Paying Ode to My Patients

I’m writing this letter because I give a damn. About my patients. Since August of 2017, I have been a member of a patient/physician advocacy group, Physicians for Patient Protection(PPP). We formed in March 2016 out of concern for the number of patients we were seeing who had been grossly mismanaged by non-physician practitioners(NPPs) practicing medicine without a medical license. 

Put simply, NPPs are being hired to replace physicians. Why? Because they are cheaper. Won’t affect you if you are a member of the C-suite or if you are Oprah Winfrey. It will affect those who don’t have a choice. PPP believes everyone, regardless of their socioeconomic status, has the right to be seen by a physician, if they so choose. But many are not being given a choice. To fight this unconscionable practice, we have attended summits and conferences, written letters, spoken to legislators and various medical organizations, as well as submitted commentary to social media sites and others. Ad nauseum. It is frustrating to say the least. Advocacy is not easy, but it is necessary. 

Now I write to you, the public. To explain how most physicians arrived at this place called the “Art of Medicine”. With the hopes that you might understand why we physicians do what we do. For you. This letter represents my view alone.

College, our medical infancy, is where the fundamental knowledge of medicine begins. In the classroom. And the foundation must be rock solid; hence, our formal education must be tight and right. How is one to understand metabolic acidosis without understanding organic chemistry or biochemistry? How does one grasp the seriousness of angulated fractures and level of injury without some concept of physics and calculus? Medical school, our adolescence, builds on the foundation that was begun in college. It is this stage in which we begin to understand the basic pathophysiology of disease and receive the rudimentary education of medical care. It is where we are introduced to the complexities of the human body, the various mechanisms which cause disease and from whence our understanding to properly manage those disorders originates. Visualization is achieved through multiple video presentations, slides, books and other technological advances required to reinforce our knowledge. Repetition is very important. Why? So that our approach to medical management becomes second nature. Practice makes perfect…or damn near. At a defined point in medical school, we segue into the clinical aspect of medicine where we now begin to see what we have learned….in action. In real-time. Here we commence the steps of applying our knowledge to the art of medicine. Clinical correlation. Pediatrics, general surgery, obstetrics and gynecology, emergency medicine, internal medicine, family medicine, psychiatry, etc. All subsets of the human population and its ills. The clinical areas in which we are expected to apply the information we have acquired. But we are not yet ready to be released to practice on the public unsupervised. Common sense and our Hippocratic Oath dictates this. “Primum non nocere”. First do no harm. We must learn more and we must learn well. So we continue this ongoing, circadian, intense indoctrination. It is imperative that we are encompassed by this world and absorb this material, for our ultimate responsibility to the patient demands it. Eventually, our medical adolescence is over. Now we begin young adulthood: Residency. Here we decide on the medical specialty in which we will practice. And we progress to that home for the next 3-9 years. In this stage we sink or we swim. The challenges are massive. The expectations….incredibly high. But we want this. It is our calling. So we proceed and learn even more so that we may become proficient in our skills and confident in our decision-making. All under the magnificent tutelage of those who came before and understand the importance of what we do; our attending physicians. The depth of knowledge we must possess to appropriately manage those entrusted in our care is overwhelming. Mistakes will happen, but they must be minimalized. How does one guarantee this? Knowledge is the key. One must have an intricate understanding of what one is doing and why one is doing it. What is the intended or expected result? Will it benefit the patient or is the risk greater? What are the options? We educate the patients and make shared decisions. How does one teach these things? One doesn’t. To master such skills requires time and patience which enhances communication between us and our patients. The patients are our guides. We are the tools. Tools have to be honed to be of any good. Residency hones us. Once we reach maturity and our educators/mentors/leaders/supervisors have fulfilled their commitment, it is time to leave the nest. There is no shortcut to this long, arduous process. We have been trained exceptionally well. We are ready venture out and use this gift we have been given. This gift we have spent years developing. For you. Our patients. So that you would have the best. To accept anything less than what we have to give would be an abomination to the art of medicine.

You should want more for yourselves also. There is a reason the road to becoming a physician is laborious; our responsibility to you is not an option. Medicine is not an easy road by any stretch of the imagination. Who in their right mind would spend 11-17 years of their life being poor just to be rich? Who would sacrifice time with one’s family, working shifts so long there is no time to eat or even indulge in the release of bodily functions; be harassed by clipboard cops, who possess no medical background, advising one on how to handle his/her patients; get spit at, verbally and physically assaulted and demeaned by patients, yet still come to work everyday to take care of you and your loved ones? Trust me, it would have been a much easier to rob a bank and take my chances. And it certainly would have been more expeditious. Don’t insult us doctors by minimizing our commitment to you because of rhetoric by those who seek to demean and diminish our role. When one has a calling, there is no choice. And becoming a physician was ours.

Currently, there exists much disdain for doctors in the public for issues beyond our control. Don’t blame us. We are fighting for you, you just don’t know it. And we will continue to do so. Now you, the public, our patients, have a decision to make. You either want the best medical care or you don’t. It’s up to you. But don’t you dare say we physicians don’t care, because we do. For the journey we have taken, we have taken for you.

