Zealand, who were treated like sub-humans by the white European settlers, can identify, and I doubt they referred to the Europeans as bringing AROHA. The rebels were subdued, as in every other war of settlement. We might think today of how universally thin the veneer of human conscience can become in every people and culture.
    The foreign languages we should be using to talk of modern American medicine are not those of brown and sunny Oceania. These concepts are purely Prussian; Prussia and the oppressive totalitarian states like it.
    Gary LeRoy should be say Lebendsezierung. It means “victim” in a particular sense, in German. A character from Arthur Koestler’s novel Darkness at Noon stated:
    There are only two conceptions of human ethics and they are at opposite poles.
    One of them is Christian and humane, declares the individual to be sacrosanct and asserts that the rules of arithmetic are not to be applied to human units.
    The other starts from the basic principle that a collective aim justifies all means, and not only allows, but demands, that the individual should in every way be subordinated and sacrificed to the community which may dispose of it as an experimentation rabbit or a sacrificial lamb. The first conception could be called anti-vivisection morality, the second, vivisection (Lebendsezierung) morality.
    “AROHA” clearly represents the first society, and belies the need for it to be Christian, to be humane. The society of traditional American corporate practice, for which LeRoy is pimping, really constitutes the latter. He tells us that doctors burn out, drop out and fly out of tall buildings and off bridges because of the “enduring flame burning within us.” What he writes is a statement of morality; just not a very good morality.

    • Perry
      January 17, 2018 at 12:23 pm

      I’m glad you clarified that. I thought he just misspelled “aloha”. Same concept though.

  5. Sir Lance-a-lot
    January 15, 2018 at 7:37 am

    First come the stealth-watchers following you on line, then come the phony Yelp and similar reviews, which you can only get taken down if you pay extortion money.

    If the AAFP is immature and over-sensitive enough to do one, do you doubt that sooner or later they’ll do the other? Also, a private investigator “secret shopper” is not out of the question (looking for some politically-incorrect statement or action that would violate your medical board’s lengthy “professionalism” rules).

    Keep an eye on your on line reviews. You’ll know when they do it. The sleazier review sites may even solicit you for extortion money.

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