Plagiarism – the Repost in the modern world – is alive and well.

As one colleague, Joel Hassman, winds down his blog, let me do him the honor of stealing some of his prime stuff.

Below, for psychiatrists – but hardly psychiatrists alone..


Dear Colleagues:

Just wanted to let you know, I think our profession is so lost, it is amazing people still want to come to us for care.  Me, why would I want a majority of whores and cowards to claim to be able to help me.  Really, what was the Oath we allegedly took at the end of medical school, praise the golden calf, every man or woman for him or herself, and I really think some of you would honestly say this if brutal candor would prevail, “I forgot the part where you are my problem!”

Anyway, to those of you who do care, who do practice psychiatry with attention to standards of care and an honest desire to advocate and help those who are patients, thank you for trying to make a difference, but, your overall silence has been deafening.

Well, that’s it, this isn’t going to be a long correspondence, after all, how many different ways can you say to peers and colleagues, I am disappointed to be associated with too many of you!

Cordially, at best,

Joel Hassman, MD

The ring of the Ancient One, Dr. Hunter S. Thompson, peals forth from his honesty – whores and cowards, indeed!


Dear PreMed Student:

Greetings to you during this Holiday Season of 2013, my name is Joel Hassman,  I am a graduate from the University of Maryland Medical School class of 1989, and have been a clinical psychiatrist for the past 20 plus years, practicing mostly in Maryland for my career.

I write to you now offering an unsolicited opinion to whether it is worth the commitments and expenses you will make these next 8 or more years, expenses not only in money but equally in time and energy, to earn a Medical Doctorate degree.  I respect I am just one opinion in a sea of a million or so colleagues who have already traveled the path you now face, and many may not agree with what I will opine below.  But, I feel I have a duty to advise, and more so caution any who are interested to weigh what are my observations, experiences, and expectations what physicians have been able to provide as health care professionals, and how those skills and efforts will be impacted hereon.

My concerns I want to impart from those years of observations, experiences, expectations, and collected discussions with colleagues during my career are simple:  with the likelihood that PPACA, also dubbed “Obamacare”, is going to be a legislative intrusion of sizeable magnitude as envisioned now,  medicine as practiced to this point in time will be forever negatively altered in ways that will not be appreciated until the consequences play out for all who participate in the health care system.  And those participants include many players,  be them patients, providers, associated supports to patients and providers, affiliated allied health supports, hospitals,  outside medical technology and pharmaceutical industries, and even insurers in place as of now.  I am sure I am forgetting others, so my apologies for not naming them all.

For those of you interested in becoming doctors for the simple, yet valuable reason to be a provider who can impact on peoples’ lives for the better, in efforts to heal, comfort, advise, and support, well, those were key reasons that drove me to choose medicine as a career.  And an equally important part to my choice was to maintain a level of autonomy and independence that for me, at least, was a driving force in formulating such a career pursuit.   While making a decent income also had some bearing in the decision, money was never a primary driving force to my choices throughout my career.  You receive a decent income as a doctor overall, so money should not be a primary consideration to decisions what to do as a health care provider.  If you are not already aware, the for-profit drive that has consumed much of the health care profession has wrought enough damage before what PPACA will surely do further.

Unfortunately, in my opinion, money, profit, financial gain, these are the driving forces to health care of late, until proven otherwise, and you need to be aware at least what some providers are offering as advice and direction in your contacts in formulating your plans to become a doctor will NOT likely be what you experience once you complete your training within the next decade.  No, you will most likely not be asked to make decisions that are in the best interests of patient care, comfort, and resumption of health and function.  Instead, you may risk being  forced to practice to provide what is popular, easy, convenient, and for the system what is inherently cheap and redirects income streams to select peoples’ personal pockets.   As for any interest in maintaining autonomy and independence, forget it, you won’t have it unless you are fortunate to be in a care setting outside the system being forged into stone now.

My intent in forwarding this open letter to those of you interested in becoming doctors now is simply this:  I do not want to deter people who want to be a doctor for what the profession inherently intends;  I want people to succeed me to provide future care that helps people the way medicine was and still should intend to be practiced.  But, I want people to be well aware of what potential intrusions and disruptions await you in your developing education not only within the didactic settings, but encourage you be attentive to what are dubbed the “street smarts” no professor, mentor, or advisor will be able to provide within the system.  Medicine has to be practiced with both mind and heart.  I hope you won’t lose track of this simple expectation.

