Sunday, February 5, 1995

FISCAL FITNESS: A Day in a White Coat

Most people, at one time or another, have probably wondered what it's like to be a doctor. Recently, I had the opportunity to see firsthand part of what being a physician is like in today's health care system by participating in the Humboldt-Del Norte Medical Society's "mini-intern" program.

The purpose of the program, said Dr. Brian Dorman, president of the Humboldt-Del Norte Medical Society, is to give members of the public an "unfiltered view" of the medical profession. "We want people to see what we do and draw their own conclusions," he said.

He recognizes that each participant draws different conclusions because of varied training and experience. "Your conclusions as an economist would be different from those of someone with a different perspective," he told me.

The program was suggested to local medical societies by the California Medical Association (CMA). The Humboldt-Del Norte Medical Society has offered the program twice and plans to repeat it about every six months. So far, a total of 17 mini-interns have participated.

During my two days in the program, I spent time with physicians in four different medical specialties. I discovered there is no simple answer to the question, "What is it like to be a doctor?"

The first stage of the program is an orientation. The general nature and objectives of the program are summarized, as well as the importance of confidentiality. One physician explained that he does not discuss his patients even with his wife. Mini-intern participants are required to sign a statement agreeing strictly to respect patient confidentiality.

At the orientation, participants also are issued lab coats. It is surprising how the trappings of a profession make an impact. When I showed up at my first assignment the next morning, the staff thought I was a physician, even though they were expecting me.

Mini-intern participants accompany the physician as he goes about his regular activities. Before each appointment, the patient is asked permission to allow the observer in the room. I was surprised that during my two days, only one patient declined to give permission even though some of the ailments were rather personal in nature. On behalf of the other mini-interns and myself, I want to thank all those patients who participated. Without their cooperation the program would be greatly diminished.

My first morning was spent with Dr. Kim Bauriedel, a urologist. I arrived in his office before his first patient arrived and he gave me an overview of the kinds of activities he was expecting. He also showed me some of the things it's possible to detect in x-rays of kidneys. Later he showed me what he looks for under the microscope when looking at a urine sample. At about 9 a.m. the first patient arrived and for the next three hours it was basically perpetual motion from one patient to the next. Although certain aspects of each examination were similar, the patients had a wide range of ailments. It became quite obvious to me that a physician cannot take a cookie-cutter approach to his practice, even when he or she is a specialist.

Most of Dr. Bauriedel's patients are male, and the part of the anatomy that creates many of the problems he sees is the prostate. One of the patients he saw was about 60 and had his prostate removed because of a malignancy. His appointment was a regular follow-up exam. Besides the exam, the patient also had several questions concerning aftereffects of the surgery.

As was the case with the other physicians, I got the impression that besides being a physician, Dr. Bauriedel is a teacher at heart. He seemed to enjoy explaining things to me, and certainly to his patients.

Furthermore, he was not the least bit reticent to tell his patients what he did not know. He did not overpromise. He conveyed optimism and hope regarding prescribed treatments without implying certainty of the outcome. He enlisted the patient in the decision making process.

The afternoon of my first day was spent in the radiology department of General Hospital. The two radiologists on duty were Drs. James McAllister and James Moore. During the entire afternoon, the two doctors saw only one patient face-to-face. Most of their time was spent interpreting X-rays, CAT scans (computerized axial tomography) and MRIs (magnetic resonance imaging).

Radiologists serve primarily as consultants to other physicians. I had already seen that morning the extent to which radiology is important to a urologist.

That one patient was suffering from an enlarged thyroid gland. She was about 40 years old and Dr. Moore described to her the treatment he would recommend for the problem.

I learned that there is a way to essentially destroy a thyroid gland without invasive surgery. The treatment is the closest thing to a "magic bullet" I've ever heard of. The patient was visibly relieved to learn that her prospects were so favorable. The absence of a thyroid gland results in other complications, but those are relatively easy to offset with medication.

A major demand on a physician's time is documentation and record keeping. This was especially true of the radiologists. They spend a considerable amount of their time dictating notes. These notes are fed to a transcription service and converted to "hard copy" for use by the patient's other physicians and become part of the patient's record.

The second day of my mini-internship started with Dr. John Van Speybroeck, a thoracic and vascular surgeon. One of my hopes going into the program was that I would have the opportunity to observe surgery, but Dr. Van Speybroeck had none scheduled that morning, so I missed my chance. His morning was spent moving between examining rooms consulting with patients primarily regarding pre- and postoperative procedures and consultation.

My final half-day was spent with Dr. Phillip Wagner, head of Humboldt Occupational and Environmental Medicine (HOEM). HOEM, affiliated with General Hospital, specializes in a number of services including pre-employment physicals, drug testing and substance abuse prevention.

I accompanied Dr. Wagner and his assistant on a "house call" to a potential employer/client. Dr. Wagner explained to the person in charge how HOEM could operate the employer's drug prevention program. Such programs are mandated for certain employers, especially those having connections with or contracts from federal agencies.

I doubt that he would think of himself as a "techie," but I was impressed with Dr. Wagner's facility with his lap-top computer. It was obvious that it saved him a considerable amount of time and helped keep him organized within his varied responsibilities, as well as enhancing his capabilities as a physician.

Did I find the program worthwhile? Did it justify taking two days away from my own schedule? Definitely so. I wish other professions and businesses could arrange such programs.

One strong impression I came away with is that one of the most valuable aspects of a physician's responsibilities is decision making. He has to decide, for example, what is the malady? Are more tests needed and are they worth the extra expense? What treatments and medications should be used?

In most cases the decisions have to be made with highly imperfect information. As often as not, symptoms give ambiguous and even contradictory messages. Sometimes the ailment fails to respond to the prescribed medication. The human body is an overwhelmingly complex organism. What we don't know is vastly greater than what we do know. Nevertheless, decisions have to be made, and I was amazed at the number and frequency. The success rate must be quite high or we would see even more lawsuits than we do.

The making of momentous decisions is something doctors seem to take in stride. It's part of being a doctor, and it's what they expected when they chose their profession.

What does seem to be bothering them is the profound change and upheaval currently taking place in the health-care industry. Even though comprehensive health care reform is now a moribund national issue, dramatic changes continue to occur.

New forms of competition are developing and physicians can't help feeling uncertain about what their places will be in the future. Health maintenance organizations (HMOs), for example, are a growing force in the industry. Many physicians worry that HMOs and other trends will have a detrimental effect on the patient-physician relationship.

The next mini-intern program is tentatively scheduled for March. Participation is by invitation. The medical society is basically looking for people who are active in the community. If you would like to be considered, get in touch.


FISCAL FITNESS: A Day in a White Coat - North Coast Journal

Ron Ross Ph.D. is a former economics professor and author of The Unbeatable Market. Ron resides in Arcata, California and is a founder of Premier Financial Group, a wealth management firm located in Eureka, California. He is a native of Tulsa, Oklahoma and can be reached at

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