Natalie Newman MD

Dr. Natalie Newman is a residency-trained, board-certified emergency physician who has been practicing for over 20 years. She graduated from California State University in Sacramento, California with a degree in Biological Sciences. She then attended medical school at Case Western Reserve University in Cleveland, Ohio on an Army scholarship. As a graduating senior, Dr. Newman was presented with the Marjorie M. and Henry F. Saunders award for her compassionate care of patients within the family structure. After her graduation, she was accepted into the Emergency Medicine Residency at North Shore University Hospital in Manhasset, New York. Upon her graduation, Dr. Newman entered active duty service with the U.S. Army. Her first assignment was at Womack Army Medical Center in Fort Bragg, North Carolina. During her stint in the Army, Dr. Newman was deployed to Bosnia-Herzegovina(formerly Yugoslavia) where she was Chief of the Emergency Department at Eagle Base in Tuzla, Bosnia. She had the honor of serving under the command of Colonel Rhonda Cornum(now a retired brigadier general), a urologist, pilot and former prisoner-of-war during the Persian Gulf War. While in Bosnia, and as the only American female physician in the Balkans at that time, Dr. Newman was assigned as the official physician for Queen Noor of Jordan during a humanitarian visit to a local hospital in Bosnia. After her return home to the U.S., she was promoted to Major and completed the rest of her Army service at Fort Bragg. Dr. Newman subsequently returned to her home state of California. She has worked in rural facilities, community hospitals and trauma centers. She has also served as a ship physician for a major cruise line and also provided physician services at the Coachella/Stagecoach Festival in Indio, California for three years. Dr. Newman participates in public speaking engagements discussing the value of education, of which she is passionate. She continues to practice clinically as a traveling physician.

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4 Responses

  1. Jesse Lee Belville,PA-C says:

    YOU, Those who came before You , knelt before the Government, 1964, Medicare, medicade 1965 or so. AMA was against it. They LOST. With the US government growing tentacles, regulations, rules ,controlling Fees, for services The noose tightens. The rest is A Business Model. Make a better Business Model then
    POLITICS, and get all the Medical organizations nursing societies, Lab, Hospitals behind it . Elect congress critters, and Senators, maybe a President and sell your better Business Model..
    Medicine is a truely WONDERFUL, Fantastic PROFESSION, but it is a BUSINESS.
    I AM A Physician Assistant -Certified for 43 years. Yes they hired ME to be a CHEAP DOCTOR. I am a PA-C. I wear a name badge clearly telling everyone my name and Profession. When I Introduce myself I tell them I am Jesse Belville,PA-C. When they call me Doctor, I stop them Thank them for my Promotion and tell them I am not an MD or DO. I AM A PA-C. I have had a Supervising Physician at every location ,in every state I have practiced in. 2 of those Physicians took the time to Help educate Me ….in 43 years. When I started PA SCHOOL you needed 2000 hours of Patient care experience and could have no degree, or bachelors. Many early PA’s had an associates or bachelors. I had 3 years as a medic and 3 years as a nursing Tech as John Hopkins hospital. During PA school I worked nights,in an ER, went to school during day and sometimes slept more than 4 hours a day. Graduated in 76, went to North Carolina, and worked with an FP and a General Surgeon at a rural 50 bed hospital. 3 MD’s in town. Me on call 2 weeks out of 3 doing admits, daily rounds, discharges, codes in ER and on floor, sometimes assisting in Surgery. Wild Fantastic times . Todays PA school graduates Cannot do what I DID as a new PA-C EVEN WITH THEIR MASTERS DEGREE. More school less real world experience. Less confidence, Need lots of on job training in learning how to think like MD/DO method. To start getting good need 3 to 5 years experience. I am a PA-C I want to be part of the TEAM with MD As head of the team. I want to do 70 to 90% of what my Supervising MD/DO DOES. I want the routine stuff I want to improve access to Health Care for all. While my highly trained MD/DO handles the tough stuff. I want the practice to rotate visits,I see the patient one time and the Physician sees them the next time.
    I want to always be #2 with MD /DO as #1. Army PA’s motto is First, Do No Harm.They were just starting PA school in 1970 when I came back from 19 months in Vietnam. I extended my tour by 6 months cause I really liked being a Medic. Learned a lot. I am still a medic 50 years after that conflict.
    MEDICINE IS A BUSINESS MODEL. To change it You/ We must develop a better Business Model. Soon we may be forced too anyway.

    • Natalie Newman, MD says:

      I sincerely appreciate your sentiment as to the roles and scope of practice and specific role of physicians and yours as a physician assistant. They are distinct but symbiotic.

      Where we differ is in the belief that I have to develop a better business model. I do not subscribe to the current “business model” of medicine–there is no place for it. I do not and will never practice that way, it is incongruous with my oath. No one can force me to do anything I choose not to do. I practice under my own license. It is mine and I own it. No one else. No one has any say in how I use my license unless I do not meet the standard of care or I violate laws.

      I am not a participant in crowdthink and refuse to follow the status quo. Patients first. Always. F**k business.

  2. PW says:

    Sadly, the last true patient advocates, physicians are being marginalized.

  3. soccerdoc11 says:

    Eloquent and so very true.

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