Become a doctor because you want to help people be healthy, or to regain health, offer further  supports beyond what the patient’s own support systems can provide, and most importantly, advocate and defend what are the principles and necessary boundaries of what the needs and expectations medicine has to maintain to work and succeed.  I feel the last part of that last sentence needs to be magnified:  medicine needs people to be strong advocates and defenders from those looking to alter the system in inappropriate, irresponsible, and disruptive ways.

I think health care, and the practice of medicine more specifically, has now passed the proverbial “cross roads” of adhering to principles and needs for the society we commit to when accepting that “MD” title.  But, passing this point does not mean health care is lost or forever tarnished.  You just have to want and need to care and focus on doing what is right and responsible.  If you listen to those who don’t understand or even don’t respect that basic premise, well, then good luck in your pursuits.  I hope what drives you to want to be a doctor will guide you well and see you be successful and appreciated by most you work with, be them patients or colleagues.

I hope your journey will be enlightening and inspiring, as much as safe and valuable.  Thank you for taking the time to read this open letter, share it as you see fit with others.


Joel Hassman, MD

I agree.

I had an odd path into medicine.  Shortly into college, I realized that I did not have that ineffable “something” that it takes to be a doctor, and I felt shamed and inadequate.  I rationalized it as being “goal oriented,” as scientists are, not “process-oriented,” as doctors are.

I was to discover a certain character flaw, that could be called pride – I was too proud to lick the hand, if licking the hand was what was called for.  In the modern educational system, being a good doctor and being a good working dog are equated.

If you are torn between what master wants, and what is the right thing to do, you may also be burdened with pride, and not do well in medicine.

I am an internist, and quite good at what I do.  My checklist scores are mediocre, as are all scores on checklists – they are designed to measure something that is immeasurable, by means of counting check-boxes.    The pagan deity of the Internist is Diana, the Goddess of the Hunt.  I find disease by the most subtle of clues, and track it.  When I score a diagnosis, then I give it to the lesser specialists, whose job is merely to fix it, the same thing, over and over again.  I did not subspecialize, because I wanted to know about humans and their care, not merely a liver or a kidney.

I am immodest, which is a fatal flaw in medicine.  There is a difference between immodesty and arrogance.  Arrogance is a public announcement of the great esteem with which one holds one’s self.  Immodesty is a list of achievements.  Name a disease, and I will tell you how I hunted it, and got it.  Acute Intermittent Porphyria?  I will tell you how I have hunted it, and made a new diagnosis of it.  Simply treating what is known – that is one thing.  Finding it in the wild, that’s another thing entirely.  I loved to bring residents along – let’s hunt.

Of course, the medical schools want me the hell away from their students, for I teach them bad habits.  If you have hunted and acquired, say Guillan-Barré in the wild, and captured it – you are better at it than any professor.  They of the University, who could not catch a cold in the wild, are angry and jealous.

In the short amount of time when I lived in the old medicine days, the hunters gathered for lunch or small groups in the doctor’s lounge, and told hunting stories.  Those are the only things to learn by.  The beloved Cabot Cases of the Journal are for medical students – you can capture a lion in Africa, if you search all Africa for a lion – and the Cabot Cases do so.  But how do you hunt the lion with a rifle, rather than a tank, equipped with machine guns?  One-on-one?  That is an art.  It is also “choosing wisely,” as the scholared apes call it.  It only takes one shot to kill a lion, true.  But you must do it exactly right.

Should anyone be offended by the metaphor, I do not hunt in real life, for I do not kill.  I also do not worship Diana – she is fictive.  Do not be confused.

I came back to medicine for the same reasons that people practice sexual fetishes – it is what I do and like.  Perhaps it is more like people who are trans-gender; when I am being a doctor, I feel like who I really AM.  Sadly, that thrill does not extend to the White Coat or the Parking Space.  It is only about healing the sick.

There is no thrill like being She of the Hunt – it is incomparable.  Unlike the actual hunt, the pursuit brings life, not death.  If you cannot live without that thrill, then come along.  But the rest is nonsense.